Minimizing the complications associated with migrating catheters

Knowledge and beliefs of intensive care nurses about urinary catheter securement: Results of a national survey

OBJECTIVE

To explore the knowledge and beliefs of intensive care nurses about urinary catheter securement.

METHOD AND SETTING

A self-report survey tool comprising 19 questions (15 closed, 4 open-ended) was developed through consultation with a panel of experts and then disseminated electronically to nurse members of two societies for critical care medicine and nursing in Spain. Responses were analysed by calculating descriptive statistics and through qualitative analysis.

MAIN OUTCOME MEASURES

Nurses' self-reported knowledge and beliefs about urinary catheter securement in the intensive care patient.

RESULTS

Responses of 333 nurses were analysed. Most respondents considered that urinary catheter securement was beneficial for patients (n = 261, 78.4 %) and that it reduced the risk of both meatal pressure injury (n = 266, 79.9 %) and accidental tugging (n = 304, 91.3 %). Regarding the securement procedure, less than a quarter of nurses mentioned the use of barrier film to protect the skin at the securement site (n = 62, 18.6 %) or the need to leave slack in the tube to avoid tugging (n = 45, 13.5 %). Qualitative analysis of responses to open-ended questions revealed that some nurses believed that catheter securement was contraindicated due to the risk of skin injury, or that it interfered with some aspects of basic care, thus increasing their workload.

CONCLUSIONS

There appears to be a lack of knowledge among Spanish intensive care nurses about recommended procedures for securing a urinary catheter. Clear and concise guidelines for the intensive care setting are required to ensure safe and standardised practice without creating additional burden for nurses.

IMPLICATIONS FOR CLINICAL PRACTICE

Lack of knowledge among intensive care nurses about how to secure urinary catheters may pose certain risks to patients, therefore specific training in how to secure a urinary catheter is needed.

Securement of the Indwelling Urinary Catheter: A Prevalence Study

PURPOSE

The aims of this study were 4-fold: (1) to examine the proportion of indwelling urinary catheters that were secured in an acute care setting; (2) to determine the proportion of secured catheters that were secured correctly; (3) to examine the association of catheter securement with type of unit, age, sex, and location of insertion; and (4) to determine the proportion of units with catheter securement products available on the unit.

DESIGN

Descriptive prevalence study.

SUBJECTS AND SETTING

All medical and surgical units (n = 21) were surveyed for inpatients with indwelling urinary catheters in 1 urban tertiary care hospital in Western Canada. Critical care and pediatric units were excluded.

METHODS

During a 6-hour period, 6 RNs data collectors recorded presence and accuracy of catheter securement, area where the participant was catheterized, and availability of securement products on unit. Data were collected using a data form designed for the study.

RESULTS

Seventy-two of 370 inpatients had indwelling catheters on the day of the study. Of these, 61% (44/72) participated. The overall prevalence of catheter securement was 18% (8/44). Seven of the 8 secured catheters were secured correctly. The primary method of securement was a commercial adhesive device (6/8; 75%). Securement products were stocked on 47% of medicine units and 92% of surgical units.

CONCLUSION

Findings are consistent with other studies and indicate that catheter securement practices are inadequate despite several guidelines published on catheter care.

Innovation in catheter securement devices: minimising risk of infection, trauma and pain

Urinary catheters are one of the most common invasive devices used in the NHS. The risks are well-documented and the practice of catheterisation of the bladder has been around for years. Traditionally catheter fixation devices have not been widely used, despite many best practice guidelines advising on their use as a standard within catheter care and maintenance. This article considers some of the evidence around urinary catheterisation and the benefits and limitations of fixation devices. There will be a product focus on the Optimum Medical Ugo Fix Gentle catheter fixation device, with case histories to demonstrate patient satisfaction with the product.

Concept Analysis and Content Validation of Risk of Injury to the Urinary Tract: Nursing Diagnosis

PURPOSE

To elaborate, propose, and validate risk for urinary tract injury as a nursing diagnosis.

METHODS

Methodology was divided into three phases: analysis of the concept of urinary tract injury, elaboration of the diagnosis, and validation by a group of specialists.

FINDINGS

Diagnosis label, definition, and inclusion in taxonomy were validated. In 15 risk factors proposed, 12 were validated.

CONCLUSIONS

Risk of urinary tract injury was validated as a nursing diagnosis to contemplate the vulnerability of patients using urinary catheters.

IMPLICATIONS FOR NURSING PRACTICE

Identification of these risk factors contributes to the elaboration of care plans to improve quality of care.

Catheter lubrication and fixation: interventions

This article looks at the indications for catheterisation, the anatomy of the urethra, the importance of asepsis and the rationale for the use of urethral lubrication for catheter insertion. The variations of lubrication available are discussed, including the use of products containing lidocaine and chlorhexidine. It then considers the problems caused by traction to the catheter and discusses the securement devices available for preventing tissue damage at the bladder neck, within the urethra and also at the meatus. The variation of devices is examined along with the potential problems associated with their use. Finally, it discusses the importance of clinicians being knowledgeable about the problems looked at and how to resolve them.

Improving service provision for patients who are prescribed continence products

It is estimated that 14 million people experience problems with bladder control and 6.5 million people have a bowel control problem (Bladder and Bowel Foundation, 2008). Many will rely on continence products to manage their problem and as such require products which ensure user dignity and discretion is maintained. Locally, an ever-increasing spend on prescribed continence products promoted a review of current service delivery. The combined results of a clinical audit and patient satisfaction survey highlighted areas in which service delivery needed immediate improvement. Significant service re-design has been undertaken with prescribing responsibility for continence-related products being transferred from GP practices to specialist nurses working within the continence service. Improvements in clinical care have been achieved and cost savings have been re-invested in the service.

Biofilm and other causes of pain in catheterization

This article looks at the anatomy of the bladder and how sensations, including pain, are transmitted to the brain. The use of urinary catheters is discussed and initially, the development of biofilm is addressed, from its cause, structure and effect, to how it can be treated. Many of the problems arising from biofilm and the resulting encrustation, can lead to pain, and the causes of this are discussed. Other problems which can cause patients to experience pain are also considered, and where there are possible solutions, these have been put forward. However, even when good practice is carried out, there will still be problems encountered, and further research is needed.