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Chang WL, Lai SH, Cheng CF, Chiu V, Lin SK. Comparative Effectiveness of Two Models of Point-of-Care Ultrasound for Detection of Post-Void Residual Urine during Acute Ischemic Stroke: Preliminary Findings of Real-World Clinical Application. Diagnostics (Basel) 2023; 13:2599. [PMID: 37568961 PMCID: PMC10417127 DOI: 10.3390/diagnostics13152599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
We conducted a comparative study of two models of point-of-care ultrasound devices for measuring post-void residual urine (PVRU). We prospectively enrolled 55 stroke inpatients who underwent both real-time B-mode ultrasound (Device A) and automated three-dimensional (3D) scanning ultrasound (Device B), with a total of 108 measurements. The median PVRU volume of Device B was 40 mL larger than that of Device A. The PVRU difference between the devices was positively and linearly correlated with PVRU. The correlation of PVRU volume between the devices was strong, but the agreement level was only moderate. Measurement deviations were observed in 43 (40%) and 11 (10%) measurements with Device B and Device A, respectively. The PVRU volume was low in spherical bladder shapes but sequentially increased in triangular, undefined, ellipsoid, and cuboid bladder shapes. Further comparison of 60 sets of PVRU without measurement deviations revealed higher agreements between the devices at correction coefficients of 0.52, 0.66, and 0.81 for PVRU volumes of <100, 100-200, and >200 mL, respectively. The automated 3D scanning ultrasound is more convenient for learning and scanning, but it exhibits larger measurement deviations. Real-time B-mode ultrasound accurately visualizes the urinary bladder but tends to underestimate the urinary bladder when the PVRU volume is large. Hence, real-time B-mode ultrasound with automated PVRU-based adjustment of calculation formulas may be a better solution for estimating bladder volume.
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Affiliation(s)
- Wan-Ling Chang
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan; (W.-L.C.); (C.-F.C.)
| | - Shu-Hui Lai
- Department of Nursing, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan;
| | - Chu-Fang Cheng
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan; (W.-L.C.); (C.-F.C.)
| | - Valeria Chiu
- Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan;
| | - Shinn-Kuang Lin
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan; (W.-L.C.); (C.-F.C.)
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
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2
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Prevent postoperative urinary retention in day surgery adult patients: evidence-based quality improvement project. INT J EVID-BASED HEA 2022; 20:344-354. [DOI: 10.1097/xeb.0000000000000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND After a stroke, urinary dysfunction and urinary tract infection are estimated to be approximately 20%. Increased postvoid residual (PVR) is a risk factor for urinary dysfunction and urinary tract infections. These complications can negatively impact recovery weeks after the initial hospitalization. Early identification of risks and patient education are important. PROJECT DESCRIPTION This project was initiated for those patients admitted for a diagnosis of stroke on a 55-bed neuroscience unit in an acute care hospital. Patients were scanned after the initial void post stroke. Nurses followed a specific bladder scanning algorithm for subsequent scanning if the PVR volume was greater than 100 mL. RESULTS Seventy-eight patients were scanned in the original phase of the project, and 41 (53%) had PVR volumes greater than 100 mL after the initial void/scan. Of those, 22 patients still had a volume of greater than 100 mL after the second void/scan, and 12 had PVR volumes greater than 100 mL after a third scan. IMPLICATIONS FOR PRACTICE Patients admitted with stroke have demonstrated increased PVR volumes. Portable ultrasound bladder scanning is a safe, noninvasive method to measure residual urinary volumes. The use of a bladder scanning algorithm encourages nurses' autonomy in assessing and identifying patients at a higher risk for urinary complications. CONCLUSION Identifying the risk for urinary complications post stroke can lead to early interventions that can improve recovery. This also allows for specific patient education related to preventative measures to reduce risk of urinary complications. The use of a specific bladder scanning protocol is recommended as standard practice for all patients admitted with stroke.
