Indwelling Catheter Management: From Habit-based to Evidence-based Practice
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Catheter irrigation is not recommended unless obstruction with clots or mucous is anticipated8; breaking the catheter drainage bag connection (closed system) is a major point of bacterial entry into the system.3 Closed, continuous irrigation with a three-way catheter may be necessary for patients with repeated obstructions.8 The CDC recommends that catheter irrigations conform to aseptic technique with sterile saline and sterile syringe for each irrigation, but home care agencies may have a policy for cleaning and reuse of irrigation supplies. Vigorous irrigation and aspiration can be damaging to delicate bladder mucosa and should be avoided.27
Catheter Change Interval
No evidence exists to support routine monthly catheter changes. Rather, nurses should monitor patients closely for signs of blockage or encrustation and should change the catheter based on specific patient needs.7,8
Traditionally, nurses have been taught to aspirate fluid from catheter balloons for removal of fluid. Recent studies have demonstrated that aspiration by pulling on the syringe plunger may result in collapse of the inflation lumen; encourage formation of creases, ridges, or cuffing at the balloon area; and increase the catheter balloon diameter size on deflation.10,13 This enlargement of the balloon area can result in difficult removal and urethral trauma. One major catheter manufacturer is now recommending that the fluid be allowed to return to the syringe by gravity and not by aspiration. (CountItDown, C.R. Bard, Covington, Ga.) Due to the small diameter of the inflation lumen, it may take up to 30 seconds for all of the fluid to return (see Table 2). Manufacturer’s instructions for deflation should be followed.
Cleaning and Reuse
Over the past few years, technique has shifted from sterile to clean in the home care setting. Cleaning and reusing catheter drainage bags and irrigation supplies are now common. Manufacturers do not recommend cleaning and reuse of products labeled “single use sterile” because these products have not been tested to see how various cleaning products may effect them. Cleaning medical products can be an added burden to patients or caregivers who may be confused regarding cleaning procedures. Cleaning procedures must be individualized and take patient and caregiver needs and their ability to follow the procedure into consideration.4 Recommended solutions for cleaning urine drainage bags or irrigation equipment include full strength vinegar, one part vinegar to three parts water (1:3),22 and 4 oz of bleach (5.25%) to 1 gallon of water.
Vinegar has been used safely in the home for many years — it decrystalizes sediment that may build up and changes the pH balance, which inhibits bacterial growth.25 Bleach solutions have been found to have excellent antimicrobial activity but lose strength quickly; hence, they must be mixed daily.4,28,29 If bleach is used, patients must be taught proper handling, which includes avoiding inhalation and contact with the skin, eyes, and clothing. Solutions should be instilled down the tubing and into bag. Care should be taken to avoid wetting the air vent located on the top of the drainage bag; a wet vent can lead to impaired drainage due to air lock. After cleaning, the product should be rinsed thoroughly and air should be instilled into the bag to promote drying.
1. Dobson C, Naidu S, Johnson M. Nurses’ perceptions of urinary catheter selection and management. Urology Nursing. 1996;16:140–144.
2. Evans E. Indwelling catheter care: dispelling the misconceptions. Geriatric Nursing. 1999;20(2):85–89.
3. Maki DG, Tambyah PA. Engineering out the risk of infection with urinary catheters. Emerg Infect Dis. 2001;7(2)342–347.
4. Wilde M. Meanings and practical knowledge of people with long-term urinary catheters. Journal of Wound Ostomy Continence Nursing. 2003;30(1):33–39.
5. Saint S, Veenstra DL, Sullivan SD, et al. The potential clinical and economic benefits of silver alloy urinary catheters in preventing urinary tract infection. Arch Intern Med. 2000;160(17):2670–2675.
6. Cravens DD, Zweig S. Urinary catheter management. Am Fam Physician. 2000;61(2):369–376.
7. Fanti JA, Newman DK, Colling J, et al. Clinical Practice Guidelines, No. 2, 1996 Update: Urinary Incontinence in Adults. Acute and Chronic Management. Rockville, Md. US Department of Health and Human Services. Public Services Agency for Health Care Policy and Research; March 1996. AHCPR Publication No.96-0682.
8. Wong ES, Hooten TM. Guideline for prevention of catheter-associated urinary tract infection. Center for Disease Control and Prevention. 1981;Feb. [serial online]. Available at: http://www.cdc.gov/ncidod/hip/GUIDE/uritract.htmnece. Accessed September 8, 2003.
9. Addison R, Mould C. Risk assessment in suprapubic catheterization. Nursing Standard. 2002;14(36):43–46.
10. Robinson J. Deflation of a foley catheter balloon. Nursing Standard. 2003;17(27):33–38.
11. Mitsui T, Minami K, Furuno T, et al. Is suprapubic cystostomy an optimal urinary management in high quadriplegics? A comparative study of suprapubic cystostomy and clean intermittent catheterization. Eur Urol. 2000; 38(4):434–438.
12. Nomura S. Ishido T, Teranishi J, Makiyama K. Long-term analysis of supra-pubic cyctostomy drainage in patients with neurogenic bladders. Urologia Internationalis. 2000;65(4):185–189.
