Indwelling Catheter in Home Care

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Clinical Guidelines (Nursing)

Some ambulatory home care patients transfer to a leg bag for urine containment during the day, which results in a breach of the closed urinary drainage system. When possible, breaching the closed urinary system is to be avoided. An IUC should remain in place only as long as the reason for insertion is still present.

However, managing patients' long-term IUCs will continue to be a routine service provided by home care and hospice nurses and we need to base our patient care practices on evidenced-based data whenever possible. Association for Professionals in Infection Control and Epidemiology.

Guide to preventing catheter-associated urinary tract infections. Gould C. Guideline for prevention of catheter-associated urinary tract infections Infection Control and Hospital Epidemiology , 31 4 , Hooton T. Diagnosis, prevention and treatment of catheter-associated urinary tract infections in adults: international practice guidelines. Clinical Infectious Diseases , 50, Institute for Healthcare Improvement. Cambridge, MA. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: update. Infection Control and Hospital Epidemiology , 35 5 , Loveday H.

The Journal of Hospital Infection , 86 Suppl. McGoldrick M. Data were available for three of the pre-stated comparisons.

Care of Patients with Long-Term Indwelling Urinary Catheters

All the included trials were small and under-powered. The reporting of the trials was inadequate and as a result, risk of bias assessment was judged to be unclear for the majority of the domains in two out of the three trials. There was insufficient evidence to indicate that i there was a lower incidence of symptomatic UTI in people whose catheter was changed both monthly and when clinically indicated risk ratio RR 0.

However, none of the 16 participants developed a symptomatic catheter -associated urinary tract infection CAUTI at day The following outcomes were considered critical for decision-making and were also selected for the 'Summary of findings' table: i participant satisfaction, ii condition-specific quality of life, iii urinary tract trauma , and iv formal economic analysis.

Urinary catheter - Living with - NHS

However, none of the trials reported these outcomes. None of the trials compared the following comparisons: i replacing catheter versus other policy e. Policies for replacing long-term indwelling urinary catheters in adults Background information A urinary catheter is a tube that is inserted into the bladder from the end of the urethra to drain urine from the bladder.

The main findings of the review This review identified that there is currently insufficient high-quality evidence which evaluates the effectiveness of different policies for replacing long-term urinary catheters. Adverse effects None of the trials reported any adverse effects relating to the policies investigated. Any limitations of the review All three trials which were included in this review were very small with methodological flaws.

Authors' conclusions:. Search strategy:.

Care of Patients with Long-Term Indwelling Urinary Catheters

Selection criteria:. Data collection and analysis:. Elders residing in long-term care facilities or private homes have a high prevalence of chronic genitourinary symptoms and bacteriuria, and are at risk for urinary catheter associated infections Bregenzer et al.

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  • Indwelling Urinary Catheter Care.
  • A Duel.

Functionally impaired elders with multiple co-morbidities may not have clinical signs and symptoms consistent with bacteriuria, and therefore standard diagnostic criteria may not be applicable to them Orr et al. Risk factors commonly associated with bacteriuria are female gender Tambyah et al. Type of catheter and use of antibiotic prophylaxis are thought to prevent infection, however, the research evidence is equivocal. In a laboratory study, all-silicone, hydrogel-silver coated silicone, and hydrogel-silver-coated latex catheters were compared for bacterial adhesion Ahearn et al.

The hydrogel-silver coated catheters had lower rates for bacterial adhesion than all-silicone catheters. Although the hydrogel-silver coated catheters are twice the cost of the all-silicone catheters, cost savings were realized related to decreased number of infections and the associated medical costs of treatment Bologna et al.

Cranberry juice has been commonly used and recommended for management of UTIs. The research evidence does not support the effectiveness of cranberry juice for either prevention or treatment of UTIs. Catheter encrustation develops due to urease producing bacteria, such as Proteus mirabilis species, that elevates the urine pH.

A Suby G solution 3. Two sequential irrigations of 50 ml of solution were more effective than one irrigation with either 50 ml or ml. Suby G contained 3. The sodium chloride solution contained 0. The amount of encrustation was lowest following Suby G irrigations.

Following the Suby G irrigations, there were more red bloods cells in the washout fluid than after the other two irritation solutions, indicating possible irritation to the bladder mucosa. However, no baseline measures of RBCs in urine samples were taken before irrigations.

The irrigation solutions were similar in their ability to remove crystals at 10 days, but they had no effect on removal of bacteria or urease-producing bacteria. In a laboratory model of the catheterized bladder, all-silicone catheters took longer to block than Teflon, silicon-coated, or hydrogel-coated catheters Morris et al.

However, the all-silicone catheter has a larger internal diameter 2. Catheter blockage may pose a potential risk for kidney damage. However, this has not been studied in humans. Catheter obstruction due to encrustation results in blockage of the catheter lumen Getliffe, a. Routine care of patients with indwelling catheters includes meatal care, bag emptying and decontamination, and catheter replacement. Povidone-iodine solution and ointment applied twice a day to the meatus of catheterized patients, and daily application of nonantiseptic solutions of green soap and water were less effective than no treatment in reducing bacteriuria Burke et al.

Twice daily poly-antibiotic ointment Burke et al. These results should discourage the use of topical antibiotic treatments for meatal care. Bag decontamination and reuse were cost-effective and patients reported ease in following the procedure. There was no increase in UTIs among community-dwelling adults who reused urinary drainage leg bag systems routinely cleansed with diluted bleach solution Rooney, Breaking or opening a closed system during routine care The number of system openings was not related to the rate of bacteriuria.

In a hospital setting, catheter drainage systems were opened primarily related to: irrigation, drainage bag change, and accidental disconnections. The number of system openings was not related to the rate of bacteriuria.

Topic Overview

The incidence of bacteriuria was higher in patients catheterized on medical units than among those catheterized in the operating room, presumably due to better use of sterile technique in the operating room. Sterile technique was always used for intermittent catheterization in hospital and nursing home settings. Catheter systems were opened for: bag change, bladder irrigation, and to collect urine samples. Eighty-three percent of staff reported that they washed their hands after emptying drainage bags. Hospital staff more frequently reviewed the need to continue indwelling catheter use compared to nursing home and home care staff.

Staff knowledge of written guidelines for catheter related procedures was greatest among hospital staff compared to nursing home and home care staff.

Topics A - Z

On average, catheters were replaced three times per patient days of catheterization. In vitro, silicon-coated latex catheters retained balloon volumes better than all-silicone catheters.

Catheter Care

Of the 22 in vivo catheters, all but one needed to be replaced before 21 days, and all catheter balloons showed some deflation. Because of the management difficulties and complications associated with long-term catheterization, periodic assessment should be made to determine whether a catheter could be removed. However, for patients who are bedbound and cared for in the home, the use of an indwelling catheter may be preferable to the possibility of skin breakdown associated with incontinence. Seventy percent of the respondents reported instilling fluid into the bladder until the patient expressed an urge to void.

If a patient was unable to void immediately, respondents reported waiting 5 to 15 minutes for the patient to void. Upon catheter removal, a visiting nurse performed twice daily catheterizations for post-voiding volume until the volumes were less than ml. Two weeks following catheter removal, patients received biofeedback-assisted pelvic floor exercises for 8 weeks. Long-term indwelling urinary catheterization is associated with the complications of bacteriuria and UTI Bronsema et al.

Management techniques to decrease these complications include: systemic antibiotic prophylaxis Riley et al. Encrustation was reduced with the use of all-silicone catheters compared to other catheter types Kunin et al.

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