Clinical skills: how to remove and change a suprapubic cathether

Suprapubic catheterization is becoming more widely used to drain the urinary bladder either short or long term or is inserted where initial urethral or recatheterization is problematic. No matter where you work as a nurse, either in the hospital, community, hospice or nursing care home, sooner or later you will have to deal with a patient with a suprapubic catheter in situ. One of the concerns nurses encounter when changing the suprapubic catheter is what action to take when the catheter appears to have become stuck when removing it. The main cause of this problem is owing to a 'cuffing' effect occurring to the deflated catheter balloon, especially if using 100% silicone catheters. This article looks at the problem of removing a suprapubic catheter that has become stuck and how to change such catheters safely.     

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.     

Long-term catheter management: minimizing the problem of premature replacement due to balloon deflation

Balloon deflation in long-term indwelling urinary catheters has been reported, and can necessitate a premature replacement of the catheter. This problem is studied in catheters of various materials and their performance in this respect compared. The catheters are also compared in terms of any change in effective shaft diameter. The results show that 100% silicone catheters perform significantly less well than silicone-coated latex ones on both parameters. The implications of these findings are discussed, and recommendations are made with regard to the selection of catheters for long-term use.     

Suprapubic catheterization: challenges in changing catheters

Suprapubic catheterization of the bladder is used as a short- or long-term alternative to urethral catheterization. As with any indwelling urinary catheter, correct insertion, care and removal are vitally important to minimize problems. A particular problem that affects suprapubic catheters is 'cuffing', which on its own or combined with encrustation can potentially cause a great deal of difficulty on removal or discomfort for the patient. This article discusses the causes of cuffing, and suggests using catheters with integral balloons to reduce the incidence of the problem.     

Surveying patients about their experience with a urinary catheter

About 15–20% of hospital inpatients are catheterized, and it has been estimated that in an average sized hospital 10–15 patients will die each year from catheter‐related sepsis. Reducing catheterization rates or indwell times has been shown to reduce associated sepsis. This study examined patient experience of catheterization; the rationale for the study was to broaden understanding of catheter impact as part of a wider quality improvement agenda. Fifty patients completed a detailed catheter‐experience patient questionnaire. The patients were all inpatients from 17 wards across a range of specialties. Data were sought on demographics, catheter status, experience and their knowledge of and involvement in the catheter care. Fifty percent gender split. Median catheter time was 5 d (range 2 h to long term). Median age 72 years (range 22–92). Thirty‐four percent (n = 17) of patients did not have the process and options discussed before catheterization. Eighteen percent did not know why they were catheterized. Patients experienced leaking (32%), ‘pain’ (26%), inconvenience (26%), embarrassment (24%), blocking (24%) with 8% finding their catheters ‘restrictive’. Fourteen percent felt they could have coped without the catheter. Urinary catheters have a profound and often negative effect on the inpatient experience. This information can help support and empower colleagues to push for less urinary catheter use in the non‐urological inpatient population and start to better understand the patient experience.     

Effect of triclosan on the development of bacterial biofilms by urinary tract pathogens on urinary catheters

OBJECTIVES: To examine (i) the effect of triclosan on the formation of catheter biofilms by urinary tract pathogens and (ii) the diffusion of triclosan through the retention balloons of urinary catheters. METHODS: Models of the catheterized bladder were infected with eight different urinary tract pathogens and the effect of triclosan on biofilm formation was assessed by determining the numbers of viable cells colonizing the catheters and by scanning electron microscopy. HPLC was used to determine the triclosan concentration in urine draining from models that had been fitted with triclosan-inflated silicone catheters. RESULTS: When catheters were inflated with triclosan (10 g/L) the formation of catheter biofilm by Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and Proteus mirabilis was prevented. The numbers of Enterococcus faecalis and Providencia stuartii cells colonizing catheters were also significantly reduced (P<0.05). Serratia marcescens, Morganella morganii and Pseudomonas aeruginosa, however, were able to produce extensive catheter biofilms in the presence of triclosan. Only P. mirabilis produced alkaline urine and encrusted the catheters. Concentrations of 0.02-0.16 mg/L of the biocide were detected in urine draining from the model over the 48 h experimental period. CONCLUSIONS: Triclosan diffused through silicone catheter balloons and produced urinary concentrations that prevented catheter encrustation by P. mirabilis and biofilm formation by several other common pathogens of the catheterized urinary tract. It had little effect on urease-producing P. aeruginosa, S. marcescens or M. morganii but these species did not produce alkaline urine or crystalline biofilms.     

