Review of intermittent catheterization and current best practices

Intermittent catheterization is the insertion and removal of a catheter several times a day to empty the bladder. This type of catheterization Is used to drain urine from a bladder that is not emptying adequately or from a surgically created channel that connects the bladder with the abdominal surface (such as Mitrofanoff continent urinary diversion). Intermittent catheterization is widely advocated as an effective bladder management strategy for patients with incomplete bladder emptying due to idiopathic or neurogenic bladder dysfunction. Urologic nurses are at the forefront of educating and teaching patients how to self-catheterize. Catheterizations performed in institutions, such as acute and rehabilitation hospitals and nursing homes, are done aseptically. Historically, however, intermittent catheterization has been performed by the patient in the home environment using a clean technique involving the re-use of catheters. New guidelines released in the past three years have recommended changes to the practice of re-using catheters. Currently, nurses use their clinical judgment to determine which technique and type of catheter to use, in conjunction with patient preference. Differential costs and insurance coverage of catheters/echniques may also influence decision making. The authors provide an overview of the indications, use, and complications associated with intermittent catheterization, present current guidelines on self-catheterization and treatment of catheter-associated complications, detail types of catheters, and review clinical practice of intermittent catheterization.     

Silver hydrogel urinary catheters: evaluation of safety and efficacy in single patient with chronic spinal cord injury

Urinary tract infections (UTIs) are a large health burden for patients with spinal cord injury (SCI) who have neurogenic bladder dysfunction, especially those patients using indwelling catheters. One method that has shown promise in recent years is the use of a silver hydrogel catheter (SHC). This article describes the outcome of a subject who was part of a prospective, randomized, double-blind study and assigned to use an SHC for 6 months. Using the indwelling SHC effectively prevented this subject from developing a symptomatic UTI. He did not display any symptoms suggestive of silver toxicity or increased serum levels of silver with chronic use of the device. Although no general conclusions can be drawn from this single-subject observation, the results suggest that SHC use has a positive effect. Use of this catheter for persons with neurogenic bladder dysfunction after SCI should be explored further with a study design that optimizes subject recruitment.     

Monitoring urinary bladder temperature in the intensive care unit: state of the science.

Body temperature of patients in critical care units can be monitored with a variety of devices and at a variety of body sites. In recent years, monitoring of urinary bladder temperature has become more common. Temperature-sensing indwelling urinary catheters allow continuous drainage of urine and continuous measurement of body temperature. This article provides a comprehensive and critical review of research undertaken in intensive care units to compare body temperatures measured in the urinary bladder with temperatures measured at a core site, the pulmonary artery. The studies support the use of urinary bladder temperature as a reliable index of core temperature during times of thermal stability. For critically ill patients who are already under considerable stress and whose condition necessitates the use of an indwelling urinary catheter, bladder temperature monitoring is an easy and convenient method that eliminates the need to use alternative sites. Further studies on the effects of shivering and urinary flow rate on temperatures measured in the bladder in critical care patients are needed. The economics of monitoring urinary bladder temperature also should be studied.     

脊髓病后神经源性膀胱患者肠道膀胱扩大术的护理

目的总结脊髓病后神经源性膀胱患者行乙状结肠膀胱扩大术围手术期护理。方法回顾性分析脊髓病后神经源性膀胱行乙状结肠膀胱扩大术31例患者的围手术期护理及术后随访资料。结果术后出现肠梗阻2例,短暂精神障碍1例,膀胱内真菌感染1例,均治愈。2例失访,余29例随访6个月～4年,恢复良好,能长期坚持间歇导尿。结论术前正确健康指导、肠道及膀胱准备,术后严密病情观察、胃肠减压及引流管道的护理,出院前间歇导尿的训练,出院后定期随访,是护理的关键内容,也是保证手术疗效的重要环节。     

Short-channel duodenoscope: innovations in selective biliography

The selective cannulation of the intrahepatic branches of the biliary system is made possible by the use of torsion-stabilized angiographic catheters passed via short-channel duodenoscopes. Other feasible applications are the endoscopic selective positioning of biliary endoprosthesis, and the cannulation of the gall bladder using a cysto-nasal catheter through which a litholytic fluid can be installed directly into the gall bladder.     

