Transcript Coping with Catheter Problems

Urinary Catheters & Problem Solving
William Ryan
Nurse Advisor
Aim of Presentation
• Cover common issues related to Indwelling
Urinary Catheters (IDC & SPC)
• Always consider why is the catheter in-situ?
• Is it required?
• Is there an alternative?
• Documentation!!!!
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Intermittent Catheterization
The GOLD STANDARD of artifical drainage of the
bladder (Barton 2000;Bardsley and Kaighin,2008)
Page
•
To prevent risk of over-distension
•
Generally the procedure is carried out 4-5 times/24hours (Barton
2000; Robinson,2007)
•
Number of times may need adjusting depending on residual (less
then 100mls)
•
Should be considered for patients attending A&E with ROU as an
immediate or planned alternative method of bladder emptying
instead of an IDC. Not suitable for all patients!
Advantages
•
Reduced risk of infection (Bakke & Digranes,1991)
•
Improvement in urinary symptoms & bladder health –
maintains bladder tone
•
Offers opportunity to be self caring
•
Regain personal control over bladder function
•
Allows easier & more spontaneous sexual relations
•
Reduced need for equipment / appliances – easier to choose
clothing – mobility less hindered
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Advantages contd
Less risk of problems associated with
indwelling catheters
Helps maintain positive body image
(Addison 2001)
“Ready to go”, saves time & more cost
effective
Improved quality of life and independence
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To Begin!
Indwelling Catheters!
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Bypassing
 Kinked Tubing
 Constipation
 Infection
 Detrusor Instability
 Trigone Irritation (Catheter Size? Traction?)
 Encrustation (Struvite)
 Debris & Mucous
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No Drainage
Kinked Tubing, Constipation, Debris &
Encrustation
Renal Impairment - Anuria
(Cessation of urine production)
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Infection
CAUTI (Catheter Associated Urinary Tract Infections)
account for 45% of all hospital acquired infections

Dougherty, L. and Lister, S. (2004) The Royal Marsden Hospital Manual of Clinical Nursing
Procedures
 22.5% of Healthcare Associated Infections or
nosocomial Infection are UTIs of those 56.2% Catheter
related
(2006 prevalence survey of HCAI)
Patients do die from urinary sepsis (Stewart 1998)
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Managing / Reducing Risk of Infection

Aseptic Technique When Catheterising

Maintain Closed System

Hygiene
-
- Meatal Cleansing / Bathing etc
-
- Wash Hands/Wear PPE Aprons when carrying out catheter care
-
- Daily washing of catheter
Adequate Fluid Intake

Frequency of drainage bag changes and use of night

drainage systems
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Encrustation
What is encrustation and how do we
deal with it?
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Encrusted catheters
Normal catheter
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Encrusted catheter
Encrustation of the catheter from deposits of mineral
salts is a complication in approximately 50% of all longterm catheterised patients.
Encrustation on catheter surface can cause trauma
to the urethra during catheter removal.
The risks associated with CMS use may be
outweighed by increasing catheter life
SARI 2011
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Process of Encrustation
BACTERIA (Proteus, E-Coli,
Klebsiella)
Produce
UREASE
Spliting Urinary Urea into
AMMONIA
Change in pH (6.8 - 9.5)
Alkaline Urine
MINERAL
PRECIPITATION
ENCRUSTATION
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CARBON
DIOXIDE
Stickler, D. J. 1996. Biofilms, catheters, and urinary tract infections.
Eur. Urol. Update Ser. 5:1-8.
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Assess
• Inspect retrieved catheter – Visual examination of tip and
cut catheter along its length to determine cause of
catheter failure. Document findings – photograph if
possible.
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Unblocking / Checking Patency
The traditional manner in which ‘washouts have been performed is using 50-60ml syringe
attached to the catheter. The plunger is alternately depressed and withdrawn to facilitate
drainage and removal of debris. This may be potentially damaging to the tissues because
of the considerable force exerted. (Getliffe & Dolman, 1997)
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Urotainer Solutions
Uro-Tainer Twin SUBY-G (3.23% Citric Acid)
Uro-Tainer Twin SOLUTIO-R (6% Citric Acid)
SODIUM CHLORIDE (0.9%)
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When to use Uro-Tainer

Prophylactic Treatment for known “BLOCKERS”

To Clear an Encrusted Catheter

Prior to Catheter Removal

To Remove Debris, Mucous, Haematuria from the Bladder

To instil Prescribed Drugs
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Using Uro-Tainer

Assessment of the Problem

Promotes Patient Comfort

Prolongs Catheter Life (within manufacturers guidelines)

Patients and/or carers may be taught self administration
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Note:
Catheter Maintenance Solutions are not bladder
washouts.
Do not provide a therapeutic effect
Are Class 1 (Sterile) Medical Devices
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Contraindication
Autonomic Dysreflexia
Autonomic dysreflexia (also known as autonomic hyperreflexia) is one of the
most serious conditions affecting people with spinal cord injury at or above the
6th thoracic vertebrae.
Develops secondary to any noxious stimulus below the level of injury.
Nerve impulses cannot pass normally to the brain, therefore, the body
produces exaggerated abnormal nerve signals that cause problems above
and below the spinal injury.
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Symptoms range from mild to sever and patients may present with one or more of
the following:
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•
•
•
•
•
•
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Pounding headache
Flushing and/blotching above the level of spinal injury
Slowed heart rate
Profuse sweating above the level of injury
Palpitations
Goosebumps
Blurred vision or seeing spots
Stuffy nose
Feeling of impending doom, anxiety or apprehension
Elevated blood pressure.
TREAT AS A MEDICAL EMERGENCY
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Antimuscarinic medications
block the messages that initiate
bladder contractions and reduce
frequency of bladder emptying.
These can be very effective in
managing an overactive bladder
but risk causing a dry mouth as
common side effect.
Source: MS Trust UK
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