View
120
Download
3
Category
Preview:
DESCRIPTION
Urinary catheter care skills & asepsis
Citation preview
08/04/2023 1
Urinary Catheter CareSkills & Asepsis
08/04/2023
Urinary CatheterDr. Frederick Foley
• Developed in the 1920s by Dr. Frederick Foley
• The urinary catheter was originally an open system with the urethral tube draining into an open container.
• In the 1950s, a closed system was developed in which the urine flowed through a catheter into a closed bag.
2
08/04/2023 3
What is a Foley's catheter
08/04/2023 4
What is a urinary catheter
• Urinary catheter is any tube placed in the body to drain and collect urine from the bladder
08/04/2023 5
Catheter type
08/04/2023 6
Structure of Foley Catheter
08/04/2023
Urinary Catheter Utilization• About 15-25% of patients
during their hospitalization will have an urinary catheter placed
• Many are placed either in the intensive care or Emergency Department
• 40% - 50% of these patients do not have a valid indication for urinary catheter placement
7
08/04/2023 8
Purpose of Catheterization
Catheterization is carried out for a number of reasons and can either be a temporary or permanent solution to a number of problems. Problems include physical disease and damage, psychological issues and a way to help to improve the quality of life to someone who is bed ridden. Good regular catheter care involves good hygiene, observation, monitoring well-being and prevention of problems associated with catheterization.
08/04/2023 9
Foley Catheter
08/04/2023 10
Documentation• Details regarding the
catheterisation should be recorded in the patient’s notes. For further information please refer to your hospitals policy and procedure manual.
08/04/2023 11
Matters to consider for Catheterization
• Indication for catheterisation• • Time and date of catheterisation• • Type of catheter• • Amount of water in balloon• • Size of catheter• • Expiry date of product• • Any problems on insertion• • Description of urine, colour and volume drained• • Specimen collected• • Review date• (Marsden Manual 2001)
08/04/2023 12
What you Need for Catheterization
• 1 Dressing trolley• 2. Catheterisation pack• 3. Sterile gloves• 4. Appropriate size catheter• 5. Xylocaine jelly syringe• 6. Sterile water for the balloon• 7. Syringe• 8. Specimen jar• 9. Antiseptic solution• 10. Waterproof Sheet• 11. Extra Jug• 12. Light source• 13. Tape to secure the catheter to the leg• 14. Drainage bag• 15 Urine bag holder
08/04/2023 13
Choose the Right Catheter
• Choose the smallest catheter size that will drain adequately for its intended use
• Catheters range in size from 5 – 24 Fg.
• (Joanna Briggs Institute 2003)
08/04/2023 14
Guidelines on Size• Women 12 – 14 Fg• Men 16 – 18Fg• Suprapubic 16 –20Fg• Haematuria 20 -24 Fg• If a haematuria catheter is required a 3 –way
should be used to allow for the option of continuous bladder irrigation without requiring a further catheter change. When not in use, the irrigating port should be spigotted.
08/04/2023 15
Length of Catheters • Catheters are available in 3 lengths: Paediatric,
Regular length and Female length.• Female length is a shorter length catheter (20-
25cm). A shorter length catheter may be more convenient for ambulant women with a long term catheter. A shorter length catheter is not appropriate for all women particularly those who are bedridden or obese.
08/04/2023 16
Catheters in Obese Women • In obese women, the
inflation valve of the shorter catheter may cause soreness by rubbing against the inside of the thighs, and the catheter is more likely to pull on the bladder neck (Britton & Wright 1990; Pomfret 1996)
08/04/2023 17
Catheterization is a skill in Medicine
• The ability to insert a urinary catheter is an essential skill in medicine.
• Catheters are sized in units called French, where one French equals 1/3 of 1 mm. Catheters vary from 12 (small) FR to 48 (large) FR (3-16mm) in size.
08/04/2023 18
Catheters are available in different varieties
• They also come in different varieties including ones without a bladder balloon, and ones with different sized balloons - you should check how much the balloon is made to hold when inflating the balloon with water!
