Catheter lubrication and fixation: interventions

Catheters at home: managing urinary catheters in the home environment

In England, there are some 90000 people with catheters in the community, and community nurses often have to manage catheter-related problems. This article looks at these common catheter problems found in the community, for example, blockage, infections and positioning problems. These problems were identified by a literature review and from the author's experience, from many years working in the community. It has been found that education, knowledge, empowerment and communication are vital factors affecting patients' ability to manager their catheters themselves. The article begins with a discussion about how patients can be involved in and manage many aspects of care for their own catheters. It goes on to talk about the common catheter-associated problems and how these can be avoided or addressed. It is hoped that better management of catheter-associated complications in the community settings can prevent unnecessary visits to the emergency department, which will save time and costs for the health service, as well as avoid the negative impact of these on patient lives.

Managing complications associated with the use of indwelling urinary catheters

The insertion of an indwelling urethral urinary catheter is an invasive procedure that is commonly undertaken in healthcare settings. However, there are several risks and potential complications associated with these devices, so their use should be avoided where possible. It is important that nurses are equipped with the necessary knowledge and skills not only to assess if a patient requires a catheter, but also to minimise the risk of associated complications and to understand how these can be managed. This article discusses some of the common complications that can occur with the use of indwelling urinary catheters, including: catheter-associated urinary tract infections; catheter blockages; encrustation; negative pressure; bladder spasm and trauma; and, in men, paraphimosis. It also explains the steps that nurses can take to reduce the risk of these complications and how to manage them effectively.

One trust's rationale for choosing a lubrication gel for use in catheterisation

Current NHS policy is to reduce the number of catheter-associated urinary tract infections (CAUTIs). To achieve this, guidance suggests reducing the use of catheterisation as much as possible. For those patients requiring catheterisation, Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH) ensured that a medicinal anaesthetic, antiseptic lubricant containing chlorhexidine and lidocaine was used for all catheterisations. Between 2011 and 2018 the Trust reduced CAUTIs by around 50%. This article discusses catheterisation, national policy in reducing CAUTIs, and how NNUH achieved this reduction.

Catheter-associated meatal pressure injury in hospitalized males

AIMS

To assess the prevalence of catheter-associated meatal pressure injury in acute hospitalized males, to determine risk factors for its formation and to propose a grading system for meatal pressure injury severity.

METHODS

In this cross-sectional study, we screened all adult males concurrently hospitalized at a tertiary medical center for indwelling urethral catheters and for meatal pressure injury. We proposed a system to grade meatal pressure injury severity and used logistic-regression modeling to calculate odds ratios (ORs) of possible risk factors.

RESULTS

A number of 168/751 (22.4%) hospitalized males with indwelling urethral catheters were included. Median age was 70.5 (inter-quartile range [IQR]: 57.0-80.3) years, median time from catheterization 5.5 (IQR: 2-11) days. A total of 61 (36%) had meatal pressure injury, as early as the first day after catheterization. Grade III injuries (<2 cm ulcer) developed in 22 (13%) patients, earliest noted on the second catheter day, and grade IV injuries (≥2 cm) in 7 (4%) patients, as early as 5 days post catheterization. In a multivariable analysis, catheter fixation (OR: 0.26 [95% CI: 0.10-0.70]; P = .008) was associated with reduced risk of meatal pressure injury, while catheter presence over 14 days (OR: 1.46 [95% CI: 1.01-1.08]; P = .005) and other skin ulcers (OR: 2.45 [95% CI: 1.05-5.71]; P = .038) were associated with a higher risk of meatal pressure injury.

CONCLUSIONS

Meatal pressure injury is a common complication of indwelling catheters in hospitalized males, beginning days after catheterization. Meatal pressure injury was associated with prolonged catheter presence, other pressure injuries, and lack of catheter fixation. Prospective studies are needed to establish evidence-based guidelines.

A catheter friction tester using balance sensor: Combined evaluation of the effects of mechanical properties of tubing materials and surface coatings

In this study, we introduce a new experimental approach to characterize the forces emerging from simulated catherization. This setup allows for a linear translation of urinary catheters in vertical direction as controlled by an actuator. By employing silicone-based elastomer with a duct of comparable diameter with catheters as urethra model, sliding contacts during the translation of catheters along the duct is generated. A most unique design and operation feature of this setup is that a digital balance was employed as the sensor to detect emerging forces from simulated catherization. Moreover, the possibility to give a variation in environment (ambient air vs. water), clearance, elasticity, and curvature of silicone-based urethra model allows for the detection of forces arising from diverse simulated catherization conditions. Two types of commercially available catheters varying in tubing materials and surface coatings were tested together with their respective uncoated catheter tubing. The first set of testing on the catheter samples showed that this setup can probe the combined effect from flexural strain of bulk tubing materials and slipperiness of surface coatings, both of which are expected to affect the comfort and smooth gliding in clinical catherization. We argue that this new experimental setup can provide unique and valuable information in preclinical friction testing of urinary catheters.

Making a choice of catheterisation gel and the role of chlorhexidine

It is estimated that over 90 000 people in the UK community live with an indwelling catheter ( Wilson, 2016 ). It is essential that a lubricating gel is used during catheterisation, as this helps to reduce the risk of pain, trauma and infection ( Loveday et al, 2014 ; National Institute for Health and Care Excellence, 2012 ). Chlorhexidine is an antiseptic contained in many catheterisation gels. Evidence demonstrates that increasing numbers of patients are experiencing hypersensitivity reactions to this ingredient ( Australian and New Zealand College of Anaesthetists, 2014 ). This article considers the range of catheterisation gel choices available to clinicians and the importance of selecting the correct gel for each patient. It addresses the benefits of using OptiLube Active CHG Free (with lidocaine 2%) - the only catheterisation gel currently available in the UK that contains the benefits of local anaesthetic without chlorhexidine - and recommends that this should be the gel of choice for non-specialist staff conducting catheterisations without individual patient assessments.

Long-term urethral catheterisation: guidelines for community nurses

An estimated 3% of people living in the community and 12% of those living in residential care use long-term urethral catheterisation for the management of urine drainage. This article provides an overview of safe practice for catheterisation in the community setting, highlighting the need for competent and safe patient assessments. It also aims to provide a rationale for product choices.

APSIC guide for prevention of Central Line Associated Bloodstream Infections (CLABSI)

This document is an executive summary of the APSIC Guide for Prevention of Central Line Associated Bloodstream Infections (CLABSI). It describes key evidence-based care components of the Central Line Insertion and Maintenance Bundles and its implementation using the quality improvement methodology, namely the Plan-Do-Study-Act (PDSA) methodology involving multidisciplinary process and stakeholders. Monitoring of improvement over time with timely feedback to stakeholders is a key component to ensure the success of implementing best practices. A surveillance program is recommended to monitor outcomes and adherence to evidence-based central line insertion and maintenance practices (compliance rate) and identify quality improvement opportunities and strategically targeting interventions for the reduction of CLABSI.

Urine-drainage leg bags: an overview

This article looks at leg bags from the perspective of the clinical guidance available, published research, review papers, the diverse nature of products available, and their use with catheters, sheaths or urinals. The part that leg bags play in catheter-associated urinary tract infection control is addressed. Other aspects of catheter safety are discussed, including the avoidance of catheter traction. Variations in leg-bag structure including bag size, inlet tubing, tap, connector and backing, along with the reasons for selecting a particular leg bag are considered, along with the choice of either leg-bag straps or sleeves. The article concludes that, as a result of the variation of leg bags available, patients may require assistance and support from health professionals in finding the right leg bag for them.