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Christianson TM, Hoot TJ, Todd M. Understanding Nursing Knowledge of Continence Care and Bladder Scanner Use in Long-Term Care: An Evaluation Study. Gerontol Geriatr Med 2021; 7:23337214211046090. [PMID: 34692925 PMCID: PMC8532246 DOI: 10.1177/23337214211046090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 11/20/2022] Open
Abstract
Because urinary continence is an essential indicator for quality of life for older adults in long-term care, it is important to accurately assess and treat those at risk for incontinence. This evaluation study was to increase understanding of the issues related to the implementation of bladder scanners while exploring nursing staff knowledge about continence care of older adults in long-term care settings. Using a mixed-methods design, nursing care staff (RN, LPN, Care Aide) at six long-term care homes completed a bladder care knowledge survey and participated in focus group discussions to explore continence care knowledge and use of bladder scanners to manage continence issues. Twenty-eight nursing care staff participated; findings showed continence care knowledge varied by profession, and the use of portable bladder scanners is affected by knowledge, training, and scopes of practice. Going forward, exploring scopes of practice and education are needed for effective assessment, management, and treatment of continence.
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Affiliation(s)
| | | | - Melanie Todd
- Thompson Region Division of Family Practice, Kamloops, BC, Canada
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Schallom M, Prentice D, Sona C, Vyers K, Arroyo C, Wessman B, Ablordeppey E. Accuracy of Measuring Bladder Volumes With Ultrasound and Bladder Scanning. Am J Crit Care 2020; 29:458-467. [PMID: 33130866 DOI: 10.4037/ajcc2020741] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Removal of urinary catheters depends on accurate noninvasive measurements of bladder volume. Patients with acute kidney injury often have low bladder volumes/ascites, possibly causing measurement inaccuracy. OBJECTIVE To evaluate the accuracy of bladder volumes measured with bladder scanning and 2-dimensional ultrasound (US) compared with urinary catheterization among different types of clinicians. METHODS Prospective correlational descriptive study of 73 adult critical care patients with low urine output receiving hemodialysis or unable to void. Bladder volumes were independently measured by (1) a physician and an advanced practice registered nurse using US, (2) an advanced practice registered nurse and a bedside nurse using bladder scanning, and (3) urinary catheterization (cath). Bland-Altman and χ2 analyses were conducted. RESULTS Mean (SD) cath volume was 171.7 (269.7) mL (range, 0-1100 mL). Abdominal fluid was observed in 28% of patients. Bias was -1.3 mL for US vs cath and 3.3 mL for bladder scanning vs cath. For patients with abdominal fluid and cath volume less than 150 mL, decisions to not catheterize patients were accurate more often when based on US measurements (97%-100%) than when based on bladder scanning measurements (86%-89%; P = .02). In patients with cath volume of 300 mL or more, decisions to catheterize patients were accurate more often when based on bladder scanning measurements (94%-100%) than when based on horizontal US measurements (50%-56%; P = .001). CONCLUSIONS Bladder volume can be measured accurately with bladder scanning or US, but abdominal fluid remains a confounding factor limiting accuracy of bladder scanning.
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Affiliation(s)
- Marilyn Schallom
- Marilyn Schallom is director of research, Donna Prentice is a research scientist, Kara Vyers is a research coordinator, and Cassandra Arroyo is a statistician in the Department of Research and Carrie Sona is a clinical nurse specialist in the Department of Surgical Services, Barnes-Jewish Hospital, St Louis, Missouri
| | - Donna Prentice
- Marilyn Schallom is director of research, Donna Prentice is a research scientist, Kara Vyers is a research coordinator, and Cassandra Arroyo is a statistician in the Department of Research and Carrie Sona is a clinical nurse specialist in the Department of Surgical Services, Barnes-Jewish Hospital, St Louis, Missouri
| | - Carrie Sona
- Marilyn Schallom is director of research, Donna Prentice is a research scientist, Kara Vyers is a research coordinator, and Cassandra Arroyo is a statistician in the Department of Research and Carrie Sona is a clinical nurse specialist in the Department of Surgical Services, Barnes-Jewish Hospital, St Louis, Missouri