08/04/2023 19
What is indwelling Catheter• In indwelling urinary catheter is one that is left in place
in the bladder. Indwelling catheters may be needed for only a short time, or for a long time. These catheters attach to a drainage bag to collect urine. A newer type of catheter has a valve that can be opened to allow urine to flow out, when needed. An indwelling catheter may be inserted into the bladder in two ways:
• Sometimes, one may insert a tube, called a suprapubic catheter, into your bladder from a small hole in your belly. This is done as an outpatient surgery or office procedure.
08/04/2023 20
Caution on catheterization • The potential for contact with a
patient's blood/body fluids while starting a catheter is present and increases with the inexperience of the operator. Gloves must be worn while starting the Foley, not only to protect the user, but also to prevent infection in the patient. Trauma protocol calls for all team members to wear gloves, face and eye protection and gowns.
08/04/2023 21
Explain the patient before doing the catheritization
• Before you start tell the person what you are going to do and why. This is important for everyone, but especially if the person is confused, has memory problems as in Alzheimer's disease or dementia. If you can, assist the catheterized person with their hygiene, rather than doing it yourself. It is important to try to help the person / patient keep their skills rather than just take over for them. There are so many advantages but it can just take that bit longer.
08/04/2023 22
Which Disinfectant Should be Used for Catheter Site Care?
• Povidone-iodine (PI) is currently the most widely used agent for site disinfection
• Chlorhexidine gluconate (CHG) has been compared to PI with mixed results
• We performed a formal meta-analysis of published and unpublished studies to clarify relative efficacy
08/04/2023 23
Skills in catheterization to be Perfected
08/04/2023 24
CONDOM CATHETERS• Condom catheters are most
frequently used in elderly men with dementia. There is no tube placed inside the penis. Instead, a condom-like device is placed over the penis. A tube leads from this device to a drainage bag. The condom catheter must be changed every day.
08/04/2023 25
When Men suffer with Incontinence
• When a man is unable to control his urine for long periods of time he is said to be incontinent. To avoid soiling his clothes and bed a condom-style sheath can be used to connect the penis to a closed drainage system in which the urine is collected.
• This avoids having a catheter inserted into the man's urinary bladder and greatly decreases the risk of bladder infections.
08/04/2023 26
INTERMITTENT (SHORT-TERM) CATHETERS
• Some people only need to use a catheter on occasion. Short-term, or intermittent, catheters are removed after the flow of urine has stopped. For more information on this type of catheter, see: Clean intermittent self-catheterization.
08/04/2023 27
Hand washing the most important preparation before catheterization
• Wash your hands before and after handling the drainage device. Do not allow the outlet valve to touch anything. If the outlet becomes obviously dirty, clean it with soap and water.
08/04/2023 28
Antiseptic Hand Rinses many using alcohols
• 60-70% alcohol solutions
• Effective against most bacteria, viruses, fungi
• Protective against hand drying
• Faster, increased compliance
08/04/2023 29
Caring before the insertion of Catheter
• Wash around the catheter entry site with soap and water twice each day. Clean the top several inches of the catheter too.Always wash the site after a bowel movement.
08/04/2023 30
Health care workers should develop skills in introduction of Catheter
• Introduction Female urethral catheterization, the insertion of a catheter through the urethra into the urinary bladder to permit drainage of urine, is a fundamental skill Insert the catheter completely into the urethra, and do not inflate the balloon until there is return of urine, to avoid trauma …
08/04/2023 31
Principles of placement of catheter and collecting bag
08/04/2023 32
The Urine collecting bag should be at a lower level to the patient
to prevent retrograde flow
08/04/2023 33
• Criteria for insertion and continuation of a F/C includes:
a. Retentionb. Critical I&Oc. Comatosed. Paralyzede. Neurogenic Bladderf. Pre-op placementg. Wound with incontinenceh. Bladder Irrigationi. Physical trauma/pain with bedpan/incontinence briefj. Terminal illness/comfort measures
08/04/2023 34
Care of Inserted Catheters
• Every day , wash around the catheter and perineum with soap and water; rinse and dry these areas well. you may shower while wearing the catheter
• Sitting in the tub, however , is not recommended. Good personal hygiene pre vents the accumulation of bacteria, reduces the risk of infection, and prevents odor
08/04/2023 35
POSSIBLE COMPLICATIONS• Inability to catheterise• • Urethral Injury – by inflating balloon before insuring correct catheter
placement in the• bladder• • Infection• • Psychological Trauma• • Haemorrhage – trauma sustained during insertion or balloon inflation• • False Passage – by injury to the urethral wall during insertion• • Urethral Strictures – following damage to the urethra – long term
problem• • Paraphimosis due to failure to return foreskin to normal position
following catheter insertion.
