Essay: Urinary Catheterization Urinary Catheterisation: Indwelling

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[. . .] In addition, an appropriate lubricant from a single-use container is significant to reduce trauma and infection (Narzako). There is no advantage of using antiseptic preparations over normal saline for cleaning; therefore, physicians should follow the recommendations. In addition, the use of lubrication is to ease discomfort and reduce friction during the procedure (Mangnall).

Research suggests that catheterization in women is a challenge compared to men, because in women, the urethra's location is in the vulvas vestibule (Pelter and Stephens, 2008). There are two methods of catheter insertion. One is by using sterile gloves and the second one is without gloves. The latter is commonly used because risk of contamination is low; however, there is no literature to support this. If the patient lacks a palpable bladder, then it is significant to fill the bladder with at least 300ml prior to insertion of a catheter. However, for patients with a history of lower abdominal surgery, then it is appropriate to perform an open surgery to insert the catheter.

Risks of Catheterization

Infection: Although insertion is an aseptic procedure, microorganisms can find their way in on insertion or via the catheter leading to CAUTIs. For this reason, some products have clorhexidine; however, some bacteria responsible for catheter encrustation, Proyeus mirabilis, are resistant to chlorhexidine. Therefore, patient remains vulnerable to catheter related tissue damage, such as trauma, skin opening at the tract, and necrosis (Wilson, 2013). Indwelling urinary catheterizations carry risks and the risk of these complications relates to the duration of catheterization. The risks include; Tissue damage, bladder damage, infection and catheter encrustation and blockage (Nazarko, 2007).

Tissue damage: This is because of an inflammatory reaction, owing to the fact that the catheter is new to the body and may cause inflammation. The response may have mild or severe effects to an individual. Mild outcomes include oedema, while severe responses include hemorrhage. In addition, the catheters are made of silicone, latex, and some reactive elements, which call for selection of an appropriate catheter to minimize the risk of reaction.

Bladder damage: The catheter undertakes the task of the bladder; therefore, catheterization, and continuous drainage to take over the bladder's job, reduces the bladder's capacity. In addition, these catheters may cause the bladder to misshapen (Mangnall, 2011).

Alternatives to Placing an Indwelling Catheter

An indwelling catheter is only necessary when there is a need. In addition, its stay should not exceed than necessary. However, it is significant to consider alternatives before recommending an indwelling catheter and should consider as the last resort when all other options fail. Other alternatives include intermittent catheterization, or a male external catheter. In addition, when appropriate, patents may use suprapubic catheter, compared to an indwelling catheter. This is because, intermittent catheterization is appropriate in comparison to indwelling catheter, if it is medically fit and practically applicable for the patient.

Measures to Prevent Infections

Hand washing

Hand initiated transmission is a significant element in increasing infections to patients, which stresses the influence of hand hygiene and the usage of protective equipment such as gloves and aprons. Hand washing is an essential clinical practice before cleaning procedures to prevent HCAI (Bhatia et al., 2010). WHO emphasizes that this practice is important and this organization aims to implement hand hygiene as an appropriate clinical practice when handling catheterization (Wilson, 2008; Wilson 2013). This practice is significant and adoption will help to accomplish reliable care, avoid confusion among nurses and standardize measurement of conformance with hand hygiene policies. Hand hygiene is not a barrier to providing timely care to patients. One particular recommendation for hand hygiene is to apply it in urinary catheters (Kilpatrick et al., 2012).

Material and Methods

The study took place in a referral hospital in New Delhi. It involved 125 patients admitted consecutively in the wards of a tertiary care, it excluded patients who had undergone catheterization using Foley's catheter (Bhatia et al., 2010). Age, sex, diagnosis, functional condition, psychological condition, indication, period and place of catheterization are some of the parameters used for evaluation. Data collection utilized interviewing the treating nurses and data from the patient records. The physicians were to answer questions touching on the place of catheterization, indication of catheterization. Recording of data utilized a performa, which included the following parameters: functional status as well as age, sex, diagnosis and medical ward, duration of catheterization and analysis of urine culture.

