Managing difficult catheterisation in nurse‐led catheterisation services: Does guidewire‐assisted urethral catheterisation make a difference?

The use of guidewires is well established in medical practice, but relatively new in nurse‐led catheterisation services (NCS). We investigate the incidence of difficult urethral catheterisation and whether guidewire‐assisted catheterisation reduces disrupted patient care. A retrospective Audit (September 2016‐August 2017) recorded incidence and management of difficult catheterisation in two NCS. In NCS‐A, nurses were familiar with improvised guidewire‐assisted catheterisation, whereas in NCS‐B nurses were not enabled and had to refer patients to urologists when they encountered problems. From September 2017 to August 2018, a National Institute for Health and Care Excellence (NICE)‐approved urethral catheterisation device with integrated guidewire (Urethrotech UCD) was used in NCS‐B for difficult urethral catheterisation. User and patient satisfaction was evaluated prospectively. Of 540 men attending NCS‐A for trial without catheter (TWOC), 31% (169/540) were recatheterized, of whom 4%(6/169) required a guidewire‐catheterisation technique to manage difficult catheterisation without problems. This was also done in 45 of 146 men attending for long‐term catheter change with known history of difficult catheter change. Of 1002 men attending NCS‐B for TWOC, 23% (226/1002) were recatheterized. This was difficult in 25% (57/226), of which 40% (23/57) suffered complications with bleeding from repeated catheterisation attempts and 10 men had to be admitted for specialist interventions to manage retention and catheterisation‐associated urethral injury. During the prospective audit, 945 men attended the TWOC‐clinic of NCS‐B. In 11% (13/120), the UCD was used for failed Foley‐catheterisation without complications. Patients and users were very satisfied because the difficult recatheterisation episode was managed successfully without patient harm and care delay. Difficult urethral catheterisation is a frequent occurrence in NCS with significant risk of urethral trauma. Catheterisation‐associated urethral injury can be prevented with guidewire‐assisted urethral catheterisation techniques. The NICE‐approved UCD with integrated guidewire was easy to use with high user and patient satisfaction avoiding patient care delay and is supporting nurses to manage difficult urethral catheterisation safely making efficient use of specialist resources.     

Long-term urethral catheterisation

This article discusses long-term urethral catheterisation, focusing on the relevant anatomy and physiology, indications for the procedure, catheter selection and catheter care. It is important that nurses have a good working knowledge of long-term catheterisation as the need for this intervention will increase with the rise in chronic health conditions and the ageing population.     

Urethral catheter audit

An audit was undertaken in one children's hospital to evaluate practice relating to indwelling urethral catheterisation of children. The records of 47 patients admitted over an eight-month period were reviewed to obtain information regarding catheter use. A questionnaire was sent to 384 qualified nursing staff and 174 medical staff to identify what training they had received and their level of knowledge about catheterisation practice. In the absence of national guidelines for urethral catheter care, locally developed standards were used for comparison in the audit. Timing and location of catheter insertion were noted. Duration of catheterisation ranged from one to 38 days but in 13 per cent of cases it was not possible to identify duration because of lack of documentation. Both nursing and medical staff reported low levels of training and areas of limited understanding of practice. A majority of nursing staff had never catheterised a child or did so less than once a year. Novel approaches to education are required to maintain knowledge and skills in this area of practice. Documentation needs to improve and include the use of computerised care plans and catheter care pathways.     

Documented adherence to standards and guidelines: an audit

The authors conducted a cross-sectional audit within Newcastle-upon-Tyne Hospitals NHS Foundation Trust to determine the prevalence of urethral catheterisation and documented adherence to relevant NHS standards. An on-line audit questionnaire was completed for all 80 inpatient wards within the Trust on a single day during the third week in June 2009. The tool collected data on prevalence and care requirements detailed in the Department of Health's (DH) Saving Lives High Impact Intervention 6 (2007). Data were analysed using Snap survey software. Overall, 172 of 1187 (14.5%) inpatients were catheterized and all were using a closed drainage system or catheter valve. Evidence of correct continuing catheter care was documented for 168 (98%) patients, while details of catheter insertion were identified in 153 (89%) patient records. Eight (4.5%) patients were being treated for a urinary tract infection. The authors found satisfactory adherence to basic documentation standards with regard to catheter care. This was associated with a low prevalence rate of catheterization and catheter-associated urinary infection within the Trust relative to previously published figures. Details of catheter insertion were missing from 10% of patient records, requiring further development of accessible and transferable documentation tools. Provision of relevant information to patients is also a target for development.     

