Urinary catheter care - Skills and Asepsis


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Urinary catheter care - Skills and Asepsis

  1. 1. Urinary Catheter CareSkills & AsepsisDr.T.V.Rao MDRao,s Infection care on FACEBOOK 120-05-2013
  2. 2. Urinary CatheterDr. Frederick Foley• Developed in the 1920sby Dr. Frederick Foley• The urinary catheter wasoriginally an open systemwith the urethral tubedraining into an opencontainer.• In the 1950s, a closedsystem was developed inwhich the urine flowedthrough a catheter into aclosed bag.220-05-2013 Rao,s Infection care on FACEBOOK
  3. 3. What is a Foleys catheterRao,s Infection care on FACEBOOK 320-05-2013
  4. 4. What is a urinary catheter• Urinary catheteris any tubeplaced in thebody to drainand collecturine from thebladderRao,s Infection care on FACEBOOK 420-05-2013
  5. 5. Catheter typeRao,s Infection care on FACEBOOK 520-05-2013
  6. 6. Structure of Foley CatheterRao,s Infection care on FACEBOOK 620-05-2013
  7. 7. Urinary Catheter Utilization• About 15-25% of patientsduring their hospitalizationwill have an urinarycatheter placed• Many are placed either inthe intensive care orEmergency Department• 40% - 50% of these patientsdo not have a validindication for urinarycatheter placement720-05-2013 Rao,s Infection care on FACEBOOK
  8. 8. Purpose of CatheterizationCatheterization is carried out for a number ofreasons and can either be a temporary orpermanent solution to a number of problems.Problems include physical disease and damage,psychological issues and a way to help toimprove the quality of life to someone who isbed ridden. Good regular catheter care involvesgood hygiene, observation, monitoring well-being and prevention of problems associatedwith catheterization.Rao,s Infection care on FACEBOOK 820-05-2013
  9. 9. Foley CatheterRao,s Infection care on FACEBOOK 920-05-2013
  10. 10. Documentation• Details regarding thecatheterisationshould be recordedin the patient’snotes. For furtherinformation pleaserefer to yourhospitals policy andprocedure manual.Rao,s Infection care on FACEBOOK 1020-05-2013
  11. 11. Matters to consider forCatheterization• Indication for catheterisation• • Time and date of catheterisation• • Type of catheter• • Amount of water in balloon• • Size of catheter• • Expiry date of product• • Any problems on insertion• • Description of urine, colour and volume drained• • Specimen collected• • Review date• (Marsden Manual 2001)Rao,s Infection care on FACEBOOK 1120-05-2013
  12. 12. What you Need for Catheterization• 1 Dressing trolley• 2. Catheterisation pack• 3. Sterile gloves• 4. Appropriate size catheter• 5. Xylocaine jelly syringe• 6. Sterile water for the balloon• 7. Syringe• 8. Specimen jar• 9. Antiseptic solution• 10. Waterproof Sheet• 11. Extra Jug• 12. Light source• 13. Tape to secure the catheter to the leg• 14. Drainage bag• 15 Urine bag holderRao,s Infection care on FACEBOOK 1220-05-2013
  13. 13. Choose the Right Catheter• Choose the smallestcatheter size thatwill drain adequatelyfor its intended use• Catheters range insize from 5 – 24 Fg.• (Joanna BriggsInstitute 2003)Rao,s Infection care on FACEBOOK 1320-05-2013
  14. 14. Guidelines on Size• Women 12 – 14 Fg• Men 16 – 18Fg• Suprapubic 16 –20Fg• Haematuria 20 -24 Fg• If a haematuria catheter is required a 3 –wayshould be used to allow for the option ofcontinuous bladder irrigation without requiring afurther catheter change. When not in use, theirrigating port should be spigotted.Rao,s Infection care on FACEBOOK 1420-05-2013
  15. 15. Length of Catheters• Catheters are available in 3 lengths: Paediatric,Regular length and Female length.• Female length is a shorter length catheter (20-25cm). A shorter length catheter may be moreconvenient for ambulant women with a longterm catheter. A shorter length catheter is notappropriate for all women particularly thosewho are bedridden or obese.Rao,s Infection care on FACEBOOK 1520-05-2013
