Management of short-term indwelling urethral catheters to prevent urinary tract infections

Preventing infection with long-term indwelling urinary catheters

This article sets out to inform readers on the care and management of indwelling catheters. The reason for urinary catheter insertion is discussed and the decision to use a long-term indwelling urinary catheter is explained. This article focuses on the risk of urinary tract infections (UTI) associated with the use of long-term indwelling catheters and how these may be avoided. Examples of current products are detailed and how the selection of the right product may be achieved is also outlined.

Strategies to promote intermittent self-catheterisation in adults with neurogenic bladders: A comprehensive systematic review

EXECUTIVE SUMMARY

Background Clean intermittent self-catheterisation is the gold standard in the management of neurogenic/neuropathic bladder disorders, providing independence, alleviating symptoms and complications of the urinary tract.Objectives The objective of this systematic review was to establish the best available evidence on strategies to promote intermittent urethral self-catheterisation in adults with neurogenic/neuropathic bladders.Methods The search strategy identified published and unpublished studies reported from 1970 to 2009. Individual search strategies were developed for the 12 databases accessed and search alerts established. The review considered qualitative and quantitative studies, mixed methods and case studies. Interventions, programs and strategies preparing adults to self-catheterise included education, suitability for selfcatheterisation and interventions promoting compliance and continuity. Outcomes of interest were the quality of life and depression, long-term compliance, advantages/disadvantages of urethral self-catheterisation and limitations to selfcatheterisation.Standardised critical appraisal instruments developed by the Joanna Briggs Institute were used by two independent reviewers to assess the quality of eligible studies for inclusion in the review. Standardised Joanna Briggs Institute tools were also used to extract data. Criteria developed by Yin were employed to assess case studies. Qualitative findings were synthesised. As statistical pooling of the quantitative results was not possible, these results were presented in narrative form.Results From the 18 studies reviewed, three interventions (education and preparation, suitability to self-catheterise, and interventions promoting compliance/continuity), and three outcomes (effect of self-catheterisation on quality of life and depression, and longterm compliance) were addressed with multiple studies in each intervention and outcome. The results are discussed under four headings: (i) education essentials for selfcatheterisation (ii) factors promoting compliance and continuity with self-catheterisation, (iii) factors influencing quality of life and (IV) diagnostic sub-groups of people with a neurogenic bladder.

CONCLUSION

The narrative and synthesised data from the 18 included studies identified findings to provide a basis for strategies to promote clean intermittent self-catheterisation in adults. These include an extended education program with a pre-education component, ongoing support and skills training. All aspects of education should reflect sound research findings related to quality of life issues.Implications for Practice The implications for clinical practice are the development of a comprehensive standardised education program that includes background information, skills training and follow-up support.Implications for Research The review highlights the need for further experimental research to confirm factors that will promote self-catheterisation in adults with neurogenic/neuropathic bladders, with particular reference specific sub-groups.

Nursing and medical staff knowledge regarding the monitoring and management of accidental or exposure hypothermia in adult major trauma patients

Recording a patient's vital signs is a basic requirement that in part informs clinical decision-making. Practice suggests that recording a trauma patient's temperature is occasionally overlooked in the emergency department. A staff survey was undertaken to gain an appreciation of knowledge and understanding of the issues that surround accidental or exposure hypothermia in trauma patients. Results demonstrate that nurses and doctors are unsure of how to define hypothermia and are not conversant with simple ways to prevent heat loss or rewarm patients. Complications from hypothermia such as coagulopathy and metabolic acidosis were seldom identified. Issues that limit staff recording temperature include patient access and acuity, lack of knowledge and confidence and access to temperature-measuring devices. These results emphasize the need for regular education. Implications for clinical practice were considered; an algorithm to guide staff on ways to improve the monitoring and management of temperature in trauma patients was developed. Opportunities for ongoing and further research were identified.