| | - Kara Vyers
- Marilyn Schallom is director of research, Donna Prentice is a research scientist, Kara Vyers is a research coordinator, and Cassandra Arroyo is a statistician in the Department of Research and Carrie Sona is a clinical nurse specialist in the Department of Surgical Services, Barnes-Jewish Hospital, St Louis, Missouri
| | - Cassandra Arroyo
- Marilyn Schallom is director of research, Donna Prentice is a research scientist, Kara Vyers is a research coordinator, and Cassandra Arroyo is a statistician in the Department of Research and Carrie Sona is a clinical nurse specialist in the Department of Surgical Services, Barnes-Jewish Hospital, St Louis, Missouri
| | - Brian Wessman
- Brian Wessman and Enyo Ablordeppey are associate professors in the Department of Anesthesiology and Division of Emergency Medicine, School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Enyo Ablordeppey
- Brian Wessman and Enyo Ablordeppey are associate professors in the Department of Anesthesiology and Division of Emergency Medicine, School of Medicine, Washington University in St Louis, St Louis, Missouri
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Schowalter S, Altawil Z, Schechter-Perkins EM, Pare JR. False Elevation of Volume Determined by Bladder Scanner Secondary to Bowel Obstruction. Clin Pract Cases Emerg Med 2020; 4:158-160. [PMID: 32426660 PMCID: PMC7220021 DOI: 10.5811/cpcem.2019.12.45103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 11/29/2019] [Accepted: 12/19/2019] [Indexed: 01/11/2023] Open
Abstract
Bladder scanners allow for quick determination of bladder volumes (BV) with minimal training. BV measured by a machine is generally accurate; however, circumstances exist in which falsely elevated BVs are reported. This case details a patient with a significant small bowel obstruction (SBO) due to superior mesenteric artery syndrome causing a falsely elevated BV. We believe this is the first case report of a SBO causing an elevated BV by bladder scanner. Emergency physicians should be aware of the pitfalls of using bladder scanners, and use their point-of-care ultrasound skills when possible to expand their differential.
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Affiliation(s)
- Sean Schowalter
- Beth Israel Deaconess Medical Center, Department of Internal Medicine, Boston, Massachusetts
| | - Zaid Altawil
- Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | | | - Joseph R Pare
- Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts
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Araklitis G, Paganotto M, Hunter J, Thiagamoorthy G, Robinson D, Cardozo L. Can we replace the catheter when evaluating urinary residuals? Neurourol Urodyn 2019; 38:1100-1105. [PMID: 30843290 DOI: 10.1002/nau.23963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/16/2019] [Accepted: 02/09/2019] [Indexed: 11/11/2022]
Abstract
AIMS To test the different formulae to calculate the bladder volume using ultrasound; the accuracy of patients hearing/feeling "bubbles" at the end of urodynamics testing as a measure of being empty; and how good we are at estimating PVR using X-ray at the end of video urodynamics testing. METHODS This was a prospective cohort study. Using Sonosite 180 plus, bladder volumes were calculated as, height × width × depth × proportionality constant (0.52, 0.625, 0.65, and 0.7) Patients were asked whether the patient heard or felt "bubbles" at the end of the investigation. Each patient was fluoroscopically screened and the clinician estimated the volume and compared with single-use catheter volume. RESULTS A total of 85 patients were assessed. All four formulae were significantly correlated. The PC, 0.52, correlated best (r = 0.938, P < 0.001) with no significant difference with the actual volumes ( P = 0.275). The "bubbles test" had a positive predictive value of 93%. A video postvoid residual (PVR) estimation significantly correlated with catheterised bladder volume ( r = 0.842, P < 0.001). There was no significant difference between the estimated and actual bladder volumes ( P = 0.579). CONCLUSION This study showed that although all four formulae correlated significantly, the PC of 0.52 was the only formula without a significant difference from the actual volume. More work is needed to produce patient individualised PC. Our clinicians were able to accurately estimate the PVR on X-ray. This study has identified the best formula to accurately estimate bladder volume and that video estimation along with the "bubbles" test can avoid unnecessary intervention.
