Indwelling Catheter Management: From Habit-based to Evidence-based Practice
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Indwelling urinary catheters are used in the care of more than five million patients per year. Prevalence rates range from 4% in home care to 25% in acute care. Catheter-associated urinary tract infections account for more than 40% of all nosocomial infections and can be associated with significant complications. Clinical practices in catheter management vary widely and frequently are not evidence-based. Effective nursing measures include: identifying patients who no longer need indwelling catheters, discussing appropriate catheter alternatives, and providing patient and caregiver education. Many catheter-associated problems can be avoided by selecting a closed catheter system with a small size catheter (14 to 18 French with a 5-cc balloon), following manufacturer’s recommendations for inflation/deflation, maintaining a closed system, securing the catheter, and properly positioning the drainage bag. Practices such as routine catheter irrigation should be avoided. Current recommendations related to the management of encrustation and blockage also are discussed. Providing evidence-based catheter management strategies may reduce the rate of catheter-associated urinary tract infection, catheter encrustation, and leakage as well as the discomfort and costs associated with these complications.
Over the past 65 years, the indwelling urinary catheter has become one of the most commonly used medical devices in hospitals, long-term care facilities, and the home. Although nurses routinely manage patients with indwelling catheters, studies indicate that clinical practices vary widely and frequently are not evidence-based.1,2 Caregivers and patients sometimes fail to realize that catheters can be associated with significant complications and that preventive care is critical. The goal throughout healthcare today is evidence-based practice, and all nursing interventions should be guided by this principle. This article provides a review of current knowledge and recommendations regarding indwelling catheter management.
Indications for Use
Approximately five million patients are treated with indwelling catheters per year.3 Prevalence rates range from 4% in home care4 to 25% in acute care.5 Short-term catheter use (ie, <30 days) is indicated for a variety of reasons, including management of acute retention, intra- and postoperative bladder decompression, and monitoring urinary output.3,6 Short-term catheter use is usually well tolerated, although urinary tract infection is a significant issue. In contrast, long-term catheter use (>30 days) can be associated with multiple complications including infection, bladder spasms, urethral erosion, hematuria, stones, epididymitis, urethritis, periurethral abscess, unprescribed removal, pain, fistula formation, obstruction secondary to encrustation, and leakage.7 For this reason, long-term indwelling urinary catheters should be used only for patients who cannot satisfactorily be managed with less invasive options. Specific indications for long-term catheter use include retention management in patients who are not candidates for intermittent catheterization, Stage III or Stage IV pressure ulcers on the trunk, and palliative or terminal care.6-8 Patients with indwelling catheters should be periodically assessed to determine the potential for catheter removal.
Types of Catheters:
Suprapubic versus Urethral
Long-term catheters may be placed into the bladder via the urethra or a suprapubic incision.
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