Bladder washouts in the management of long-term catheters

It has been estimated that 40-50% of patients with long-term catheters can suffer with catheter blockage. This not only causes distress to the patient but also increases the demands on community nurses' time and resources. Infection with bacteria such as Proteus causes the urine to become alkaline. Crystalline deposits can then form inside the catheter lumen which causes blockage. Nurses often manage blocked catheters with the use of bladder 'washouts' or bladder instillations. However, the literature is confused over the terminology of 'bladder washouts', instillations and irrigation and a great deal of controversy surrounds the effectiveness of these procedures. Crisis management of catheters occurs when nurses wait for catheters to become blocked before changing them; this often occurs at inconvenient times and patients frequently have to wait several hours before help is available. To avoid crisis management, nurses should aim to assess individual patients' 'pattern of catheter life' and plan changes accordingly. This would improve patient care and allow nurses to utilize their time more effectively.     

Catheter valves for indwelling urinary catheters: a systematic review

This mini-review aimed to systematically review the evidence on the effect of catheter valves compared to free drainage into a bag for patients with indwelling urinary catheters. Data sources used were Medline, British Nursing Index, CINAHL, Ahmed, EMBASE, EBM Reviews, the Cochrane Library and reference lists of relevant papers. Papers considered were controlled trials comparing the use of a catheter valve with the catheter bag that were published as a full report, or detailed abstract (containing sufficient information to critique) in Dutch, German or English. Two studies with a total of 122 subjects were identified. The main outcome measures considered were reduction of incidence of bladder spasm and urinary tract infection (UTI) and patient preference. No statistically difference in the incidence of bladder spasm or UTI was demonstrated but patients showed a clear preference for the valve. Further research into catheter valves is needed, with larger study groups, which include housebound male and female patients, and longer follow-up period.     

External Female Urinary Catheter: Implementation in the Emergency Department

The emergency department is a care environment in which indwelling urinary catheters are placed frequently; however, the significance of the role of the emergency department in catheter-associated urinary tract infection prevention has been overlooked. The use of an external female urinary catheter is an alternative to placing an indwelling urinary catheter for female patients in the emergency department who are incontinent of urine or are immobile. The purpose was to describe the implementation of an initiative to decrease the number of indwelling urinary catheters and increase the use of external urinary female catheters in non–critically ill women who visited the emergency department at a 451-bed Magnet-designated community hospital in the Southeast. For this clinical implementation project, the Plan, Do, Check, Act framework was used to develop the initiative, and outcome data were collected retrospectively and included an indirect calculation of the number of indwelling urinary catheters placed in the emergency department. A total of 187 external catheters were used in place of indwelling catheters in female patients over a 3-month period. No skin irritation or breakdown was observed. This project demonstrated the initial staff acceptability and feasibility of external female urinary catheter use in the ED setting.     

Urinary catheter management

The use of urinary catheters should be avoided whenever possible. Clean intermittent catheterization, when practical, is preferable to long-term catheterization. Suprapubic catheters offer some advantages, and condom catheters may be appropriate for some men. While clean handling of catheters is important, routine perineal cleaning and catheter irrigation or changing are ineffective in eliminating bacteriuria. Bacteriuria is inevitable in patients requiring long-term catheterization, but only symptomatic infections should be treated. Infections are usually polymicrobial, and seriously ill patients require therapy with two antibiotics. Patients with spinal cord injuries and those using catheters for more than 10 years are at greater risk of bladder cancer and renal complications; periodic renal scans, urine cytology and cystoscopy may be indicated in these patients.     

神经外科昏迷病人拔除尿管方法对尿潴留的影响

目的 为神经外科昏迷病人留置尿管恢复正常排尿功能选择一种最佳的拔尿管方法,以减少病人的重复插管.方法 选择神经外科男性昏迷并留置尿管病人100例,随机分为观察组和对照组,各50例.两组均遵医嘱拔除尿管.观察组采用拔管前膀胱灌注温热液体至膀胱充盈时,结合膀胱区按摩拔除尿管.对照组不论膀胱是否充盈随即拔除尿管.比较两组拔管后排尿的成功率.结果 观察组拔管后第1次排尿成功率为90%,排尿时间9.3±3.6min;对照组拔管后第1次排尿成功率为64%,排尿时间60.7±19.3min.两组比较有显著性差异(P<0.01).结论 在膀胱充盈时,结合膀胱区按摩拔除尿管,排尿效果显著.     