Results

Out of the 125 patients, 80 were males and 45 were females. 33 of the patients were catheterized in the wards and the rest in the medical emergency. In addition, 60 of the patients recorded an impaired mental status (Bhatia et al., 2010). The duration of catheterization was 4.8 days, and the mean of catheterization for patients in the emergency was 4.3 days, 6.2 days for those catheterized in the medical wards.

Urinary Tract Infections

28 patients developed a symptomatic UTI during the period. In addition, all the patients developed a BCFC, revealing that all the patients had similar organisms as those separated from their urine (Bhatia et al., 2010). 38 of the patients developed a symptomatic colonization owing to their Foley's catheters (Feneley, Calvin and David, 2011). Majority of the patients developed colonization owing to their catheters. Majority of the patients catheterized in the emergency wards, developed a BCFC.

Inappropriate catheterization

From the study, only 36 patients were wrongly catheterized. The most inappropriate reason that showed evidence of inappropriate catheterization was urinary inconsistence without substantial skin breakdown (Bhatia et al., 2010). For the female sex, the risk associated with inappropriate catheterization was mental status (Nazarko, 2009). In addition, wrong catheterization did not show association with development of BCFC.

Discussion

Inappropriate catheterization is prevalent, in both medical wards and tertiary referral wards, and it leads to development of BCFC, which led to patients diagnosed with CAUTI (Nazarko, 2009). Concerning previous studies, the evaluation of this study shows that, previously, the number of inappropriate catheterization was higher. The large numbers of patients developing a BCFC calls for implementation of aseptic methods when inserting a Foley's catheter and proper infection control (Bhatia et al., 2010). In addition, it is important to note that catheterization in the emergency is likely to result to inappropriate catheterization. This is due to the large number of patients, spontaneous decision on catheterization, and lack of evaluations on the real need for catheterization (Feneley, Calvin and David, 2011).

The substantial risk elements with BCFC include age, non-ambulatory functional status, emergency catheterization and long periods of catheterization. CAUTI is the significant morbidity because of catheterization of the urinary tract. In addition, elderly patients are more vulnerable to all infections including CAUTI (Bhatia et al., 2010). Prevalence of CAUTI in the elderly was high owing to the long catheterization period. The long period, encourages bacterial development on the surface of the catheter leading to high incidences of BCFC and CAUTI (Clinical Review, 2011). From the evaluation, it is apparent that inappropriate catheterization led to CAUTI and reduced use and period of catheters, led to reduction of CAUTI. Therefore, inappropriate use of indwelling urinary catheters is a risk element for CAUTI.

Conclusion

There is a need for health practitioners to evaluate patients to determine a real requirement for catheterization before proceeding with the medical intervention. This is significant for women and those catheterized in the emergency wards. In addition, physicians should maintain aseptic measures while performing catheterization (Bhatia et al., 2010). For instance, washing hands will help in attaining hygienic standards by health workers in order to minimize incidences of infections. Overall, CAUTI is preventable by suitable selection of patients and by applying or upholding aseptic techniques in using catheters.

Providing evidence-based enable nurses to remove catheters, which are not medically indicated (Mangnall, 2011), thereby enhancing the patient's health by avoiding severe impacts of catheterization, such as UTI (Bray and Sanders). In addition, this approach will ensure the patient enjoys the most appropriate quality of life without enduring the severe effect of avoidable catheter negative effects. Although there are several reasons why patients experience catheter pain, those identified early are treatable. In addition, pain is a valuable warning, which patients should use to their advantage to seek medical checkup and discover the cause.

Patients should recognize that catheterization carries substantial risk, and nurses should only approve it when necessary. However, catheterization requires competent health workers to undertake the process to avoid further damages to the patient. Nevertheless, when catheterization is necessary, the algorithm provided in this report is significant (Winder, 2012). Therefore, health workers should develop their medical knowledge and support a model of competency statements, which are provable (Bray and Sanders). Primary care Trusts must ensure they offer or rather training on clinical proficiency to ensure safe and evidence-based catheterization. However, the training should have a relation to the requirements aligned to the proficiency framework requirement that provides practice for nurses (Bray and Sanders).

Recommendations

1. Physicians and patients should avoid unnecessary emptying of the drainage bag as it increases the threat of bacteria getting into the bladder.

2. There is… [END OF PREVIEW]

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