  16. 16. Catheters in Obese Women• In obese women, theinflation valve of theshorter catheter maycause soreness byrubbing against theinside of the thighs, andthe catheter is morelikely to pull on thebladder neck (Britton &Wright 1990; Pomfret 1996)Rao,s Infection care on FACEBOOK 1620-05-2013
  17. 17. Catheterization is a skill in Medicine• The ability to insert aurinary catheter is anessential skill inmedicine.• Catheters are sized inunits called French,where one Frenchequals 1/3 of 1 mm.Catheters vary from 12(small) FR to 48 (large)FR (3-16mm) in size.Rao,s Infection care on FACEBOOK 1720-05-2013
  18. 18. Catheters are available in differentvarieties• They also come indifferent varietiesincluding ones withouta bladder balloon, andones with differentsized balloons - youshould check how muchthe balloon is made tohold when inflating theballoon with water!Rao,s Infection care on FACEBOOK 1820-05-2013
  19. 19. What is indwelling Catheter• In indwelling urinary catheter is one that is left inplace in the bladder. Indwelling catheters may beneeded for only a short time, or for a long time.These catheters attach to a drainage bag to collecturine. A newer type of catheter has a valve thatcan be opened to allow urine to flow out, whenneeded. An indwelling catheter may be insertedinto the bladder in two ways:• Sometimes, one may insert a tube, called asuprapubic catheter, into your bladder from a smallhole in your belly. This is done as an outpatientsurgery or office procedure.Rao,s Infection care on FACEBOOK 1920-05-2013
  20. 20. Caution on catheterization• The potential for contact with apatients blood/body fluids whilestarting a catheter is present andincreases with the inexperienceof the operator. Gloves must beworn while starting the Foley,not only to protect the user, butalso to prevent infection in thepatient. Trauma protocol calls forall team members to weargloves, face and eye protectionand gowns.Rao,s Infection care on FACEBOOK 2020-05-2013
  21. 21. Explain the patient before doing thecatheritization• Before you start tell the person what you are goingto do and why. This is important for everyone, butespecially if the person is confused, has memoryproblems as in Alzheimers disease or dementia. Ifyou can, assist the catheterized person with theirhygiene, rather than doing it yourself. It isimportant to try to help the person / patient keeptheir skills rather than just take over for them.There are so many advantages but it can just takethat bit longer.Rao,s Infection care on FACEBOOK 2120-05-2013
  22. 22. Which Disinfectant Should be Used forCatheter Site Care?• Povidone-iodine (PI) iscurrently the most widelyused agent for sitedisinfection• Chlorhexidine gluconate(CHG) has been comparedto PI with mixed results• We performed a formalmeta-analysis of publishedand unpublished studies toclarify relative efficacy20-05-2013 Rao,s Infection care on FACEBOOK 22
  23. 23. Skills in catheterization to bePerfectedRao,s Infection care on FACEBOOK 2320-05-2013
  24. 24. CONDOM CATHETERS• Condom catheters are mostfrequently used in elderlymen with dementia. Thereis no tube placed inside thepenis. Instead, a condom-like device is placed overthe penis. A tube leads fromthis device to a drainagebag. The condom cathetermust be changed every day.Rao,s Infection care on FACEBOOK 2420-05-2013
  25. 25. When Men suffer with Incontinence• When a man is unable to controlhis urine for long periods of timehe is said to be incontinent. Toavoid soiling his clothes and bed acondom-style sheath can be usedto connect the penis to a closeddrainage system in which theurine is collected.• This avoids having a catheterinserted into the mans urinarybladder and greatly decreases therisk of bladder infections.Rao,s Infection care on FACEBOOK 2520-05-2013