Insertion, care and management of suprapubic catheters

A suprapubic catheter may be used to drain the bladder of urine as an alternative to an indwelling urethral catheter. It can be inserted as a temporary or permanent measure in patients with urinary dysfunction or if initial urethral catheter insertion or recatheterisation is problematic. This article discusses insertion of suprapubic catheters, management and care, including changing suprapubic catheters, drainage systems and the importance of patient education.     

Standards to Prevent Complications of Urinary Catheterization in Children: Should and Should-Knots

purpose. To share standards for urinary, catheterization developed at Children's Hospital, Washington, DC, to prevent complications from using feeding tubes, inserting intermittent catheters too far into the bladder, or not inserting Foley catheters far enough into the bladder.

population.

population. Infants and children requiring urinary catheterization.

conclusions.

conclusions. Using appropriate length urinary catheters and/or inserting catheterizing devices appropriate lengths based on sex, age, and purpose will help prevent knotting of catheters in the bladder and urethral trauma.

practice implications.

practice implications. Short urinary catheters should be used for intermittent urinary catheterization. If these are not available, standards for length of insertion of the catheterizing device should be followed. To prevent urethral trauma, Foley catheters should be inserted to the hub before inflation of the balloon.     

Neurogenic continence. Part 2: Neurogenic bladder management

This article addresses physical and psychosocial issues in neurogenic bladder management. The impact of neurogenic bladder and its assessment will be discussed. There are a wide range of treatment options available to manage neurogenic bladder dysfunction and this article offers an overview of key management techniques, including non-invasive techniques, self-intermittent and suprapubic catheters, medication and surgical management. The importance of the nursing role in assessment, teaching and supporting patients by enabling them to make informed choices about their bladder management is addressed.     

Core temperature measurement in the intensive care unit

OBJECTIVE: To compare three devices that measure core body temperature at the bedside in ICU patients. DESIGN: Prospective, consecutive sample. SETTING: Voluntary community teaching hospital. PATIENTS: Fifteen patients, 78 +/- 6 (SD) yrs of age, admitted to the medical ICU over a 5-month period who had pulmonary artery catheters inserted as part of their routine care were studied. Thirteen patients were studied once, one patient twice, and one patient six times for a total of 21 sets of measurements. INTERVENTIONS: All patients had urinary bladder thermistor catheters inserted just before pulmonary artery catheterization. Simultaneous core temperatures were measured for the duration of pulmonary artery catheterization every 4 hrs by the pulmonary artery thermistor catheter, the bladder thermistor catheter, and by a tympanic membrane infrared probe set on its core temperature setting. The three devices were then compared with each other in vitro using a specialized constant water bath setup. Finally, two of the tympanic membrane infrared probes were compared with each other in 20 ambulatory emergency department patients. MEASUREMENTS AND MAIN RESULTS: Over 32 hrs of pulmonary artery catheterization, the pulmonary artery thermistor catheters and bladder thermistor catheters showed excellent agreement, with a bias of only -0.04 degrees C between the two. However, the bias comparing the tympanic membrane infrared probe with the pulmonary artery thermistor catheter was -0.38 degrees C, and the bias was -0.34 degrees C comparing the tympanic membrane infrared probe with the bladder thermistor catheter. The tympanic membrane infrared probe readings remained significantly higher than the pulmonary artery thermistor catheter or bladder thermistor catheter readings over the entire 32-hr period. The two tympanic membrane infrared probes compared with each other in emergency room patients showed excellent agreement (p less than .001). In the in vivo water bath setup, the tympanic membrane infrared probe on most of its settings again registered significantly (p less than .01) higher than both the pulmonary artery thermistor catheter and the bladder thermistor catheter. CONCLUSIONS: Pulmonary artery thermistor catheters and bladder thermistor catheters appear to give consistent, highly reliable bedside measurements of core body temperature in ICU patients. The currently available device that measures core body temperature from the tympanic membrane appears to give erroneously high readings, and should be used with caution.     