Female catheterisation: what nurses need to know!

Urinary catheter insertion is a common procedure used in the management of hospitalised and community based patients. Nurses need to be aware of the associated complications of catheterisation in order to practice safely and minimise the risks to the patient. This article is a practical guide for nurses who will be involved in female catheterisation, from decision to catheterise, choosing the type and size of catheter, and tips on catheter care and how to avoid the most common problems associated with catheterisation.     

Australian registered nurse medical device education: a comparison of simple vs. complex devices

As the primary users of medical devices in direct patient care, registered nurses must be competent both with simple and complex devices because any device improperly used can have serious consequences Results of a cross-sectional survey of registered nurses ( n = 238) working at a large South Australian tertiary care centre on units with high usage both of indwelling urethral (Foley) catheters and intravenous infusion pumps revealed that participants were significantly more likely to have learned to use the indwelling urethral (Foley) catheter in nursing school than they were to have learned how to use an intravenous infusion pump Participants differed significantly on most (13 of 17) items about what they learned, with nurses being more likely to learn various factors about the indwelling urethral catheter than the infusion pump Registered nurses were more likely to feel stressed when using an intravenous infusion pump than when using an indwelling urethral catheter, but were more likely to have used an indwelling urethral catheter that caused a patient harm than an intravenous infusion pump that caused a patient harm The most frequently identified reasons for incidents of patient harm resulting from use of an intravenous infusion pump were user error and inadequate device education The most frequently identified reasons for incidents of patient harm resulting from use of an indwelling urethral catheter were the patient's condition, particularly confusion, user error, equipment malfunction, and inadequate device education     

Female urethral catheterisation

This article examines the procedure of female urinary catheterisation. The importance of holistic patient assessment is emphasised, and patient consent, catheter selection and patient education are discussed.     

留置尿管时机对全麻苏醒期不良反应的影响

目的探讨全麻手术患者术中留置导尿管的最佳时机,减轻术前患者插尿管的痛苦,减少不良反应的发生,保证医疗护理的安全。方法选择我科2014年6月-2015年10月150例全麻手术术前需导尿的成年患者,按数字表法随机分为A、B、C组,A组患者术前在病房导尿并留置尿管,B组患者在全麻插管后导尿并留置尿管;C组患者在麻醉诱导期为患者进行导尿并留置尿管。比较三组患者导尿前及导尿时的生命体征、全麻复苏期躁动、舒适度的情况及麻醉复苏时间。结果通过分组研究,C组即麻醉诱导期留置导尿管患者在全麻复苏期躁动最少,尿道刺激症状少,舒适度增加,患者的满意度提高。结论麻醉诱导期留置导尿管,既可减少全麻苏醒期躁动的发生,又增加了患者的舒适感,提高患者的满意度。     

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.     

Indwelling catheters: developing an integrated care pathway package

Urinary catheterisation is a common nursing procedure in hospital and in the community, yet there are risks associated with it. Complications include urethral trauma, urinary tract infection, strictures, urethral perforation, encrustation, bladder calculi and neoplastic changes (Lowthian, 1998). The procedure is also linked to nosocomial infection and, in some cases, these catheter-related infections can prove fatal (Pratt et al, 2001). Due to the risks, catheterisation is indicated as a last resort after all other interventions have failed.     

术前留置导尿的时机选择

目的探讨手术患者术前留置导尿时机的选择。方法选择我院普通外科择期手术患者60例,随机分成两组,对照组在手术麻醉前导尿,观察组在手术室麻醉成功后导尿,分别记录两组患者导尿前、导尿中的血压、心率及一次导尿成功率。结果对照组患者留置导尿时,心率加快,血压增高,导尿前、导尿时的心率、血压比较差异有统计学意义(P<0.01)。观察组导尿前、导尿时的心率、血压比较差异无统计学意义。观察组一次导尿成功率(96.7%)高于对照组(86.7%)(P<0.01)。结论在麻醉成功后是手术患者导尿最佳时机。手术患者麻醉后留置导尿较麻醉前生理反应小,提高一次导尿成功率。     

