Internal and External Urinary Catheters: A Primer for Clinical Practice
- 1 Comments
- 22763 reads
2 These devices come in many sizes and a measurement or sizing guide is recommended. The penis is measured halfway down the shaft and the measurement should be preformed when the penis is non-erect, extended, and gently pulled forward away from the body. If the man has nocturnal erections and uses an EC while asleep, the size should be adjusted.
New Regulations and New Catheter Technology that are Influencing Clinical Care
“Single-use” intermittent catheters. In late 2007, the VA57 issued guidance to clinicians on the re-use of urinary catheters for patients using IC for bladder management. This guideline noted that the FDA considers urinary catheters to be single-use devices and that manufacturers of catheters specifically identify them as such. The VA recommends that until manufacturers specifically change labeling for urinary catheters, no policy interpretation allows the re-use of urinary catheters; therefore, clinicians who practice in the VA system “should follow the manufacturer’s instructions for catheter use. Catheters identified as single-use devices should not be re-used in any setting.” 57
In the spring of 2008, the CMS4 noted an increase in monthly coverage to 200 coated or uncoated catheters used for IC (formerly four catheters per month). The evidence for decreased UTIs in patients using single-use catheters versus clean technique is still evolving. 58
Nonpayment for CAUTIs. The CMS recently has reshaped reimbursement regulations for acute care facilities, holding acute-care hospitals accountable for failing to avert preventable harm resulting from medical care and withholding additional payments to hospitals for “serious preventable events.” 59 Payment can be denied for eight costly and sometimes deadly preventable hospital-acquired conditions, one of which is CAUTIs, 60 placing a high priority on reducing CAUTIs viewed as unacceptable harm resulting from medical care. Hospitals will be at risk for financial losses (nonpayment for additional costs) if CAUTIs occur.
Applying infection control-based practices may enhance safety. Other practices that may decrease CAUTIs include: using indwelling catheters only when necessary and removing them when no longer needed via the use of various reminder systems, using antimicrobial catheters in patients at high risk of infection, using portable ultrasound bladder volume technology (eg, BladderScan®, Verathon, Bothell, WA) to detect post void residual urine amounts, maintaining proper insertion technique, and using alternatives to IUCs, such as external devices or intermittent catheterization. 61 Table 5 outlines a nursing protocol for patient care following catheter removal. This protocol was developed by Robyn Strauss, MSN, ACNS-BC, CVN, WCC, in collaboration with this author, for use at the Hospital of the University of Pennsylvania, Philadelphia, PA.
Use of an introducer tip when performing self-catheterization. The first portion (1.5 cm) of the distal urethra harbors perineal bacteria, particularly Escherichia coli. An introducer tip (sometimes referred to as a guide and part of most closed IC systems) allows the catheter to bypass the colonized area, preventing migration of these bacteria into the bladder (see Figure 9.) Bennett et al62 found that using an introducer tip catheter reduced UTI in hospitalized spinal cord injured patients performing IC.