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Affiliation(s)
- George Araklitis
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Maria Paganotto
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Jo Hunter
- Department of Urogynaecology, King's College Hospital, London, UK
| | | | - Dudley Robinson
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
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Meehan AJ, Maher AB, Brent L, Copanitsanou P, Cross J, Kimber C, MacDonald V, Marques A, Peng L, Queirós C, Roigk P, Sheehan KJ, Skúladóttir SS, Hommel A. The International Collaboration of Orthopaedic Nursing (ICON): Best practice nursing care standards for older adults with fragility hip fracture. Int J Orthop Trauma Nurs 2019; 32:3-26. [DOI: 10.1016/j.ijotn.2018.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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9
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Cartwright A. Reducing catheter-associated urinary tract infections: standardising practice. ACTA ACUST UNITED AC 2018; 27:7-12. [PMID: 29323992 DOI: 10.12968/bjon.2018.27.1.7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Inspired by innovations in catheter practice from the USA, in 2014 Nottingham University Hospitals NHS Trust introduced catheterisation standardisation across the Trust's two acute sites. Standardisation was achieved by the introduction of an all-in one catheterisation tray (Bard® Tray), which included all the necessary equipment required for catheterisation, coupled with a training programme. The introduction of the tray was followed by a clinically significant 80% reduction in the CAUTI rate from 2014 to 2016. This reduction in CAUTI rate provided the Trust with a considerable reduction on annual expenditure (nearly £160 000 less in 2016 compared with 2014). The introduction of the tray has additionally improved practice with nursing staff now less likely to forget the necessary equipment before commencing catheterisation as all the components are provided in one place.
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Affiliation(s)
- Amy Cartwright
- Clinical Procurement Specialist, previously Continence Team Lead, Nottingham University Hospitals NHS Trust
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10
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Prentice DM, Sona C, Wessman BT, Ablordeppey EA, Isakow W, Arroyo C, Schallom M. Discrepancies in measuring bladder volumes with bedside ultrasound and bladder scanning in the intensive care unit: A pilot study. J Intensive Care Soc 2017; 19:122-126. [PMID: 29796068 DOI: 10.1177/1751143717740805] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective Intensive care unit patients are at risk for catheter-associated urinary tract infection. Earlier removal of catheters may be possible with accurate measurement of bladder volume. The purpose was to compare measured bladder volumes with bedside ultrasound, bladder scanner, and urine volume. Design Prospective correlational descriptive study. Setting Surgical/trauma intensive care unit and medical intensive care unit. Patients Renal dialysis patients with less than 100 ml of urine in 24 h prior to urinary catheter removal and patients with suspected catheter obstruction. Measurements and main results A physician trained in ultrasound and an advanced practice registered nurse trained in bladder scanning measured bladder volume; each blinded to the other's measurement. Device used first (ultrasound or bladder scanner) alternated daily. The intensive care unit team determined need for intermittent catheterization or treatment for suspected obstruction. Fifty-one measurements from 13 patients were obtained with results reported in milliliters. Ultrasound measurements were a mean volume of 72.1 ± 127 (range: 1.7-666) and the bladder scanner measurements were 117 ± 131 (0-529). On six occasions in five dialysis patients, urine volume measurement was available. The mean difference in ultrasound-urine volume mean difference was 0.5 ± 37.8 (range: -68 to 38.2) and the bladder scanner-urine volume was 132 ± 167 (-72 to 397). Two patients with suspected catheter obstructions had ultrasound, bladder scanner, urine volume measurements, respectively: (1) 539, 51, >300 (began voiding before catheter replaced); (2) 666, 68, 1000 with catheter replacement. Conditions leading to greatest differences were obesity, indwelling catheter and ascites. Conclusions These results demonstrate the inaccuracy of the bladder scanner. Ultrasound measurements appear more accurate. To remove urinary catheters in patients with minimal to low urine output, serial ultrasound measurements can be used to monitor bladder volumes and return of renal function.
