Biofilms and urethral catheter infections

Flexible cystoscopy: outpatients or domiciliary?

The cost of caring for people in the community with long-term indwelling catheters varies widely but represents a significant amount of NHS spending. A rapid access catheter clinic was established at a Bristol hospital, for people experiencing difficulties with their long-term catheters, to facilitate prompt assessment and treatment. Many patients were found to be severely disabled with mobility problems and relied on hospital transport to attend the clinic for flexible cystoscopy. As a consequence the concept of undertaking this procedure on a domiciliary basis was introduced with a view to cutting costs, improving time management and offering a more reliable service to patients. A prototype battery-powered flexible cystoscope was developed to facilitate this service and five visits were undertaken. Feedback from patients indicated a preference for the domiciliary service and cost benefits were identified. As a result of these initial experiences, we are now planning a pilot study to establish the feasibility and costs of providing a domiciliary service on a permanent basis and gather qualitative data from patients on quality-of-life issues.

An audit of problems associated with urinary catheter withdrawal

Long-term catheterisation is associated with many complications, including urinary tract infections which may lead to encrustation and catheter blockage. Current management of catheters susceptible to frequent blocking is to attempt to prolong catheter life by using bladder maintenance solutions or to change catheters proactively by identifying a characteristic blocking pattern for the patient. However, catheter removal is associated with a number of problems. This article describes an audit conducted in one trust to identify the types of catheter material associated with removal difficulties. All-silicone catheters appeared to have a higher incidence of reported problems. The formation of a 'cuff' in all-silicone catheters when the catheter balloon fails to deflate to its original shape has been investigated as an important factor in difficult removal. The audit also examined what action was taken when nurses were unable to remove a catheter.

Catheterization and urinary tract infections: microbiology

Patients with urinary catheters are a substantial proportion of the total patient population and catheter care is an important area of nursing practice. Urinary tract infection associated with catheterization is known to be the most common nosocomial (hospital-acquired) infection. Urinary tract infections can be caused by exogenous microorganisms or endogenous faecal or urethral microorganisms. The different microorganisms which are responsible for causing urinary tract infections have particular characteristics. Many microorganisms form a biofilm, a living layer of cells which stick to the surfaces of the catheter and the catheter bag. Biofilms not only lead to urinary tract infections, but also they are associated with encrustation and catheter blockage. The article considers the microorganisms implicated in catheter-associated urinary tract infections and aims to develop an increased awareness of the characteristics of different pathogens which could lead to enhanced nursing practice and improved patient care.

Management of long-term urethral catheters: minimizing complications

Urinary tract infections, tissue damage and encrustation of the catheter, which may cause blockage, are all complications that can arise during long-term catheterization. It is important for nurses to provide effective catheter care in order to minimize the incidence of these complications. There is still controversy in the nursing literature about certain aspects of catheter management. This article explores a number of aspects of catheter care and suggests a rationale for effective and safe management, including the choice of catheter, choice of drainage system, care of the individual and the care of catheter and drainage system.

Urinary catheters: selection, maintenance and nursing care

Catheterization is often undertaken without sufficient assessment, and the high rates of bacteriuria (10-20%) occurring in catheterized patients seem to be accepted (Ward et al, 1997). This article reviews catheter selection, maintenance and nursing care, highlighting problem areas and suggesting measures that may be taken to reduce the risk factors. A problem-solving approach, based on research evidence relating to catheter care, is presented. Often there is a simple solution to a problem, but treatments based on traditions or myths appear to be the first choice in many situations. This article aims to provide nurses with the evidence base required to establish and maintain a urinary drainage system safely.