What should you do prior to inserting an indwelling catheter?
Use of Indwelling Urinary Catheters | Acute Care Catheter Use |
Indications for indwelling urinary catheter use Show The settings in which the prevalence of long-term IUCs usage is the greatest are: 1) skilled nursing facilities, where they are used in residents with UI, and 2) homes where the person requires skilled nursing visits. In the home-care setting, the prevalence of IUCs is growing with the increasing number of older adults. The median time of indwelling catheter use in home care is reported as 3 to 4 years. However, the number of “home-bound” patients who use a catheter indefinitely to manage UI or because of urinary retention has not been well documented in medical or nursing research. Indications for Indwelling Catheter (medical necessity) Indwelling catheter overuse occurs when a device is in place without an appropriate indication. There are two ways of reducing IUC use: 1) by minimizing the initial placement of IUCs and 2) by reducing the duration of each catheterization. Urinary catheters have various medical indications but the most common is short term drainage of the urinary bladder. For some patients with upper tract deterioration due to elevated bladder storage pressures (e.g. poor compliance from prior radiation therapy, neurogenic disease, etc.), an IUC may have a role. The catheter permits low pressure, unimpeded drainage of urine from the upper urinary tract through the bladder and then directly into a collection receptacle. The following are indications for IUC use. - Short term for acute urinary retention:
- Temporary relief of bladder outlet obstruction secondary to:
- Chronic urethral obstruction or urinary retention and surgical interventions, or the use of intermittent catheterization, has failed or is not feasible, or both Use of Indwelling Urinary Catheters Although indwelling urinary catheters are commonly used in most clinical settings, data suggest that more than 20% of these catheters are placed without a specific medical indication and that they often remain in place without the knowledge of the patient’s physician. Studies of the appropriateness of use of urinary catheters indicate that 21 to 38% of initial urinary catheterizations are unjustified, and one-third to one-half of days of continued catheterization are unjustified. The current challenges are to develop effective methods to sensitize the minds of clinicians to avoid the routine use of indwelling catheters, remove catheters when they are no longer needed, develop alternative methods for care of urinary incontinence (UI), employ noninvasive methods to measure bladder function and urine output, and improve urine drainage systems. Catheter Use in Acute Care Setting (Hospitals, Acute Rehabilitation) In acute care hospital settings, approximately 12-16% of adult patients and up to 25% of all hospitalized patients usually for surgery, urine output measurement, urinary retention, or UI. Their use is greater in high acuity patient units, with critical care and intensive care units having the highest. At least 8%-23% of patients admitted through the emergency room have an IUC. Nearly 50% of surgical patients remain catheterized beyond 48 hours postoperatively; approximately 50% of medical patients do not have a clear indication for an IUC. Hospitals use IUCs more than any other medical device. Because the most important risk factor for catheter-associated bacteriuria is duration of catheterization, most catheters in hospitalized patients are placed for only 2 to 4 days. Extended indwelling catheter use in older adult patients sustaining hip fracture who are discharged to skilled nursing facilities with a catheter in place have been associated with poorer outcomes because these individuals are at higher risk of rehospitalization for CAUTIs and sepsis. Increased mortality at 30 days is seen in these individuals when compared to patients whose catheter was removed prior to discharge. In hospitalized older medical patients with UI, without a specific indication, an IUC has been associated with a greater risk of death - four times as great during hospitalization and two times as great within 90 days after discharge. The risk of infection is associated with the method and duration of catheterization, the quality of catheter care, and host susceptibility. Around 50% of hospitalized patients catheterized longer than 7 to 10 days contract bacteriuria. Although frequently asymptomatic, 20 to 30% of individuals with catheter-associated bacteriuria will develop symptoms of CAUTI. Many of these infections are serious and lead to significant morbidity and mortality. Catheter Use in a Nursing Home The prevalence of indwelling urinary catheter use in nursing homes has been established as 5-7%. Catheter Use in Home Care In the community, the prevalence of IUC is difficult to determine as many of the long-term IUC patients are lost to urologic follow-up and are managed by home care nurses or allied clinicians. A National Home and Hospice Care Survey in 2007 reported catheter prevalence in home care (excluding hospice) at 9% (n = 4683) or 135,000 people with catheters of the 1.5 million home care patients in 2007. (http://www.cdc.gov/nchs/fastats/homehealthcare.htm). Alternatives to indwelling urinary catheter
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2. Before placing an indwelling catheter, does the patient have one of the following appropriate indications* for placing indwelling urinary catheters?
Selected peri-operative needs:
References What is the process of inserting an indwelling catheter?Insert catheter into the urethral opening, upward at approximately 30 degree angle until urine begins to flow. Inflate the balloon slowly using sterile water to the volume recommended on the catheter. Check that child feels no pain. If there is pain, it could indicate the catheter is not in the bladder.
How do you prepare for Foley catheter insertion?Review the male anatomy. Gather equipment.. Explain procedure to the patient.. Assist patient into supine position with legs spread and feet together.. Open catheterization kit and catheter.. Prepare sterile field, apply sterile gloves.. Check balloon for patency.. What considerations need to be made when placing a Foley catheter?Check the tape or strap used to secure the catheter tube to your skin. Make sure it is not blocking the tube. Make sure you are not sitting or lying on the tubing. Make sure the urine bag is hanging below the level of your waist.
When preparing to insert an indwelling urinary catheter in a male patient it is important for the nurse to do what?When preparing to insert an indwelling urinary catheter in a male patient, it is important for the nurse to do what? Remove the cotton balls from the kit for later use. Advance the catheter 10 to 12 inches or until urine flows. Lubricate the first 5 to 7 inches of the catheter.
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