  26. 26. INTERMITTENT (SHORT-TERM) CATHETERS• Some people only needto use a catheter onoccasion. Short-term, orintermittent, cathetersare removed after theflow of urine hasstopped. For moreinformation on this typeof catheter, see: Cleanintermittent self-catheterization.Rao,s Infection care on FACEBOOK 2620-05-2013
  27. 27. Hand washing the most importantpreparation before catheterization• Wash your handsbefore and afterhandling the drainagedevice. Do not allow theoutlet valve to touchanything. If the outletbecomes obviouslydirty, clean it with soapand water.Rao,s Infection care on FACEBOOK 2720-05-2013
  28. 28. Antiseptic Hand Rinses manyusing alcohols• 60-70% alcoholsolutions• Effective against mostbacteria, viruses, fungi• Protective againsthand drying• Faster, increasedcompliance20-05-2013 Rao,s Infection care on FACEBOOK 28
  29. 29. Caring before the insertion of Catheter• Wash around thecatheter entry site withsoap and water twiceeach day. Clean the topseveral inches of thecatheter too.Always wash the siteafter a bowelmovement.Rao,s Infection care on FACEBOOK 2920-05-2013
  30. 30. Health care workers should develop skillsin introduction of Catheter• Introduction Femaleurethral catheterization, theinsertion of a catheterthrough the urethra into theurinary bladder to permitdrainage of urine, is afundamental skill Insert thecatheter completely intothe urethra, and do notinflate the balloon untilthere is return of urine, toavoid trauma …Rao,s Infection care on FACEBOOK 3020-05-2013
  31. 31. Principles of placement of catheter andcollecting bagRao,s Infection care on FACEBOOK 3120-05-2013
  32. 32. The Urine collecting bag should be at alower level to the patientto prevent retrograde flowRao,s Infection care on FACEBOOK 3220-05-2013
  33. 33. • Criteria for insertion andcontinuation of a F/C includes:a. Retentionb. Critical I&Oc. Comatosed. Paralyzede. Neurogenic Bladderf. Pre-op placementg. Wound with incontinenceh. Bladder Irrigationi. Physical trauma/pain with bedpan/incontinence briefj. Terminal illness/comfort measuresRao,s Infection care on FACEBOOK 3320-05-2013
  34. 34. Care of Inserted Catheters• Every day , wash around the catheter andperineum with soap and water; rinse and drythese areas well. you may shower whilewearing the catheter• Sitting in the tub, however , is notrecommended. Good personal hygiene prevents the accumulation of bacteria, reducesthe risk of infection, and prevents odorRao,s Infection care on FACEBOOK 3420-05-2013
  35. 35. POSSIBLE COMPLICATIONS• Inability to catheterise• • Urethral Injury – by inflating balloon before insuring correctcatheter placement in the• bladder• • Infection• • Psychological Trauma• • Haemorrhage – trauma sustained during insertion or ballooninflation• • False Passage – by injury to the urethral wall during insertion• • Urethral Strictures – following damage to the urethra – long termproblem• • Paraphimosis due to failure to return foreskin to normal positionfollowing catheter insertion.Rao,s Infection care on FACEBOOK 3520-05-2013
  36. 36. Complications of catheterization• The main complications are tissue trauma and infection. After48 hours of catheterization, most catheters are colonized withbacteria, thus leading to possible Bacteriuria and itscomplications. Catheters can also cause renal inflammation,nephro-cysto-lithiasis, and pyelonephritis if left in forprolonged periods.• The most common short term complications are inability toinsert catheter, and causation of tissue trauma during theinsertion.• The alternatives to urethral catheterization includesuprapubic catheterization and external condom catheters forlonger durations.Rao,s Infection care on FACEBOOK 3620-05-2013
