Download Common Catheter Problems_Bon

yes no Was this document useful for you?
   Thank you for your participation!

* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project

Document related concepts

Neonatal infection wikipedia , lookup

Infection control wikipedia , lookup

Schistosomiasis wikipedia , lookup

Multiple sclerosis signs and symptoms wikipedia , lookup

Hospital-acquired infection wikipedia , lookup

Urinary tract infection wikipedia , lookup

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!!!!
Page 2
Intermittent Catheterization
The GOLD STANDARD of artifical drainage of the
bladder (Barton 2000;Bardsley and Kaighin,2008)
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!
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
Advantages contd
Less risk of problems associated with
indwelling catheters
Helps maintain positive body image
(Addison 2001)
“Ready to go”, saves time & more cost
Improved quality of life and independence
To Begin!
Indwelling Catheters!
Page 6
 Kinked Tubing
 Constipation
 Infection
 Detrusor Instability
 Trigone Irritation (Catheter Size? Traction?)
 Encrustation (Struvite)
 Debris & Mucous
Page 7
No Drainage
Kinked Tubing, Constipation, Debris &
Renal Impairment - Anuria
(Cessation of urine production)
Page 8
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
 22.5% of Healthcare Associated Infections or
nosocomial Infection are UTIs of those 56.2% Catheter
(2006 prevalence survey of HCAI)
Patients do die from urinary sepsis (Stewart 1998)
Page 9
Managing / Reducing Risk of Infection
Aseptic Technique When Catheterising
Maintain Closed System
- 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
Page 10
What is encrustation and how do we
deal with it?
Page 11
Encrusted catheters
Normal catheter
Page 12
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
Page 13
Process of Encrustation
BACTERIA (Proteus, E-Coli,
Spliting Urinary Urea into
Change in pH (6.8 - 9.5)
Alkaline Urine
Page 14
Stickler, D. J. 1996. Biofilms, catheters, and urinary tract infections.
Eur. Urol. Update Ser. 5:1-8.
Page 15
• Inspect retrieved catheter – Visual examination of tip and
cut catheter along its length to determine cause of
catheter failure. Document findings – photograph if
Page 16
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)
Page 17
Urotainer Solutions
Uro-Tainer Twin SUBY-G (3.23% Citric Acid)
Uro-Tainer Twin SOLUTIO-R (6% Citric Acid)
Page 18
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
Page 19
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
Page 20
Catheter Maintenance Solutions are not bladder
Do not provide a therapeutic effect
Are Class 1 (Sterile) Medical Devices
Page 21
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.
Page 22
Symptoms range from mild to sever and patients may present with one or more of
the following:
Pounding headache
Flushing and/blotching above the level of spinal injury
Slowed heart rate
Profuse sweating above the level of injury
Blurred vision or seeing spots
Stuffy nose
Feeling of impending doom, anxiety or apprehension
Elevated blood pressure.
Page 23
Page 24
Page 25
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
Page 26