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Affiliation(s)
| | | | - Brian T Wessman
- 2Department of Anesthesiology and Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Enyo A Ablordeppey
- 2Department of Anesthesiology and Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Warren Isakow
- 3Department of Pulmonary Medicine, Washington University School of Medicine, St. Louis, MO, USA
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Dawson CH, Gallo M, Prevc K. TWOC around the clock: a multimodal approach to improving catheter care. J Infect Prev 2017; 18:57-64. [PMID: 28989506 DOI: 10.1177/1757177416668584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 08/06/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Urinary tract infections (UTI) are the second-largest group of healthcare-associated infections (HCAI). The Saving Lives Urinary Catheter Care Bundle was introduced to reduce catheter-associated urinary tract infections (CAUTI). In response, we implemented a catheter care group to examine ways to improve catheter care in an acute hospital NHS Trust. METHODS We adopted a multimodal approach, revolving around four components: (1) Catheter Care Pathway; (2) HOUDINI checklist; (3) catheter magnets; and (4) use of bladder ultrasound scanners. RESULTS The yearly CAUTI prevalence survey showed an annual reduction in CAUTI from 2012-2013 to 2014-2015 (3.5% to 2.4%). Evaluations of the multimodal approach have highlighted limitations, leading to priorities being established around provision of tools, education, and use of measurement and feedback. CONCLUSIONS Our multimodal approach demonstrates CAUTI rate improvements are achievable, directly benefiting patients. However, long-term maintenance of multimodal components is required to ensure sustained benefit. Engagement and accountability have emerged as significant challenges to the effectiveness and longevity of the catheter care group. We suggest greater emphasis on such challenges if long-term national or international improvement is to be achieved.
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Affiliation(s)
- Carolyn H Dawson
- Infection Prevention and Control Team, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Melanie Gallo
- Infection Prevention and Control Team, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Kate Prevc
- Infection Prevention and Control Team, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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12
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Kim TH, Kim HS, Park JW, Lim OK, Park KD, Lee JK. Falsely Elevated Postvoid Residual Urine Volume in Uterine Myoma. Ann Rehabil Med 2017; 41:332-336. [PMID: 28503470 PMCID: PMC5426254 DOI: 10.5535/arm.2017.41.2.332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/11/2016] [Indexed: 11/23/2022] Open
Abstract
Precise measurement of postvoid residual (PVR) urine volume is a key factor in assessing patients with voiding dysfunction, including those with lower urinary tract problems. The safe and noninvasive ultrasound bladder scan is the preferred mode to measure PVR volume. However, this procedure has a false-positive rate up to 9%, in the presence of ovarian cysts, renal cysts, ascites, or uterine myoma with cystic degeneration. Until now, cystic lesions are known to cause false positivity in ultrasound bladder scanner. However, we encountered falsely-elevated PVR in two cases of non-cystic uterine myomas. We present these cases with detailed radiologic images and volume measurement data.
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Affiliation(s)
- Tae Hee Kim
- Department of Rehabilitation Medcine, Gachon University Gil Medical Center, Incheon, Korea
| | - Hyo Sang Kim
- Department of Rehabilitation Medcine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jung Wook Park
- Department of Rehabilitation Medcine, Gachon University Gil Medical Center, Incheon, Korea
| | - Oh Kyung Lim
- Department of Rehabilitation Medcine, Gachon University College of Medicine, Incheon, Korea
| | - Ki Deok Park
- Department of Rehabilitation Medcine, Gachon University College of Medicine, Incheon, Korea
| | - Ju Kang Lee
- Department of Rehabilitation Medcine, Gachon University College of Medicine, Incheon, Korea
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A Clinical Nurse Specialist–Directed Initiative to Reduce Postoperative Urinary Retention in Spinal Surgery Patients. Am J Nurs 2016; 116:47-52. [DOI: 10.1097/01.naj.0000490176.22393.69] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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14
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Implementation of a nurse-driven protocol to prevent catheter-associated urinary tract infections. J Nurs Care Qual 2016; 29:245-52. [PMID: 24390382 DOI: 10.1097/ncq.0000000000000041] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article describes a quality improvement project to decrease catheter-associated urinary tract infections (CAUTIs) at an academic medical center. A criteria-based, nurse-driven protocol for discontinuation of indwelling catheters and use of bladder ultrasonography in conjunction with intermittent catheterizations was the foundation for change. The CAUTI rate, the number of CAUTIs, cost of medications and supplies associated with treating CAUTIs, catheter duration, and intensive care unit length of stay decreased after protocol implementation.