国内长期留置导尿管患者硅胶导尿管更换时间的Meta分析

目的探讨长期留置导尿管患者更换硅胶导尿管的最佳时间。方法检索国内相关文献,采用Cochrane系统评价方法对符合纳入、排除标准的随机对照试验进行Meta分析。研究对象为已发表的有关长期留置导尿管患者硅胶导尿管更换时间研究的临床对照试验,观察指标为留置导尿管患者硅胶导尿管不同更换频率(每2周更换、每3周更换及每4周更换1次)下的泌尿系感染率。干预有效性的效应量采用相对危险度(relative risk,RR)。结果共检索到11篇合格文献。Meta分析结果提示:长期留置导尿管患者硅胶导尿管每2周更换1次与每4周更换1次、每3周更换1次与每4周更换1次发生泌尿系感染的RR值分别为0.51[95%CI(0.40,0.66),P0.001]、0.79[95%CI(0.58,1.08),P=0.14],每2周更换1次者泌尿系感染率明显高于每4周更换1次者,但每3周更换1次者与每4周更换1次者泌尿系感染率没有差异。结论结合硅胶导尿管的材料性质及其观察指标,根据临床最优原则,得出硅胶导尿管每4周更换1次为宜。     

An investigation of the effectiveness against bacteriuria of silver-coated catheters in short-term urinary catheter applications: A randomized controlled study

AimThe aim of this study was to investigate the effectiveness of antimicrobial-coated catheters against bacteriuria and urinary tract infection in patients who have urinary catheterization.MethodsTwenty eight and twenty six people similar in terms of demographic characteristics and primary and underlying diseases were randomly selected from patients undergoing short-time urinary catheterization in the intensive care unit. Silver-coated slicone foley catheters and normal slicone foley catheters were used for uninary catheterization in the first and second group of the patients respectively. Urine specimens were collected from patients at 2-day intervals and assessed in terms of bacteriuria.ResultsBacteriuria was found in 12 (46.2%) of the patients using normal catheters and 13 (46.4%) of those using silver-coated catheters throughout the monitoring period. No significant relationship was determined between use of different catheter types and bacteriuria (p = 0.98). The most common microorganism was identified as E. coli in the normal catheter group while microorganism other than E. coli was identified in the silver-coated catheter group. The prevalence of bacteriuria was statistically significantly higher in patients with a history of hospitalization in the previous 3 months (p = 0.028).ConclusionThe use of silver-coated silicone catheters was not shown to have a protective effect against bacteriuria in this study. Further well-designed studies with larger case numbers are now needed to confirm whether history of hospitalization, which emerged as a statistically significant factor in this study, increases the prevalence of catheter-related bacteriuria.     

表皮葡萄球菌生物膜在三种导尿材料上形成的对比

目的了解不同材料导尿管对表皮葡萄球菌生长繁殖的影响,指导临床合理选择、使用导尿管。方法选取纯硅胶、乳胶、硅橡胶三种不同材质的导尿管,培养表皮葡萄球菌生物膜,用菌落计数仪计数生物膜内实际菌落数,取其常用对数换算为标准菌落数,对比不同材料导尿管对生物膜生长的影响。结果纯硅胶组实际菌落数（6.32±1.07）×106CFU/cm3、标准菌落数（6.80±0.08）IgCFU/cm3为最少,乳胶组实际菌落数（1.98±0.31）×107CFU/cm3、标准菌落数（7.29±0.07）IgCFU/cm3为最多,硅橡胶组实际菌落数为（1.35±0.14）×107CFU/cm3、标准菌落数（7.16±0.08）IgCFU/cm3,乳胶组、硅橡胶组二者分别高于纯硅胶组（P〈0.01,P〈0.05）。结论不同材质导尿管与生物膜内细菌数量具有相关性,纯硅胶导尿管表面生物膜细菌数量最少,建议临床长期留置导尿管的患者选择纯硅胶导尿管。     

颈内静脉隧道式涤纶套导管原位置换临时导管术的回顾性分析

目的 探讨右侧颈内静脉隧道式涤纶套导管原位置换临时导管的效果和并发症。方法 选取2012．1～2012．12在武汉同济医院肾内科接受隧道式带涤纶套颈内静脉置管术的患者，对比行原位置换术和标准术式2组在手术并发症、血流量和透析充分性间的差别。结果 总手术62例次，原位置换术30例次，技术成功率100％，最大血流量366．9±37．2ml／min，尿素氮下降率67．2％±7．1％，Kt／V值1．45±0．12：标准术式32例次，技术成功率100％，最大血流量367．6±40．3ml／min，尿素氮下降率65．5％±8．5％，Kt／V值为1．46±0．13。2组并发症对比无统计学意义（χ^2=1.940，P=0．160）。结论 在严格把握手术适应证的基础上，隧道式带涤纶套导管原位置换临时导管的方法 是一种安全、简便、有效的方法 。     