成年女性手术患者应用小儿气囊尿管留置导尿效果的观察

目的减轻成年女性手术患者留置尿管后的不适感。方法将200例成年女性择期手术患者按手术日期单双日随机分成对照组和观察组各100例。对照组使用成人气囊尿管留置导尿，观察组使用小儿气囊尿管留置导尿，观察2组患者留置尿管后产生不适感的程度及留置尿管后有无尿管自行脱出及管周漏尿情况。结果观察组患者留置导尿管后的尿道刺激反应程度明显低于对照组（P〈0．01）；2组患者留置尿管后均无尿管自行脱出及管周漏尿现象。结论成年女性手术患者应用小儿气囊尿管留置导尿能明显减轻置管后的不适，且不会增加管周漏尿及尿管脱出现象。     

3种不同型号的留置尿管对妇科患者舒适度的影响

目的减轻妇科患者留置导尿管的不适感。方法将180例需留置尿管的妇科患者随机分为3组，分别为14Fr气囊导尿管组（60例），8Fr气囊导尿管组（60例），10Fr气囊导尿管组（60例），比较3组患者留置尿管的舒适度及尿管阻塞情况。结果采用10Fr气囊导尿管组患者留置导尿管后的尿路不适感明显减少，优于采用14Fr气囊导尿管组患者，差异有统计学意义（P〈0．01），且不会引起尿管阻塞。结论妇科患者采用10Fr气囊导尿管能减轻不适感，对尿道刺激小，且不会引起尿管阻塞。提倡在女性患者留置导尿中推广应用10Fr气囊导尿管。     

Care with an indwelling urinary catheter. Tips for avoiding problems in independent and institutionalized patients.

Ideally, no patient would have an indwelling urethral catheter. However, certain circumstances require long-term catheterization. In these patients, bacterial colonization is to be expected. Morbidity and mortality related to long-term catheterization can be minimized by attention to the details of catheter care, prompt treatment of often minimally symptomatic catheter-related infections, and attentiveness to changes in patient condition or alternative treatments that may permit catheter removal.     

Urinary catheter use in end of life care

Patients nearing the end of life can become agitated by a full bladder and may need urgent urinary catheterisation. However, urethral catheterisation needs authorisation by a doctor. Nurses at a London trust developed a urinary catheterisation consent form permitting nurses to perform this procedure when it becomes necessary without having to gain medical authorisation. This article discusses how the consent form can help improve bladder management, ensuring terminally ill patients do not have to attend the emergency department to be catheterised.     

手术病人留置导尿管时机及舒适度研究进展

阐述了手术病人留置导尿管的时机、麻醉后留置导尿管对病人的影响以及留置导尿管的时机与舒适度的关系。     

医院信息系统对缩短导尿管留置时间的研究

目的探索医院信息系统对缩短尿管留置时间的有效性。方法选取2016年4-6月留置尿管的111名患者为观察组,实施电子系统提醒,并制定拔除导尿管指征评估表,每日评估留置导尿管的必要性,不必要时及早拔除;将2015年1-3月留置尿管的116名患者为对照组,被动执行医嘱拔除导尿管。比较两组患者留置导尿管的时间及重置尿管例数。结果所有观察组患者留置尿管总计230d,平均留置尿管2.09d,对照组留置尿管总计407d,平均留置尿管3.47d,差异有统计学意义(P0.05)。对照组有2例患者在拔除尿管后重置导尿管,观察组无重置导尿管患者。结论电子系统提醒,护士主导的每日评估留置尿管的必要性,及时拔除不必要的留置尿管,能有效缩短患者留置尿管的时间,对减少导尿管相关性感染有临床指导意义。     

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.     

留置导尿致尿路感染的原因分析及对策

目的研究留置导尿中预防和控制尿路感染的护理对策。方法预防尿路感染的最好办法就是严格掌握导尿指征,向患者说明导尿的目的及配合要领。留置导尿后,严格执行无菌技术进行尿管护理,尽量缩短留置导尿时间并合理使用抗生素,此外,对患者及家属也要进行预见性护理,使其了解必要的留置尿管知识。结果严格掌握导尿指征及无菌操作原则,可使尿路感染的机会降低到最低限度。结论高度的责任心与行之有效的护理措施及耐心的心理指导,能明显降低尿路感染的发生机会,从而减轻患者的痛苦。     

留置气囊导尿管意外发生的原因与处理

对留置气囊导尿管意外发生的原因及处理方法进行探讨与分析。55例病中因暴力拔管致尿道损伤及膀胱异物存留19例；导尿管拔出困难19例；导尿管插入部位不当致尿道损伤17例。根据不同的意外发生采取相应的对策处理。认为重视导尿术的正规操作培训及护理是预防导尿管意外发生的主要措施。