RESEARCH EVIDENCE ON INDWELLING URETHERAL CATHETER CARE

1. RESEARCH EVIDENCE ON INDWELLING URETHERAL CATHETER CARE Francine M Cheater Professor in Public Health Nursing

2. Urinary Catheters • Indwelling urinary catheters (short or long-term use) • Intermittent (self) catheterisation • External collecting devices • Supra-pubic catheterisation

3. Medical Necessity IDC Patient preference

4. THE EVIDENCE?

5. IDC PREVALENCE • Hospital- short term use10-12% • Long term care facilities 16-18% • Home- long term use 4% Acute median 4 days Long termmedian 4 years

6. RESEARCH • Complications +++ • Specific Procedures ++ • Principles of management in hospital/home ++ • Evaluation of interventions + • Miscellaneous e.g. patient education, economic evaluations

7. COMPLICATIONS 70-90% patients with LT catheters experience 1 or more recurrent problems-many are secondary to UTI • Urinary tract infection • Pain and discomfort • Leakage of urine • Blockage

8. UTI • UTI- 105 colony forming units of single species of bacteria/ml urine • In hospital 44% patients with IDC developed bacteriuria within 3 days of catheterisation (UTIs account for 30% of all hospital acquired infections) • Within 2.5 weeks-90% will have bacteriuria (Risks greater for patients with severe underlying illness, catheter induced UTI contributes directly to morbidity and mortality).

9. UTI • The duration of catheterisation -most important risk factor • Disrupting the closed drainage system (e.g.poor practices when emptying bag/changing bag) presents risk of contamination, cross infection • Use of gloves and/or alcohol rinse and single use of disposable containers to empty bags risk of cross infection. Hand washing alone ineffective. • Optimum time to change bags ?

10. UTI • Bacteria colonise surface of catheter and drainage bag-produce “biofilm”. Some catheter materials may be less prone to colonisation (e.g. hydrogel coated or silicon Vs. silicon/teflon/latex coated) • Antibiotic therapy for uncomplicated asymptomatic UTI in catheterised patients not effective and could lead to antibiotic resistance • Perineal cleansing vs. usual care

11. LARGE CATHETERS (Over 16 Ch) -Leakage/bypassing (upto 89% patients with LT catheter) -Trauma - bladder neck -Pain

12. Selection of Catheter • Consensus: optimal size 12-16 males and 12-14 females • Leakage associated with use of balloon size over 10mls • Catheter Material (hydrogel coated and full silicone less likely to encrust) • New materials developed all the time, catheter must fit needs of patient

13. DRAINAGE BAG/CATHETER VALVES • CATHETER CLAMPING

14. Blocking • Common (40-87%) with long term catheter use, more common in females, those with poor levels of mobility & high Ph urine values and ammonia concentrates • Caused by: bladder spasm, twisted catheter tube or faecal impaction BUT main reason is encrustation

15. Blocking • Bladder washouts (dissolve or flush out mineral deposits blocking catheter) • Evidence of effectiveness of using washouts mixed • Weak acidic solution/mandelic acid effective in encrustation in laboratory tests • Saline irrigations not effective • More research needed but bladder washouts may be useful in selected patients • Alternative is to remove catheter and replace

16. Bladder installations/irrigation • Fluid intake • Antibiotics/antiseptics • Principles of catheter care

17. Patient perceptions • Patient/carer education

18. CONCLUSIONS • Considerable research ( controlled trials) to inform practice • Challenge now to implement what we know into practice