13. Parkin J, Scanlan J, Woolley M, et al. Urinary catheter “deflation cuff” formation: clinical audit and quantitative in vitro analysis. British Journal of Urology. 2002;90(7):666–671.
14. Liss GM, Sussman GL. Latex sensitization: occupational versus general prevalence rates. Am J Ind Med. 1999;35(2):196–200.
15. Vila L, Sanchez G, Ano M, et al. Risk factors for latex sensitization among health care workers. J Investig Allergol Clin Immunol. 1999;9(6):356–360.
16. Department of Health and Human Services. FDA. Federal Register: Natural Rubber-Containing Medical Devices; User Labeling, Federal Register 1997;62(189):51021–51030.
17. Tullock AGS. Ferguson AF. Catheter-induced urethritis: a comparison between latex and silicone catheters in a prospective clinical trial. British Journal of Urology. 1985;57(3):325–328.
18. Studder UE, Bishop MC, Zingg EJ. How to fill silicone catheter balloons. Urology. 1983;22(3):300–302.
19. Salgado CD, Karchmer TB, Farr BM. Prevention of catheter-associated urinary tract infections. In: Wenzel RP, ed. Prevention and Control of Nosocomial Infections, 4th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2003;297–311.
20. Robinson J. Urethral catheter selection. Nursing Standard. 2001;15(25):39–42.
21. Newman DK. Managing indwelling urethral catheters. Ostomy/Wound Management. 1998;44(12):26–35.
22. Chinnes L, Dillion A, Fauerbach L. Home Care Handbook of Infection Control 2002. Washington, DC: Association of Professionals in Infection Control and Epidemiology (APIC);2002.
23. Gerard L, Sueppel C. Lubrication technique for male catheterization. Urology Nursing. 1997;17(4):156–158.
24. Cancio LC, Sabanegh ES JR, Thompson IM. Managing the foley catheter. Am Fam Physician. 1993;48(5):829–836.
25. Wilde M. Long-term indwelling urinary catheter care:conceptualizing the research base. J Adv Nurs. 1997;25(6):1252–1261.
26. Hanchett M. Techniques for stabilizing urinary catheters. Am J Nurs. 2002;102(3):44–48.
27. Getliffe K. Managing recurrent urinary catheter blockage: problems, promises and practicalities. Wound Ostomy Continence. 2003;30(3):146–151.
28. Dille C, Kirchhoff K. Increasing the wearing time of vinyl urinary drainage bags with bleach. Rehabilitation Nursing. 1993;18(5):292–295.
29. Rutala WA, Barbee SL, Aquiar NC, et al. Antimicrobial activity of home disinfectants and natural products against potential human pathogens. Infect Control Hosp Epidemiol. 2000;21(1):33–38.
30. Daifuku R. Stann WE. Association of rectal urethral colonization with urinary tract infection in patients with indwelling catheters. JAMA. 1984;252(15)2028–20230.
31. Warren JW. Catheter-associated urinary tract infections. Int J Antimicrob Agents. 2001;17(4):299–303.
32. Maki DG, Knasinski V, Halvorson K, Tambyah PA. Risk factors for catheter-associated urinary tract infection: a prospective study showing the minimal effect of catheter care violations on the risk of CAUTI (abstract). Infect Control Hosp Epidemiol. 2000;21:165.
33. Stickler DJ. Bacterial biofilms and encrustations of urethral catheters. Biofouling. 1996;94:293–305.
34. Donlan RM. Biofilms and device-associated infections. Emerg Infect Dis CDC. 2001;(7)2:277–281.
35. Kunin CM, Chin QF, Chambers S. Formation of encrustations on indwelling urinary catheters in the elderly: a comparison of different types of catheter materials in “blocker” and “nonblocker”. J Urol. 1987;138(4):899–902.
36. Tambyah PA, Maki DG. Catheter-associated urinary tract infection is rarely symptomatic; a prospective study of 1,497 catheterized patients. Arch Intern Med. 2000;160(5):678–682.
37. Gammack JK. Use and management of chronic urinary catheters in long-term care: much controversy, little consensus. Journal of the American Medical Directors Association. 2002;3(3):162–168.
38. McGeer A, Campbell B, Emori TG, et al. Definitions of infection for surveillance in long-term care facilities. Am J Infect Control. 1991;19(1):1–7.
39. Switters DM. Assessing leakage from around the urethral catheter. Urological Nursing. 1989;9(3):8–10.
40. Bhatia NN, Bergman A. Cystometry: unstable bladder and urinary tract infection. Brit J Urol. 1986;58(2):134–137.
41. Ziemann LK, Lastauskas NM, Ambrosini G. Incidence of leakage from indwelling urinary catheters in home-bound patient. Home Healthcare Nurse. 1984;2(5):22–26.
42. Stickler DJ. Hewitt P. Activity of antiseptics against biofilms of mixed bacterial species growing on silicone surfaces. Eur J Clin Microbiol Infect Dis. 1991;10:416–421.
43. Morris NS, Stickler DJ. Does drinking cranberry juice produce urine inhibitory to the development of crystalline, catheter-blocking Proteus mirabilis biofilms? BJU Int. 2001;88(3):192–197.