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15
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Mazzo A, Martins JCA, Jorge BM, Batista RCN, Almeida RGDS, Henriques FMD, Coutinho VRD, Mendes IAC. Validation of the self-confidence scale of nursing care in urinary retention. Rev Lat Am Enfermagem 2015; 23:814-20. [PMID: 26487130 PMCID: PMC4660402 DOI: 10.1590/0104-1169.0256.2619] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 03/05/2015] [Indexed: 11/26/2022] Open
Abstract
Objective: to validate an instrument to measure self-confidence of nursing care in urinary
retention. Methods: methodological research study, carried out after ethical approval. A Likert-like
scale of 32 items related to nursing care in urinary retention was applied to
students of the graduate nursing course. For instrument validation, analysis of
the sample adequacy and main components, Varimax orthogonal rotation and internal
consistency analyses were developed. Results: in a sample of 305 students, there was high correlation of all items with the
total scale and Cronbach's alpha of 0.949. The scale items were divided into five
factors with internal consistency: Factor 1 (0.890), Factor 2 (0.874), Factor 3
(0.868), Factor 4 (0.814) and Factor 5 (0.773), respectively. Conclusion: the scale meets the validity requirements, demonstrating potential for use in
evaluation and research.
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Affiliation(s)
- Alessandra Mazzo
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Beatriz Maria Jorge
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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16
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Murphy C, Prieto J, Fader M. "It's easier to stick a tube in": a qualitative study to understand clinicians' individual decisions to place urinary catheters in acute medical care. BMJ Qual Saf 2015; 24:444-50. [PMID: 26065467 DOI: 10.1136/bmjqs-2015-004114] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/30/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Indwelling urinary catheters (IUCs) placed in acute care are a leading cause of healthcare-associated urinary tract infection. Despite initiatives to minimise the placement of IUCs, levels of inappropriate use are still considered unacceptable. IUC practice is difficult to change, and factors influencing clinicians' decisions need to be better understood. OBJECTIVE To explore why clinicians decide to place IUCs in acute medical care. METHODS We conducted a qualitative study in the emergency department and acute medical wards of a 1200+ bed hospital, undertaking 30 retrospective think aloud and 20 semistructured interviews with nurses and physicians who made the decision to place an IUC. A purposive sample and thematic analysis were used. RESULTS Opinions on when an IUC was warranted varied considerably. Inconsistency in decision-making was caused by differing beliefs on when an IUC was appropriate for each clinical indication. Numerous patient and non-patient factors, including clinical setting, resources, patient age and gender and staff workload, also impacted on each decision. Assessing when the benefit of an IUC outweighed the risk could be problematic due to conflicting goals. CONCLUSIONS These findings help to explain why clinicians sometimes deviate from IUC best practice guidance and resist interventions to modify practice. In order to engage nurses and physicians in change, interventions to reduce IUC use should acknowledge and respond to the complexity and lack of clarity often faced by clinicians making the decision to place an IUC. However, it is equally important that inconsistencies in IUC-related beliefs are recognised, investigated and, where appropriate, challenged.
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Affiliation(s)
- Catherine Murphy
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Jacqui Prieto
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Mandy Fader
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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Simon A, Piechota H, Exner M, Martius J. Katheterassoziierte Harnwegsinfektionen – neue KRINKO-Empfehlung zur Prävention. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 58:515-8. [DOI: 10.1007/s00103-015-2139-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pugh JD, Twigg DE, Giles M, Myers H, Gelder L, Davis SM, King M. Impact and costs of home-based trial of void compared with the day care setting. J Adv Nurs 2014; 71:559-69. [PMID: 25200285 DOI: 10.1111/jan.12525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2014] [Indexed: 11/28/2022]
Abstract
AIMS This paper presents the relative merits and comparative costs of conducting trial of void using Hospital-In-The-Home vs. the Day Procedure Unit. BACKGROUND Hospitals increasingly discharge patients with acute urinary retention with indwelling urinary catheters. For these to be removed and patients supported to return to normal urinary function, outpatient or in-home services are used. To date, the relative effectiveness and costs of Hospital-In-The-Home care and Day Procedure Unit care for trial of void have not been examined. DESIGN This retrospective study used a static-group comparison design. METHODS Hospital administrative data from 1 February 2009-30 March 2011 for patients having trial of void in the Day Procedure Unit (n = 107) and Hospital-In-The-Home (n = 163) of a tertiary hospital in Western Australia were compared in terms of patient outcomes and costs. RESULTS Day Procedure Unit patients had longer wait times than Hospital-In-The-Home patients; there was no difference between the two groups for average per patient days of service or successful first trials. Hospital-In-The-Home care did not increase the overall period of care. Per patient average ward-equivalent cost in the Day Procedure Unit was A$396 higher than the Hospital-In-The-Home ward-equivalent cost. The average cost saving per patient for Hospital-In-The-Home care including trial of void cost and emergency department visits was A$117. CONCLUSION Patient outcomes from Hospital-In-The-Home trial of void in low-risk patients were comparable to those of Day Procedure Unit care and less costly. Hospital-In-The-Home care for this well-defined procedure could permit more efficient management of patient throughput.