Encrustations of the urinary catheter and prevention strategies: an observational study

Patients with an indwelling urinary catheter are at risk of developing urinary tract infection: for each day of the catheter remaining in situ, there is an increasing risk from 3% to 7% for infection to appear. One of the main complications of catheterization is the onset of encrustations, frequently resulting in obstruction of the catheter. To investigate the prevalence of encrusted indwelling urinary catheters in outpatients referred to the Department of Urology. An observational study was carried out on outpatients referred to the Department of Urology in need of removal or replacement of indwelling urinary catheters. A table was completed to collect the data of each patient in order to investigate the presence of any possible encrustation. The collected data concerned 85 patients, 81 male (95·3%) and 4 female (4·7%). Patients had different pathologies and different types of catheter, with different sizes and different materials. The number of indwelling urinary catheters that during removal/replacement were visibly encrusted in the eyehole area totaled eight (9·4%). The analysis of the collected data suggests that the permanence of the catheter could potentially be one of the most relevant causes of encrustation; five out of eight patients with encrusted urethral catheter had it in place for 1 month, three of them for 2 weeks. There are many prevention strategies, among which promotion of nucleation pH (pHn) supplementation in the daily diet with liquids containing citrate is the most simple and suitable for all patients being inexpensive and effective.     

A prospective safety study of femoral vein versus nonfemoral vein catheterization in patients with burns.

A prospective study was undertaken to determine the safety of femoral vein catheterization in patients with burns. Forty-two patients had a total of 275 catheterizations and were divided into two groups: group 1, femoral vein catheterization = 80 catheters and group 2, nonfemoral vein catheterization = 195 catheters (180 subclavian, 8 internal jugular, and 7 supraclavicular). All catheters were changed to new sites every 48 hours, and dressings were changed every 24 hours. Bacteriologic surveillance was accomplished by submitting the tip and subcutaneous segment of the catheter for semiquantitative cultures. Skin exit-site cultures were obtained, and blood was drawn through the catheters for fungal-isolator cultures before removal. Catheter colonization was defined as greater than or equal to 5 colony-forming units on either the subcutaneous segment or the catheter tip. Catheter-related sepsis was diagnosed when the same organism was recovered from the fungal isolator bottle and either part of the catheter and when there was no other identifiable source of sepsis. The rate of occurrence of colonized catheters was 7.5% (6 of 80) in the femoral vein catheterization group and 13.8% (27 of 195) in the nonfemoral vein catheterization group. Catheter-related sepsis occurred in 2.5% (2 of 80) of femoral and 1% (2 of 195) of nonfemoral catheters. None of these differences are statistically significant. There were no noninfectious complications from femoral vein catheterization. Two subclavian catheters had to be repositioned. This study suggests that central venous access in patients with burns can be safely employed with the use of the femoral vein.     

两种导管在外周中心静脉置管中的应用

目的探讨两种导管在外周中心静脉置管中应用的效果。方法选取肿瘤患者65例,按单双日随机分成中心静脉导管组(35例)和PICC导管组(30例),观察两种导管置管的应用情况。结果两种导管置管在操作时间、操作中渗血量、一次置管成功率等方面的比较具有统计学意义(P<0.05),并发症的发生及平均置管天数无统计学意义(P>0.05)。结论中心静脉导管组置管可用于肿瘤手术患者较长时间的补液和术后常规化疗的患者,而对于非手术、需长时间化疗、需大剂量使用刺激性强的化疗药物的患者,则应选用PICC导管置管。     

Avoiding the pitfalls and perils of catheter care

Twelve per cent of hospital inpatients and 4% of community patients have an indwelling urinary catheter. Urinary catheterization increases morbidity threefold. The main hazards of catheterization are tissue damage, bladder damage, infection, encrustation and blockage. Obtaining informed consent before catheterization is extremely important. Restricting catheterization to those who clinically require this invasive procedure can reduce the number of people who are exposed to the hazards of catheterization. The use of silver-coated catheters can reduce the risk of infection and encrustation. Ensuring that practice is evidence-based further reduces the risks of catheterization.     