08/04/2023 36
Complications of catheterization
• The main complications are tissue trauma and infection. After 48 hours of catheterization, most catheters are colonized with bacteria, thus leading to possible Bacteriuria and its complications. Catheters can also cause renal inflammation, nephro-cysto-lithiasis, and pyelonephritis if left in for prolonged periods.
• The most common short term complications are inability to insert catheter, and causation of tissue trauma during the insertion.
• The alternatives to urethral catheterization include suprapubic catheterization and external condom catheters for longer durations.
08/04/2023 37
Urinary Catheter-related Infection: Background
• Urinary tract infection (UTI) causes over 40% of hospital-acquired infections
• Most infections due to urinary catheters
• 25% of inpatients are catheterized
• Leads to increased morbidity and costs
08/04/2023 38
Risks / Consequences of Catheterization
• UTI• PYELONEPHRITIS• DEATH R/T BACTEREMIA• DAMAGE TO URETHRA (SCARRING AND
STRICTURES)• Prostatitis and epididymitis
08/04/2023 39
• Indwelling Foley catheters are a major source of UTI’S.
• Direct relationship between duration a f/c is in the patient and incidence of infection.
• Risk factors: Female Advanced age Duration Diabetes Renal insufficiency
08/04/2023
Biofilm: Extracellular Polymers(Donlan, CID 2001; 33:1387–92, Liedl, Curr Opinion Urol 2001;11: 75-9)
• Organisms attach to and grow on a surface and produce extracellular polymers
• Intraluminal ascent (48hours) of bacteria faster than extraluminal (72-168 hours)
• Most catheters used >1 week have biofilms
• Extraluminal more important in women
40
Staphylococcus aureus biofilm on an indwelling catheter.
CDC Public Health Image Library
08/04/2023 41
What we are doing now, is it right things to do.Foley Catheter Bundle
What is the Foley Catheter Bundle? Insert using sterile technique Hand hygiene before and after any contact with the F/C
system Secure catheter to thigh at ALL timesKeep catheter bag below the level of the bladder at
ALL times Maintain a sterile, continuously closed system Specified criteria for insertion and continuation of a Foley
catheter Peri care daily and after all incontinent stoolWhat is “Peri Care” for a patient with a f/c? Daily wash with
warm soap & water then dry.
08/04/2023 42
Gravity will help the Draining of Bladder
• Gravity is important for drainage and the prevention of urine backflow. Ensure that catheter bags are always draining downwards, do not become kinked and are secured and below thigh level. Metal or plastic hangers should be attached to the side of the bed. Cloth bags tied to the bed to support the bags are also available
08/04/2023 43
Collection of urine from catheterised patients
• The process of obtaining a sample of urine from a patient with an indwelling urinary catheter must be obtained from a sampling port. The sample must be obtained using an aseptic technique.
• This port is usually situated in the drainage tubing, proximal to the collection bag which ensures the freshest sample possible. The use of drainage systems without a sampling port should be avoided (Gilbert, 2006).
08/04/2023 44
COLLECTION OF CATHETER SPECIMENSIn Urinary Tract Infections
• Clean entry port with alcohol swab using firm friction and allow to air dry
• • Insert syringe into direct entry point of bag and aspirate urine. The port will self-seal when the syringe is withdrawn.