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Schuur JD, Chambers JG, Hou PC. Urinary catheter use and appropriateness in U.S. emergency departments, 1995-2010. Acad Emerg Med 2014; 21:292-300. [PMID: 24628754 DOI: 10.1111/acem.12334] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 09/16/2013] [Accepted: 10/22/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Catheter-associated urinary tract infection (CAUTI) is the most prevalent hospital-acquired infection, yet little is known about emergency department (ED) use of urinary catheters. The objective was to describe use of urinary catheters in U.S. EDs and determine the proportion that was potentially avoidable. METHODS The National Hospital Ambulatory Medical Care Survey (NHAMCS), a weighted probability sample of U.S. ED visits, was analyzed from 1995 through 2010 for use of urinary catheters in adults. Use of a urinary catheter was a specific chart review element and was classified as potentially avoidable if none of the Centers for Disease Control and Prevention (CDC) list of appropriate indications were met by ED visit diagnoses or patient disposition. Annual frequency of urinary catheter use and appropriateness were calculated. Predictors of ED-placed urinary catheters for admitted patients were assessed with multivariate logistic regression. RESULTS The annual rate of ED-placed urinary catheters varied from 2.2 to 3.3 per 100 adult ED visits. Among admitted patients, 8.5% (95% confidence interval [CI] = 8.0% to 9.1%) received urinary catheters; 64.9% (95% CI = 56.9% to 72.9%) were potentially avoidable. Among discharged patients 1.6% (95% CI = 1.5% to 1.7%) received urinary catheters. There was no significant trend over time in the use of urinary catheters or potentially avoidable urinary catheters (PAUCs). Predictors of catheter use in admitted patients included indicators of patient severity, female sex, and race/ethnicity. Hospital characteristics predicting catheter use included region, ownership type, and urban location. Predictors of potentially avoidable urinary catheter use were lower patient severity, female sex, care by a midlevel practitioner, and nonurban location. CONCLUSIONS Reducing use of urinary catheters outside of CDC guideline criteria in ED patients is a promising strategy to reduce CAUTIs.
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Affiliation(s)
- Jeremiah D. Schuur
- The Department of Emergency Medicine; Brigham and Women's Hospital; Boston MA
- The Department of Medicine (Emergency); Harvard Medical School; Boston MA
| | | | - Peter C. Hou
- The Department of Emergency Medicine; Brigham and Women's Hospital; Boston MA
- The Department of Medicine (Emergency); Harvard Medical School; Boston MA
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Abstract
OBJECTIVES The aim of this study was to validate 4 sonographic methods of estimating stomach volume for the purpose of monitoring changes in gastric volume over time and to describe the echogenic characteristics of milk feeds. METHODS Twenty-four infants were monitored during a single intragastric tube feed, with 2 ultrasound images of the entire stomach and an image of the antral cross-sectional area (ACSA) before, during, and after the feed. Raw measurements, 3 stomach volume calculations, and ACSA were tested for intra- and interrater agreement. Calculated stomach volumes and ACSA were compared with delivered feed volumes, and characteristics of stomach image echogenicity graded at each time point. RESULTS Spheroid calculation of stomach volume was the most reliable and valid measure of stomach volume. Fortified breast milk feeds were more echogenic than unfortified breast milk feeds. Residual stomach volumes (median 2.12 mL, range 0.59-9.27 mL) were identified in 18 of 24 infants. CONCLUSIONS Direct ultrasound stomach measurement (spheroid) will provide a useful research tool and a potential clinical tool for assessing gastric emptying and feeding intolerance in preterm infants.
