Urinary Catheter Guide

Resources, Tips, and Medical Product Reviews for Urinary Catheters

As you may be aware, catheter-associated urinary tract infections are among the most common infections in hospital settings. The causes and facts for CAUTI are numerous, but typically infections are developed from compromised sterility when inserting a catheter, or from leaving them in too long. This post deals with the latter issue.

New studies by Jennifer Meddings and University of Michigan colleagues have been studying hospital reminder systems and their effectiveness in preventing CAUTI and reducing the time and number of catheters required by patients. So far, the reminder systems they’re using to remind hospital staff that patients need their catheter removed have dropped CAUTI by 52%.

This number is huge, considering the number of patients who require cathing after surgery or while immobilized in hospital beds.

According to this Press release, there are four required steps to remove a urinary catheter in a hospital. 1) A physician identifes it’s there. 2) They identify it as unnecessary. 3) The physician requests with written order to remove it. 4) A nurse removes the catheter.

A reminder system can be constructed to skip these steps a number of ways, including stickers on charts, computer-generated reminders on patient’s information form, or placing a “stop order” to identify a date to discontinue further cathing of a patient.

These systems can also be designed to help empower nurses to provide catheter care to patients without requesting an order from a busy physician.

This strategy is extremely inexpensive to implement and has seen an astounding success rate. Stopping half of hospitalized CAUTI can result in not only less patient suffering, but save hundreds of caregiver hours and millions of health care dollars.

Today I found a fact sheet on CAUTI and catheter usage and thought I’d share some of the statistics and information with you.

http://www.wocn.org/pdfs/WOCN_Library/Fact_Sheets/cauti_fact_sheet.pdf

This review of CAUTIs and urinary catheters presents factual, sourced information about the incidence, causes, diagnosis, contributing factors, treatment, and prevention of CAUTI.

Notable points:

1) Catheter infections are one of the most frequent infections today, with 8% prevalence in the homecare setting and 3-7% in the acute care setting.
2) CAUTI is the second most common cause of bloodstream infection, and 3% of patients with a catheter will develop bacteremia (a life-threatening infection). Urosepsis can also develop, which also has a high mortality rate.
3) CAUTI is diagnosed by finding bacteriuria along with an elevated white blood cell count. Some other signs are pain in the bladder or urethra, fever/chills, odorous urine, catheter obstructions, weakness, mental changes in old adults.
4) Some factors increasing the risk of CAUTI include: catheters left in place for more than 6 days, incorrect positioning of tubing, pregnancy, malnourishment, diabetes, azotemia, ureteral stent.
5) Treating CAUTI includes diagnosis and drugs and hospitalization in very serious infections.
6) Prevention starts with removal of the catheter as soon as possible. The longer a catheter is in place, the greater the risk of infection.

Here are some points to prevent CAUTI:

1) Always use sterile equipment
2) Use the smallest sized lumen possible when cashing.
3) Keep the system closed to prevent bacteria development.
4) While not proven, keeping perineal regions clean is recommended.
5) Also not proven but recommended, increased fluid intake may provide benefit.
6) Short-term silver alloy catheters can reduce incidence of CAUTI.
7) Silicone and Hydrogel catheters are recommended for cathing longer than 2 weeks.

Some more interesting points are what is NOT proven to prevent or treat CAUTI:

1) Antibiotics in the drainage bag.
2) Antibiotics and cleansers applied to the meatus.
3) Cranberry Juice (helpful in preventing recurring UTI in non-cathed people but not for preventing CAUTI.)

While most catheters are purchased for medical purposes, many men have found uses for external male catheters aside from incontinence or Urology. Once instance of this is with Scuba Diving.

Nature calls no matter where you’re at, and scuba diving presents some unique challenges. Scuba divers on extra long exploration dives in drysuits at some point need will need to urinate – surfacing on a deep dive to remove equipment and unzip the drysuit just to urinate is not practical or ideal.

And, of course, urinating in a drysuit is never a pleasant experience. So there are two realistic options that do not involve surfacing: 1) Wear a diaper or pad (such as Depends) to soak up urine and dispose when you surface or 2) Wear an external catheter that drains the urine from the suit through an output valve.