• • If direct syringe entry port is not available, insert needle into entry port and aspirate urine. The port will self-seal when the needle is withdrawn
08/04/2023 45
Specimens for Culturing Should not be Cultured from Urine bags
• Specimens should not be collected from the tap from the main collecting chamber of the catheter bag as colonisation and multiplication of bacteria within the stagnant urine or around the drainage tap may have occurred.
08/04/2023 46
Aspirating the urine with syringe and Needle
• Aspirating urine from a sampling port has traditionally been performed using a syringe and needle. However, needle-free systems are commercially available, which may reduce the risk of inoculation injury.
08/04/2023 47
Contraindications for catheterization
• Foley catheters are contraindicated in the presence of urethral trauma. Urethral injuries may occur in patients with multisystem injuries and pelvic factures, as well as straddle impacts. If this is suspected, one must perform a genital and rectal exam first. If one finds blood at the meatus of the urethra, a scrotal hematoma, a pelvic fracture, or a high riding prostate then a high suspicion of urethral tear is present.
08/04/2023 48
Epidemiology of urinary catheterization
• Up to 25% of hospitalized patients– urinary catheterization
• Catheter associated nosocomial UTI– 5% per day !
• Nosocomial UTI– 40% of nosocomial infection
• Bacteria ascend intraluminally into the bladder– within 24 to 72 hours (from Harrison’s 16th)
• > 1 month of catheterization– Nearly all will be bacteriuic
• Long-term (>30 days) and short-term (<30 days) catheterization
• 80% of patients with nosocomial UTI – have an indwelling urinary catheter
08/04/2023 49
Women in labour Need Catheterization
08/04/2023
Reminder for Appropriate Urinary Catheter Use
• Avoid urinary catheter use if not indicated
• Try to discontinue the catheter promptly when not needed
• The longer the catheter is present, the higher the risk of infection!
• The urinary drainage system should always remain a closed system
50
08/04/2023 51
Rapid draining leads to Complications
• Rapid drainage of large volumes of urine from the bladder may result in hypotension and/or haemorrhage.(Upson 1995) Clamp catheter if the volume drained is 1000mls or greater. After 20minutes release the clamp and allow urine to drain
08/04/2023 52
Repeat the Clamping when volume is higher
• If the amount of urine is 1000mls or greater repeat the clamping procedure.
08/04/2023 53
PROCEDURE FOR EMPTYING CATHETER BAGS
• Use a clean jug large enough to avoid spillage eg 2-3 litres.
• • After emptying the bag, wipe the end of the catheter outlet with an alcohol swab.
• • Note the amount and colour of drainage – record .
• • Empty jug carefully down the sluice to avoid splashing
• • Place jug straight into sanitizer and store dry
08/04/2023
Constant evaluation to continue to use catheter …….
• Both nurses and physicians should evaluate the indications for urinary catheter utilization.
• Physicians should promptly discontinue catheters that are no longer needed.
• Nurses evaluating catheters and finding no indication should contact physician to promptly discontinue catheter.
54
08/04/2023 55
Important question when to remove
• Should we need to remove the urinary catheter in 48~72 hours of smoothly post op patients to reduce the rate of catheter associated UTI? What’s the rate of catheter associated UTI in 48~ 72 hours? – Remove urinary catheter as soon as
possible!– Rate of Bacteriuria in indwelling catheter
patient in 48 hours post-OP: average 24%
08/04/2023 56
Mannequins Recruited To Teach Medicine
08/04/2023 57
Clean and Washed Hands Saves many Lives from Complications of Catheterization
08/04/2023 58
For More Articles of Interest on Infectious Diseases Visit Me …
08/04/2023 59
This platform has been started byParveen Kumar Chadha with the vision that nobody should suffer the way he has suffered because of lack and improper healthcare facilities in India. We need lots of funds manpower etc. to make this vision a reality please contact us. Join us as a member for a noble cause.
08/04/2023 60
Our views have increased the mark of the 35,000
Thank you viewers
Looking forward for franchise, collaboration, partners.
08/04/2023 61
Contact us:- 011-25464531, 9818569476
E-mail:- nursingnursing@yahoo.inSaxbee Consultants Details :-www.parveenchadha.com
08/04/2023 62
Thank you for your attention
Recommended