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Dal U, Korucu AE, Eroğlu K, Karataş B, Yalçın A. Sacral region massage as an alternative to the urinary catheter used to prevent urinary retention after cesarean delivery. Balkan Med J 2013; 30:58-63. [PMID: 25207070 DOI: 10.5152/balkanmedj.2012.083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 09/05/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of the study was to determine the effect of massage to the sacral region after cesarean delivery instead of employing a urinary catheter for the prevention of urinary retention. STUDY DESIGN Cross sectional study. MATERIAL AND METHODS This interventional study population consisted of 60 women who were divided into two intervention groups and one control group. For the first intervention group, the sacral region was massaged every hour 10-15 minutes after cesarean delivery and every 30 minutes after a voiding sensation for the second intervention group. No interventions were made in the control group, although routine hospital services were provided. Socio-demographic data were collected using a questionnaire developed by the researchers. Other data were collected via observation. RESULTS Fifteen percent (15%) of the women in the first intervention group needed to void 2 hours after cesarean delivery, 35% after 3 hours, and the mean time to void after delivery was 3.4±0.8 hours. Forty percent (40%) of the women in the second intervention group needed to void after 5 hours, and the mean time to void after delivery was 5.5±0.8 hours. Sixty percent (60%) of the women in the control group needed to void 6 hours later, and the mean time to void after delivery was 6.2±0.7 hours. Urinary retention was not observed in the first intervention group. Our statistical analysis showed a significant difference between the three groups in terms of mean times to void after cesarean delivery (p<0.05). CONCLUSION In order to facilitate voiding and to prevent urinary retention, which is seen as a post-cesarean complication, massaging the sacral region could be recommended instead of urinary catheter insertion. Additional studies with larger groups are also recommended.
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Affiliation(s)
- Umran Dal
- Department of Nursing, Faculty of Health Science, Near East University, Nicosia, Turkish Republic of Northern Cyprus
| | - Aslı Er Korucu
- Department of Nursing, Faculty of Health Science, Near East University, Nicosia, Turkish Republic of Northern Cyprus
| | - Kafiye Eroğlu
- Department of Nursing, Faculty of Health Science, Hacettepe University, Ankara, Turkey
| | - Belkıs Karataş
- Department of Nursing, Faculty of Health Science, Near East University, Nicosia, Turkish Republic of Northern Cyprus
| | - Ali Yalçın
- Department of Gynecology and Obstetrics, Life Hospital, Gazi Mağusa, Turkish Republic of Northern Cyprus
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Acute nursing care of the older adult with fragility hip fracture: An international perspective (Part 1). Int J Orthop Trauma Nurs 2012. [DOI: 10.1016/j.ijotn.2012.09.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Johansson RM, Malmvall BE, Andersson-Gäre B, Larsson B, Erlandsson I, Sund-Levander M, Rensfelt G, Mölstad S, Christensson L. Guidelines for preventing urinary retention and bladder damage during hospital care. J Clin Nurs 2012; 22:347-55. [DOI: 10.1111/j.1365-2702.2012.04229.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Nurse-directed interventions to reduce catheter-associated urinary tract infections. Am J Infect Control 2012; 40:548-53. [PMID: 22047997 DOI: 10.1016/j.ajic.2011.07.018] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 07/26/2011] [Accepted: 07/26/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are common, morbid, and costly. Nearly 25% of hospitalized patients are catheterized yearly, and 10% develop urinary tract infections. Evidence-based guidelines exist for indwelling urinary catheter management but are not consistently followed. METHODS A pre/post intervention design was used in this quality improvement project to test the impact of nurse-driven interventions based on current evidence to reduce CAUTIs in hospitalized patients on 2 medical/surgical units. Interventions consisted of hospital-wide strategies including policy and product improvements and unit-specific strategies that focused on a review of current evidence to guide practice. RESULTS The number of catheter days decreased from 3.01 to 2.2 (P = .018) on the surgery unit and from 3.53 to 2.7 (P = .076) on the medical unit. CAUTI rates were too low to achieve significant reduction. Product cost savings were estimated at $52,000/year. CONCLUSION Guidelines derived from research and other sources of evidence can successfully improve patient outcomes. Nurse-driven interventions, combined with system-wide product changes, and patient and family involvement may be effective strategies that reduce CAUTI.
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