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.
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