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URINARY CATHETERIZATION



CONTENTS:

  • What is urinary catheterization?

  • What is the prevalence of urinary catheter use?

  • When is urinary catheterization required?

  • Purpose of Urinary Catheterization

  • Conditions that require urinary catheterization

  • Types of urinary catheter

  • Main Risk factor for indwelling catheter

  • Causes of CAUTI

  • Role of a nurse before, during and after inserting the urinary catheter


What is urinary catheterization?


Urinary catheterization is a procedure where a flexible tube called the catheter is used to collect the urine and drain the bladder. Urinary catheterization is also called Foleys catheterization.


What is the prevalence of urinary catheter use?


A study revealed that catheters were more prevalent in males. It also mentioned that catheters are most prevalent in patients aged over 70. The highest prevalence was in critical care, where over 70% of patients have a catheter in situ. Most of them are discharged home with urinary catheters in situ.[1] It is revealed that long-term indwelling urinary catheter contributes to associated morbidity and mortality.


When is urinary catheterization required?


A urinary catheter is recommended when an individual is:

  • Unable to urinate

  • Unable to control the urge to urination or

  • When experiencing leaky urine or urinary incontinence.


Purpose of Urinary Catheterization


Therapeutic purpose

  • To relieve urinary retention or urinary incontinence

  • To Instill medications directly into the bladder

  • To drain the urine from the bladder, e.g. during delivery or during anaesthesia, before, during or after surgery.

  • Bladder irrigations

Diagnostic purpose

  • To accurately measure urine output

  • To collect urine for culture

  • To determine the causes of genitourinary infections


Most common conditions that require urinary catheterization

  • Neurological conditions - neurogenic bladder dysfunction

  • Spinal Injury

  • Stroke

  • Multiple sclerosis

  • Fractures

  • Falls

  • Road traffic accidents

Elderly age

  • Mental illness

  • Dementia

  • Immobility

  • Poor bladder function

  • Chronic illness

  • Kidney failure

  • Hospice care/comfort care/palliative care

Surgery

  • Hip surgery

  • Hysterectomy

  • Caesarean Section

  • Bladder nerve injury

Urinary flow obstruction or blockage

  • Enlarged prostrate

  • Tumor

  • Infection

  • Enlarged uterus

  • Kidney stones

  • Blood clots

  • Renal impairment

Types of urinary catheter


There are 2 main types of urinary catheters:

  • Intermittent catheters – Catheter that is temporarily inserted to empty the bladder

  • Indwelling catheters – Catheters that remain in place for many days or weeks, these are held in position by an inflated balloon in the bladder

Main Risk factor for indwelling catheter


The urinary infections are caused by an indwelling catheter as they allow the entry of bacteria into the urinary tract, these infections are called Catheter-Associated Urinary Tract Infections (CAUTI)


A study conducted by the Performance Improvement Department of one home healthcare agency (HHA) identified an increase in the rate of catheter-associated urinary tract infections (CAUTI) in 2009. It was revealed that it was the most common infection among long-term care residents.[2]


Causes of CAUTI


From outside the catheter:

  • Contamination at the time of insertion.

  • Touching the patient’s catheter without performing hand hygiene.

From inside the catheter

  • From reflux of urine in tubing or drainage bag positioned higher than the level of the bladder.

  • Disconnecting the system for any reason without adequate cleansing, e.g., changing from one bag to another or performing irrigation.

  • Blockage/obstruction due to debris.

  • Kinking, bending, pulling of the catheter etc


Role of a nurse before, during and after inserting the urinary catheter


It is essential for skilled nurses to put the Foley urinary catheter using aseptic and hygienic measures as the risk of acquiring infection is very high.

The nurse will clean the catheter and check for any

  • Leakage, swelling or bleeding around the urethra or catheter

  • Presence of any particular door, stones, sediments, etc in the urine collected in the urinary bag

  • Minimal or no drainage of urine collected in the urine bag even after the taking sufficient fluid

The nurse will record the urine output, document the changes, and inform the physician if any signs of infection are noted.

Other Topics

References:

  • Shackley DC, Whytock C, Parry G, Clarke L, Vincent C, Harrison A, John A, Provost L, Power M. Variation in the prevalence of urinary catheters: a profile of National Health Service patients in England. BMJ Open. 2017 Jun 23;7(6):e013842. doi: 10.1136/bmjopen-2016-013842. PMID: 28645950; PMCID: PMC5577876.

  • Kunin CM, Chin QF, Chambers S: Morbidity and mortality associated with indwelling urinary catheters in elderly patients in a nursing home – confounding due to the presence of associated diseases. J Am Geriatr Soc. 1987, 35: 1001-1006.

  • Scanlon MK, Deluca G, Bono-Snell B. Reducing catheter-associated urinary tract infections in home care: a performance improvement project. Home Health Nurse. 2012 Jul-Aug;30(7):408-17; quiz 418-9. doi: 10.1097/NHH.0b013e318252c7a9. PMID: 22546771.

  • Inelmen EM, Sergi G, Enzi G. When are indwelling urinary catheters appropriate in elderly patients? Geriatrics. 2007 Oct;62(10):18-22. PMID: 17922564.

  • https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/urinary-catheterisation#conditions-that-may-require-urinary-catheterisation

  • https://www.medicalnewstoday.com/articles/324187

  • https://www.medicalnewstoday.com/articles/324187

  • https://www.webmd.com/urinary-incontinence-oab/catheter-types

  • https://healthtalk.org/living-urinary-catheter/reasons-for-needing-a-long-term-indwelling-catheter

  • https://www.zorgers.com/blog/role-of-home-care-nursing-for-patients-with-urinary-catheterization/

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