  37. 37. Urinary Catheter-related Infection:Background• Urinary tract infection (UTI) causes over 40%of hospital-acquired infections• Most infections due to urinary catheters• 25% of inpatients are catheterized• Leads to increased morbidity and costs20-05-2013 Rao,s Infection care on FACEBOOK 37
  38. 38. Risks / Consequences ofCatheterization• UTI• PYELONEPHRITIS• DEATH R/T BACTEREMIA• DAMAGE TO URETHRA (SCARRING ANDSTRICTURES)• Prostatitis and epididymitisRao,s Infection care on FACEBOOK 3820-05-2013
  39. 39. • Indwelling Foley catheters are a majorsource of UTI’S.• Direct relationship between duration a f/c is in thepatient and incidence of infection.• Risk factors: Female Advanced age Duration Diabetes Renal insufficiencyRao,s Infection care on FACEBOOK 3920-05-2013
  40. 40. Biofilm: Extracellular Polymers(Donlan, CID 2001; 33:1387–92, Liedl, Curr Opinion Urol 2001;11: 75-9)• Organisms attach to andgrow on a surface andproduce extracellularpolymers• Intraluminal ascent(48hours) of bacteriafaster than extraluminal(72-168 hours)• Most catheters used >1week have biofilms• Extraluminal moreimportant in women40Staphylococcus aureus biofilm onan indwelling catheter.CDC Public Health Image Library20-05-2013 Rao,s Infection care on FACEBOOK
  41. 41. What we are doing now, is it right things to do.Foley Catheter BundleWhat is the Foley Catheter Bundle? Insert using sterile technique Hand hygiene before and after any contact with the F/Csystem Secure catheter to thigh at ALL times Keep catheter bag below the level of the bladder atALL times Maintain a sterile, continuously closed system Specified criteria for insertion and continuation of a Foleycatheter Peri care daily and after all incontinent stoolWhat is “Peri Care” for a patient with a f/c? Daily wash withwarm soap & water then dry.Rao,s Infection care on FACEBOOK 4120-05-2013
  42. 42. Gravity will help the Draining ofBladder• Gravity is important for drainage and theprevention of urine backflow. Ensure thatcatheter bags are always drainingdownwards, do not become kinked andare secured and below thigh level. Metalor plastic hangers should be attached tothe side of the bed. Cloth bags tied to thebed to support the bags are alsoavailable Rao,s Infection care on FACEBOOK 4220-05-2013
  43. 43. Collection of urine from catheterisedpatients• The process of obtaining a sample of urinefrom a patient with an indwelling urinarycatheter must be obtained from a samplingport. The sample must be obtained using anaseptic technique.• This port is usually situated in the drainagetubing, proximal to the collection bag whichensures the freshest sample possible. The useof drainage systems without a sampling portshould be avoided (Gilbert, 2006).Rao,s Infection care on FACEBOOK 4320-05-2013
  44. 44. COLLECTION OF CATHETER SPECIMENSIn Urinary Tract Infections• Clean entry port with alcohol swab using firmfriction and allow to air dry• • Insert syringe into direct entry point of bagand aspirate urine. The port will self-sealwhen the syringe is withdrawn.• • If direct syringe entry port is not available,insert needle into entry port and aspirateurine. The port will self-seal when the needleis withdrawnRao,s Infection care on FACEBOOK 4420-05-2013
  45. 45. Specimens for Culturing Should notbe Cultured from Urine bags• Specimens should notbe collected from thetap from the maincollecting chamber ofthe catheter bag ascolonisation andmultiplication ofbacteria within thestagnant urine oraround the drainage tapmay have occurred.Rao,s Infection care on FACEBOOK 4520-05-2013
  46. 46. Aspirating the urine with syringe andNeedle• Aspirating urine from asampling port hastraditionally beenperformed using asyringe and needle.However, needle-freesystems arecommercially available,which may reduce therisk of inoculationinjury.Rao,s Infection care on FACEBOOK 4620-05-2013