血管超声检查联合反送导丝检查法在中心静脉置管中的应用

目的 探讨血管超声联合反送导丝检查法在中心静脉置管过程中的作用。方法 实验组628例在采取常规方法置入中心静脉导管的基础上加用血管超声检查联合反送导丝检查法,通过血管超声检查颈内静脉、锁骨下静脉、腋静脉内有无导管影或导管影是否正常,以及检查退出导丝能否顺利反送到预定刻度,来判断导管有无异位和打折;对照组555例只采取常规方法置管,最终通过X线检查有无导管异位和导管打折。结果 实验组发生导管异位5例,异位率0.8%。对照组发生导管异位33例,异位率5.9%。两组患者置管导管异位率进行统计学分析,差异有显著意义（P〈0.01）。结论 血管超声检查联合反送导丝检查法对中心静脉导管异位和导管打折,能早期发现,及时调整,从而起到较好的预防作用。     

Deflation of a Foley catheter balloon

AIM: To investigate the changes in urethral and suprapubic catheter balloons following deflation and removal. METHODS: Observations were made on a selection of catheter materials, using three different deflation methods. Measurements were recorded before inflation and following deflation of catheter balloons. RESULTS: The analysis identified that before inflation all catheter balloons were 1-2 mm wider than the Charrière size. Following balloon inflation, five balloons were unchanged in appearance, four were slightly misshapen and the Coude balloon inflated at the side of the catheter shaft. CONCLUSION: The study has shown that manual syringe aspiration results in the formation of creases and ridges, and an increase in catheter balloon diameter size on deflation. Self-syringe aspiration should not be used when deflating catheter balloons. It does not, however, cause the balloon membrane to collapse or become deformed.     

Catheter-related sepsis: prospective, randomized study of three methods of long-term catheter maintenance

We studied the infectious risk of different methods of managing vascular catheters during long-term use. Consecutive surgical ICU patients requiring triple lumen catheters, pulmonary artery catheters, or arterial catheters for greater than 7 days were prospectively randomized to one of three management groups: a) percutaneous (PERC) puncture with every 7-day catheter change at a new site, b) no weekly change (NWC) with a new site when changed, or c) guidewire exchange (GWX) with every 7-day catheter change at the same site. In all groups, a catheter change was mandatory for a positive blood culture, skin site infection, or sepsis without a likely source. Cultures were obtained when clinically indicated and at the time of every catheter change. Catheter-related sepsis (CRS) was defined as a positive blood culture and catheter culture with the same organism. A total of 112 patients met evaluation criteria. There were no intergroup differences in age, primary diagnosis, severity of injury or illness, number of study days, number of protocol violations, route of catheterization, number of catheters present/patient day, catheter sepsis rate, or bacteremia rate. The NWC group demonstrated an increased number of days/catheter, fewer catheter/subcutaneous tract segment cultures/patient, and a reduced incidence of catheter tip colonization. These results occurred in a setting where the number of CRS episodes/patient was 0.17 for GWX, 0.22 for PERC, and 0.16 for NWC. We conclude that there is no difference in infectious risk between these three methods of long-term catheter management. The method with the least complications and expense should be used.(ABSTRACT TRUNCATED AT 250 WORDS)     

Suprapubic bladder drainage versus a transurethral catheter in patients following anterior colporrhaphy

Gynaecological operations for urinary stress incontinence necessitate long-term drainage of the bladder. In this retrospective study 100 patients receiving a conventional indwelling urethral catheter system were compared with 90 patients receiving a transabdominal suprapubic catheter for postoperative bladder drainage. The transurethral catheter was removed 5 days after the operation while the suprapubic catheter was left in place until no residual urine was detected. Patients with suprapubic bladder drainage showed no residual urine two days earlier (8.8 +/- 4.3 versus 10.9 +/- 5.0 days), left the hospital two days earlier (12.3 +/- 3.9 versus 13.9 +/- 4.4 days), and had a lower incidence of urinary tract infections (17% versus 30%) than patients with urethral catheters. In five cases suprapubic catheters had to be removed prematurely because of complications such as pain, persistent haematuria or obstruction of the catheter. Rates of haematuria were similar in both groups. Catheter-related pain was less frequent with suprapubic drainage. The acceptance of the suprapubic system by patients and nursing staff was good, particularly since measurement of the residual urine did not necessitate repeated urethral catheterization. The additional time required for placing the suprapubic catheter postoperatively is by far outweighed by the advantages of this system, such as shorter hospitalization and a lower incidence of urinary tract infections.     

Why catheterize?: audit findings on the use of urinary catheters

Urinary catheters can be associated with complications such as urinary tract infection, pain and discomfort. This article reports on an audit of 51 patients who had a urinary catheter inserted during their hospital stay. Urinary incontinence meant catheterization in 37.5% (n = 27) of cases, with 64.7% (n = 33) being catheterized by nurses. The study highlighted the need for accurate documentation and care planning; 15 patients did not have a plan of care for their catheter and only eight patients had a plan for the removal of the catheter. Catheterization is the most common cause of hospital-acquired infection, and therefore the use of catheters needs careful examination to reduce this type of infection. The question is raised whether catheterization is used as a convenience for nursing staff or as an essential aspect of care.