Since drysuits are made to prevent water from entering, a way to release urine underwater is needed to vent urine from inside the suit to the outside. Thankfully for male divers, valves designed for drysuits (known as a P-Valve) allow urine to release through a vent and an external catheter system.

A P-Valve connects to the drysuit on the thigh and allows for fluids to transfer out without allowing water in. It attaches directly to an external catheter system that allows the urine to drain through the tubing and out of the P-Valve.

What kind of catheters should be used for Scuba Diving?

A male external “Condom” catheter is the standard catheter worn by male divers. There are multiple options and brands in condom catheters, but typically the favorite among divers seems to be Rochester’s WideBand Catheters. Rochester WideBand series are popular scuba diving catheters because they offer more adhesive area and protection for the wearer than most other external caths.

Also popular is Rocheter Pop-On catheters, which are much shorter in length but still have a securing adhesive band.

There are also female versions of the condom catheter made for diving.

Considerations when using a Catheter during Scuba Diving

• Just as you should with all scuba equipment, keep P-valves and tubing clean. Flush the P-Valve tubing out with vinegar and water after each dive.
• Re-using catheters can cause bacteria buildup, putting you at risk for Urinary Tract Infections. Catheters are relatively cheap, so use a new one instead of attempting to re-use an old catheter.
• Minimize or eliminate kinking and bending of the tube when donning a drysuit. Kinking or bending can cause urine backflow in some instances or build pressure which can cause leaks.
• Consider an adhesive remover to keep away the “tacky” feeling common with using medical adhesives.
• Get proper sizing for the catheter. Catheters are usually measured in millimeters. If you’re unsure which catheter would provide the best fit, suppliers such as Rochester may provide samples, or try purchasing catheters individually in several different sizes to see which ones fit the best.
• If putting on a Wideband or lengthy adhesive bonded external catheter, be sure to pull back or remove any hair prior to wearing!

For good prices on scuba diving catheters, visit STLMedical.com.

For more information on diving with catheters, see these posts on Scubaboard.com:
http://www.scubaboard.com/forums/exposure-suits/212834-pee-valve-catheter-success.html
http://www.scubaboard.com/forums/exposure-suits/210719-wideband-catheter-holy-crap.html

CAUTIs are one of the most common hospital infections, and many times these infections could be avoiding by better procedures followed by nursing staff inserting and changing the catheters. Urinary tract infections increase patient suffering, but even on a purely economical level it’s bad for hospitals because it increases the time and resources needed for care. So, in essence, everyone loses.

Regardless if an individual chooses to self-cath or is being cathed by a caretaker, good procedures should always be followed to prevent infection. And an individual needing a catheter should have a good understanding of the proper procedures for cathing – so, what can a patient do to protect themselves from improper nursing procedures and prevention of UTIs?
Educate Yourself

• Learn how Catheter-associated infections happen.
• Ask a lot of questions about the hospital’s procedures for catheterization. Understand how their process works, and ask what they do to prevent infections from happening.
• Find out the answers to how long it will be needed, why its necessary, and when it expected to be removed.
• If you don’t understand an answer, keep asking. Or perhaps you’re not asking the right questions – so talk with hospital staff who can lead you to the person who can answer your questions properly. Get family and friends involved if necessary to get the right answers.

Keeping it Clean

• Ensure any visitors, nurses, and doctors all clean their hands with soap and water. All caregivers should wash their hands before touching you, the catheter, or the tubing. Don’t touch, or let anyone else touch, the catheter and tubing without washing their hands first.
• Ensure any catheter inserted into the body is sterile and opened immediately before use.
• If you are told you have a high bacteria count on your skin, clean it with an anti-septic solution.
• Keep a stock of soaps, anti-septics, no-rinse cleansers, gels, lotions, etc. for your own personal use and for nursing care.

Getting Help

• Talk with the nurses or doctors immediately if bandages or equipment get wet or dirty.
• If there is any pain, redness, or soreness around the catheter, let the nurses and doctors know.