  47. 47. Contraindications for catheterization• Foley catheters are contraindicated in thepresence of urethral trauma. Urethral injuriesmay occur in patients with multisysteminjuries and pelvic factures, as well as straddleimpacts. If this is suspected, one mustperform a genital and rectal exam first. If onefinds blood at the meatus of the urethra, ascrotal hematoma, a pelvic fracture, or a highriding prostate then a high suspicion ofurethral tear is present.Rao,s Infection care on FACEBOOK 4720-05-2013
  48. 48. Epidemiology of urinarycatheterization• Up to 25% of hospitalized patients– urinary catheterization• Catheter associated nosocomial UTI– 5% per day !• Nosocomial UTI– 40% of nosocomial infection• Bacteria ascend intraluminally into the bladder– within 24 to 72 hours (from Harrison’s 16th)• > 1 month of catheterization– Nearly all will be bacteriuic• Long-term (>30 days) and short-term (<30 days)catheterization• 80% of patients with nosocomial UTI– have an indwelling urinary catheter20-05-2013 Rao,s Infection care on FACEBOOK 48
  49. 49. Women in labour NeedCatheterizationRao,s Infection care on FACEBOOK 4920-05-2013
  50. 50. Reminder for Appropriate UrinaryCatheter Use• Avoid urinary catheter use ifnot indicated• Try to discontinue thecatheter promptly when notneeded• The longer the catheter ispresent, the higher the riskof infection!• The urinary drainage systemshould always remain aclosed system5020-05-2013 Rao,s Infection care on FACEBOOK
  51. 51. Rapid draining leads to Complications• Rapid drainage of largevolumes of urine fromthe bladder may resultin hypotension and/orhaemorrhage.(Upson1995) Clamp catheter ifthe volume drained is1000mls or greater.After 20minutes releasethe clamp and allowurine to drainRao,s Infection care on FACEBOOK 5120-05-2013
  52. 52. Repeat the Clamping whenvolume is higher• If the amount ofurine is 1000mlsor greaterrepeat theclampingprocedure.Rao,s Infection care on FACEBOOK 5220-05-2013
  53. 53. PROCEDURE FOR EMPTYING CATHETERBAGS• Use a clean jug large enough to avoid spillageeg 2-3 litres.• • After emptying the bag, wipe the end of thecatheter outlet with an alcohol swab.• • Note the amount and colour of drainage –record .• • Empty jug carefully down the sluice to avoidsplashing• • Place jug straight into sanitizer and store dryRao,s Infection care on FACEBOOK 5320-05-2013
  54. 54. Constant evaluation to continue to use catheter…….• Both nurses and physiciansshould evaluate theindications for urinarycatheter utilization.• Physicians should promptlydiscontinue catheters thatare no longer needed.• Nurses evaluating cathetersand finding no indicationshould contact physician topromptly discontinuecatheter.5420-05-2013 Rao,s Infection care on FACEBOOK
  55. 55. Important question when to remove• Should we need to remove the urinarycatheter in 48~72 hours of smoothly post oppatients to reduce the rate of catheterassociated UTI? What’s the rate of catheterassociated UTI in 48~ 72 hours?–Remove urinary catheter as soon aspossible!–Rate of Bacteriuria in indwelling catheterpatient in 48 hours post-OP: average 24%20-05-2013 Rao,s Infection care on FACEBOOK 55
  56. 56. Mannequins Recruited To TeachMedicineRao,s Infection care on FACEBOOK 5620-05-2013
  57. 57. Clean and Washed Hands Saves many Livesfrom Complications of Catheterization20-05-2013 Rao,s Infection care on FACEBOOK 57
  58. 58. For More Articles of Interest onInfectious Diseases Visit Me …Rao,s Infection care on FACEBOOK 5820-05-2013
  59. 59. • Programme Created by Dr.T.V.Rao MDfor Medical Professionals Under theHuman Safety in Medical Care• Email• doctortvrao@gmail.comRao,s Infection care on FACEBOOK 5920-05-2013