Indwelling Catheter Management: From Habit-based to Evidence-based Practice
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Pretesting silicone balloons is not recommended; the silicone can form a cuff or crease at the balloon area that can cause trauma to the urethra during catheter insertion.10,13
Much confusion exists about the proper volume to be used for balloon inflation. The guiding principle is to follow the manufacturer’s instructions. Catheter manufacturers test their balloons to determine the amount of fluid required to obtain a symmetrical balloon. Under- or overinflation can result in an asymmetrical balloon, which can deflect the catheter tip to one side. This deflection can cause occlusion of the drainage eyes, irritate the bladder wall, and lead to bladder spasms (see Figure 1 and Figure 2). In general, a 5-cc balloon requires about 10 cc of fluid for symmetrical inflation. Manufacturers recommend that sterile water be used to fill catheter balloons; normal saline can lead to crystal formation in the inflation lumen (and difficulty deflating the balloon), and inflation with air will cause the balloon to float in the bladder.24 Silicone catheter balloons can lose fluid over time as fluid diffuses out into the urine; therefore, fluid levels should be checked at least every 2 weeks and fluid added as needed.25
All urinary catheters should be secured, yet securement is not routinely performed in practice. Unsecured urinary catheters can lead to bleeding, trauma, pressure sores around the meatus, and bladder spasms from pressure and traction.26 It is recommended that the catheter be secured to the thigh for women and to the upper thigh or lower abdomen for men. The lower abdominal position in men decreases the potential for pressure necrosis and urethral erosion at the penile-scrotal junction.24 Ambulatory men may find abdominal securement difficult; these patients can be instructed to secure the catheter to the upper thigh in the daytime and to change the position to the lower abdomen for sleep.
Many securement devices are available, including adhesive, non-adhesive straps and catheter-specific anchors. A new catheter specific anchor (StatLock Foley™, Venetec International®, Inc. San Deigo, Calif. ) offers advantages that include a reclosable locking mechanism that swivels as the patient moves and an adhesive comfort pad that can be left in place for up to 1 week without altering skin integrity.26 Whatever product is selected, nurses should instruct patients in the proper use and removal of the securement device.
Drainage bags now come with a special “safe sampling” port designed to obtain urine specimens while maintaining a closed system. The CDC recommends that urine specimens be obtained directly through these ports using an aseptic technique.8 The drainage tubing is occluded below the port temporarily, allowing the urine to collect in the tubing. The port is swabbed with alcohol, and the urine is withdrawn following manufacturer’s instructions using a needle, blunt cannula, or luer lock syringe. Urine for a culture and sensitivity should be obtained from a newly inserted catheter and drainage bag to avoid culturing the system (catheter and drainage bag) rather than the urine.
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