Catheter-associated Urinary Tract Infections are the source of the suffering of patients, extended costs, and more frequent hospital care for many patients.  In fact, CAUTIs have been on the rise in hospitals for years now.

Medline’s new catheter tray helps to improve the process of cathing patients to help prevent the costly ($4.5 – 6.65 billion dollar) healthcare-associated UTIs from cathing, most of which is due to incorrect procedure in the cathing process.  CAUTIS stand for about 40% of all healthcare-associated infections.

So whats the big idea?  Medline’s new ERASE CAUTI system helps prevent these catheter infections by helping to streamline the process of correct cathing.  Here are some of the new additions:

Photo Illustrations of Tray Contents - Easy and clear instructions for nurses and health care professionals to know exactly how to use the tray.  This is helpful not only for the health care professional, but also explaining the catheter and the tray components to the patient.

Checklist of Procedures – The instructions with the system come with a checklist of procedures for the catheter tray.  Using a checklist dramatically reduces the number of procedural errors in health care; likewise, following correct procedures can dramatically reduce incidents of incorrect cathing and infections.

Patient Education Cards – Included with the tray are materials to educate the patient for the bedside care they are receiving.  The cards are an easy, useful way of providing this information to patients.

One-Layer Tray Design – The simple design of the tray allows the caretaker to follow an easy, straightforward process that leaves little room for variance (and error).  The sequence of events followed using the ERASE CAUTI system follows the instructions from start to finish.  This helps make patient care efficient and accurate.

Visit Medline’s Website for More.

This article from the AP shows that the Catheter-associated Urinary Tract Infections (CAUTIs) have been on the rise in 2009 despite changes in policy that have failed to address the shortcomings of medical care in hospital settings.

In fact, urinary infections caused by catheterization after surgery increased in frequency by 3.6 percent last month.

CAUTIs isn’t the only lacking element of health care infections; bloodstream infections increased by 8 percent, and overall infections increased 1.6 percent.

The silver lining of the report shows that pneumonia follwowing surgery has dropped by 12 percent, but these cases are far less prevelent than CAUTIs, one of the most common forms of infection.

The study also shows us that Catheter associated urinary tract  infections are most common among the low-income patients and the uninsured, disappointing officials in the Institute of Medicine who have worked to educate about medical errors and how to prevent them, including CAUTIs.

These infections increase hospitalization time, patient suffering, and costs which puts more strain on the already complex and strained healthcare system.    Minimizing infections has the opposite effect; better care, less expenses, and one more hospital bed for a new patient.  All CAUTIs can be mediated simply by providing mindful, careful consideration for any catheter insertion.  By good nursing with sterile environments, correct procedures, and changing the catheter at the correct, recommended interval infections can be prevented and possibly eliminated.

The New Jersey-based UroValve has been granted Investigational Device Exemption (IDE) approval for their product, the Surinate Bladder Management System, which means clinical studies will begin according to this Press Release from Urovalve.

Surinate is an ingenious urinary catheter designed for men who suffer from urine retention. Urine retention can be caused from a number of conditions in aging men, the most common being enlarged prostates (BPH) which create urine retention, urge incontinence, and overactive bladder issues.

Many men try drugs, incontinence products such as diapers and external catheters to help manage episodes. Men who can’t do these – or choose not to – will suffer through intermittent catheterization up to 6 times a day to drain their bladder.

The Surniate Catheter isn’t just a catheter, it’s actually a valve system that is far superior to other catheters on the market for these men. Here’s why:

Surniate keeps an open flow from the bladder to the external sphincter (just below the prostate) with a valve system easily controlled with an external magnet. The catheter valves keep the flow turned off until the wearer uses a small magnet externally to “switch” the valve’s position internally, just below the prostate, allowing the urine to flow out. When the magnet is pulled away, the valve shuts again and prevents the urine from flowing out.

• Less catheterization – The Surniate valve system can be work up to 28 days before replaced, as opposed to 4-6 times per day with traditional Intermittent/Foley catherers.
• Easier to Drain – The device allows one to function like normal; scheduling bathroom times and easily draining the bladder without unnecessary cathing and risk of UTIs and unnecessary discomfort.