Using bladder instillations to manage indwelling catheters

Indwelling urinary catheters are commonly used in both acute and primary care settings but patients often experience problems with blockage of the catheter as a result of encrustation. Bladder instillations of differing solutions are used in an attempt to prevent and treat this problem of encrustation. This article looks at some of the issues surrounding the use and methods of these solutions. Based on an audit performed by a group of continence clinical nurse specialists in five areas of the UK, results of a questionnaire sent to acute and primary care nursing staff in 2003 are presented and discussed. The questionnaire covered a variety of clinical issues involved in performing bladder instillations and the results show that there is a wide variation of practice across the UK. The authors conclude that there are issues pertaining to bladder instillations which warrant further work.     

Intermittent self-catheterisation and the female patient

The use of intermittent self-catheterisation (ISC) in the treatment of bladder disorders has increased in recent years. Manufacturers have also been developing a range of new catheters to make the procedure safer, easier and more comfortable for the patient. Patients may be taught intermittent self-catheterisation in the hospital, clinic or home setting. The amount of follow up and support given varies widely. Recent government policies aim to empower the patient to make decisions about their care (DoH 2000a, DoH 2001a). This article examines the factors that affect female patients whose bladder dysfunction is managed by ISC.     

Effectiveness of the portable ultrasound bladder scanner in the measurement of residual urine volume after total mesorectal extirpation

The measurement of residual urine volume by bladder catheterization causes quite some suffering to the patient and sometimes causes urinary tract infections. To evaluate the postoperative measurement of residual urine volume with a portable ultrasound bladder scanner (Bladder Scan BVI 3000) and the cost-benefit analysis as compared with postoperative catheterization we carried out a study on 30 patients with primary rectal cancer. The data were then compared with actual urine volumes. This was a prospective study dealing with the economical benefit of ultrasound scanning over catheterization during the hospital stay. The ultrasound bladder scanner was found to be a reliable method of estimating residual urine volume since its data correlated with actual volumes with a coefficient of 0.9. The results satisfied both physicians and patients. Ultrasound scanning of the bladder to measure residual urine volume reduced the frequency of catheterization by 38% as compared with the patients on intermittent catheterization, with 17.4 catheters saved for each patient. In conclusion, the ultrasound bladder scanner could protect patients from the discomfort and urethral injury which might have been caused by bladder catheters, thus decreasing medical expenses. This technique will play an important role in determining whether to conduct invasive urethral catheterization for postoperative urinary disturbance in rectal cancer.     

Efficacy of Combined Oral‐Intravesical Oxybutynin Hydrochloride Treatment for Patients with Overactive Detrusors and Indwelling Urethral Catheters

The purpose of this article is to investigate the efficacy of intravesical oxybutynin hydrochloride (OH) to treat patients with overactive detrusors who are unresponsive to oral anticholinergic therapy alone. Twenty‐five patients who were treated with oral OH for overactive detrusor (but who did not respond to treatment and were using indwelling urethral catheters) were given intravesical OH without changing oral treatment. Pre‐ and posttreatment bladder capacities were compared in urodynamic studies. The study showed that positive clinical results can be achieved with combined oral and intravesical OH treatments in patients with overactive detrusors who had indwelling urethral catheters because of severely reduced bladder capacity. However, a significant number of patients discontinued this treatment because of infection and difficulty in performing the procedure. Clinicians and rehabilitation nurses should provide education and support to eliminate these problems. In addition, the development of single‐use standard sterile OH preparations for intravesical applications may increase the efficacy of the method.     

An audit of problems associated with urinary catheter withdrawal

Long-term catheterisation is associated with many complications, including urinary tract infections which may lead to encrustation and catheter blockage. Current management of catheters susceptible to frequent blocking is to attempt to prolong catheter life by using bladder maintenance solutions or to change catheters proactively by identifying a characteristic blocking pattern for the patient. However, catheter removal is associated with a number of problems. This article describes an audit conducted in one trust to identify the types of catheter material associated with removal difficulties. All-silicone catheters appeared to have a higher incidence of reported problems. The formation of a 'cuff' in all-silicone catheters when the catheter balloon fails to deflate to its original shape has been investigated as an important factor in difficult removal. The audit also examined what action was taken when nurses were unable to remove a catheter.