To find out more about this new technology now undergoing clinical trials including a video, see Urovalve’s Technology page.

The National Associated for Continence (NAFC), an organization that provides education about the cause, treatments, diagnosis, and management of incontinence and other urological dysfunctions, has released a new educational pamphlet for consumers who may be facing urinary catheterization as well as nurses who need to instruct patients on self catheterization.

The publication, sponsored by the Rochester Medical Corporation, outlines step-by-step instructions for self-cathing, product selection, and Medicare coverage for urinary catheters.  There’s also a focus on preventing Urinary Tract Infections, which are of course very common implications for many using catheters that increase suffering, hospital visits, and can even mean severe urological damage for some.

Catheterization is performed by hospitals, homes, or nursing facilities about 4-5 million times per year, and the estimated cost of Urinary Tract Infections (many times due to incorrect catheterization) is over $1.6 billion US dollars annually in the United States alone.

From the article:

Leslie Wooldridge, GNP-BC, editor of this publication, believes this pamphlet will help many. “I will recommend this publication to all of my patients who catheterize, many of whom may not be aware of the recent change in Medicare coverage. Other healthcare professionals will find this pamphlet useful as well.”

Karen Sasso, RN, APN, BSN, MSN, CCCN, clinical reviewer of this publication, explains the use of this pamphlet: “Catheterization should be easy and painless. This pamphlet will help many learn the correct way to catheterize and how to avoid discomfort and possible bladder infections that occur when incorrect technique is performed.”

The pamplet can be purchased from NAFC’s online Paypal store here.  For bulk orders, call them at 1.800.BLADDER (252.3337) or e-mail memberservices@nafc.org.

When a catheter is inserted into the human body, it irritates the urethral and bladder mucosa. This reduces the natural defense mechanism and provides an ideal surface for the growth of bacteria. The chances of getting a urinary tract infection from a catheter are high. The risk of infection increases with the number of days the catheter is in place.

Silver is an antimicrobial with a molecular structure that makes an effective means of destroying microorganisms. Multiple studies indicate that urethral catheters coated with hydrogel and silver salts reduce the risk of developing a urinary tract infection. These benefits apply to catheters coated with silver alloy on both the internal and external surfaces of the catheter. The catheter is not silver in color.

The Health Care Infection Control Practices Advisory Committee has reviewed the various studies performed comparing silver-coated catheters to standard catheters. Their findings indicate that further research is needed on the effect of antimicrobial/antiseptic-impregnated catheters in reducing infections.

This advisory committee recommends:

1. Minimizing urinary catheter use and the duration of use in all patients
2. Avoid the use of urinary catheters for management of incontinence

There is growing evidence that catheter-associated urinary tract infections could be reduced by using silver-coated catheters. It is important to note that the best way to avoid urinary tract infections is to not have a catheter in place. Before deciding to use a silver-coated catheter, discuss this issue with your physician.

More data related to silver-coated catheters:

CAUTI Reduction Strategy

Science Blog

Guideline For Prevention Of Catheter-Associated Urinary Tract Infections 2009

Prevention of Nosocomial Urinary Tract Infection

Hip fracture surgery is a common surgery where a urinary catheter is used to continue regular bladder function. Of course, cathing is not a procedure that anyone wants to go through, its relatively unpleasant, and those going through surgery that requires a urinary catheter want to return to normalcy as soon as possible.

Clamping the catheter is supposed to shorten the amount of time it takes to return to normal bladder function, but a study suggests this common practice has little or no effect on the number of catheters needed or the time cathing is required post-surgery.

Researchers studied 113 patients 50+ who had a hip fracture and urinary catheters. Some had either had their urinary catheters clamped before removed, and some were removed with free drainage.

It was discovered that no difference was found between the two groups in the time it took for their bladders to return to normal function or the time they spent in the hospital.

It’s a benefit for nurses who can simplify the process of re-cathing, which before required the time and consideration to clamp the catheter as part of the procedure.