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At least 19 recordsLinked to original sources
PubMed1987

Study of patients with indwelling catheters.

Indwelling urethral catheters are used for the long-term management of intractable urinary incontinence or bladder outlet obstruction with resultant retention of urine. There are well-described problems associated with their use including urinary tract infections and mechanical problems. Urinary tract infections have been well researched, however mechanical problems associated with blockage of the catheter lumen due to encrustation, leakage of urine and general discomfort, have been the least investigated. To date, there has been no research of patients' views, understanding or feelings in relation to their catheters. This paper comprises a preliminary investigation of patients' understanding and knowledge of their catheter's location and function, its acceptance, problems associated with its use, social implications and its subsequent management. Thirty-six patients from the community of one health district were surveyed. It was concluded that an indwelling catheter is a prosthesis which, to be successful, requires adequate patient education and management. Education of the patient and carers is particularly important since an understanding of the catheter and its function will lead to better acceptance of the device and will enable better management of the urine drainage system.

Adaptation, Psychological↗
PubMed2001

Promoting planned care for patients with indwelling catheters.

Indwelling urinary catheters are common among patients in the community. Use of a catheter entails a significant lifestyle adjustment on the part of the patient, who must learn a new regime of self-care. In order to help patients to cope with the new device, it is essential that nurses play an active role in educating patients and involving them in the decision-making process. By empowering patients through knowledge of their condition and care, nurses can encourage greater compliance with care plans and reduce the risk of potentially distressing complications that can arise from indwelling catheters.

Catheters, Indwelling↗
PubMed1999

Hospital-acquired urinary tract infections associated with the indwelling catheter.

Indwelling urethral catheters are commonly used in patients admitted to acute care hospitals. Forty percent of nosocomial infections occur in the urinary tract, and greater than 80% of these infections are secondary to an indwelling urethral catheter. Fortunately, the majority of catheters are left indwelling for a short period of time. The duration of catheterization is directly related to the development of bacteriuria, nosocomial infection, and possible bacteremia with sepsis. A relatively low percentage of patients become infected during the first 3 to 5 days if sterile technique and proper maintenance of a closed system are performed. Bacteria may grow in the urine (planktonic) and ascend via the lumen, or bacteria in the biofilm around the outside of the catheter may infect the bladder. Most organisms are from the patient's intestinal flora, but exogenous sources on or near the patient may be involved. The major morbid events associated with the catheter are fever and the possible progression to bacteremia and sepsis. Early recognition of complications and arresting their progression, especially in the high-risk patient, are essential. Current research is directed at developing ways to reduce infection beyond the sterile closed system.

Catheters, Indwelling↗
PubMedDate not supplied

Using bladder instillations to manage indwelling catheters.

Indwelling urinary catheters are commonly used in both acute and primary care settings but patients often experience problems with blockage of the catheter as a result of encrustation. Bladder instillations of differing solutions are used in an attempt to prevent and treat this problem of encrustation. This article looks at some of the issues surrounding the use and methods of these solutions. Based on an audit performed by a group of continence clinical nurse specialists in five areas of the UK, results of a questionnaire sent to acute and primary care nursing staff in 2003 are presented and discussed. The questionnaire covered a variety of clinical issues involved in performing bladder instillations and the results show that there is a wide variation of practice across the UK. The authors conclude that there are issues pertaining to bladder instillations which warrant further work.

Acute Disease↗
PubMed1991

[The "TUR catheter", a new indwelling catheter for postoperative bladder irrigation].

A new catheter has been developed for bladder drainage following operations on the prostate or bladder. Instead of having 1 to 3 large holes at the tip, as in common catheters, it has 32 drainage holes, each 1.5 mm in diameter. Thus, unhindered drainage of the bladder is guaranteed even if the majority of the holes is obstructed.

Catheters, Indwelling↗
PubMed2002

Intermittent versus indwelling catheters for older patients with hip fractures.

Nursing staff identified postoperative urinary tract infection (UTI) in patients with hip fracture as an increasing problem. A quality improvement project was carried out to investigate the problem and to reduce the incidence. The aim of the study was to describe the occurrence of UTI among patients with hip fracture before and after surgery, to assess whether the decision to use intermittent catheters instead of indwelling catheters was adopted and to test the hypothesis that hospital stay is significantly longer for patients with UTI than for those without infection. One hundred and forty-four patients were investigated for bacteriuria before the first catheterization and 1 week after the last catheterization. Positive urine cultures on admission to hospital were found in 38% of patients. Among those free from bacteria on admission, 61% had a positive urine culture after indwelling catheterization compared with 32% in the group treated with intermittent catetherization. A significantly longer hospital stay (P </= 0.05) was found among patients with UTI. The reason for using an indwelling catheter was not found in any medical or nursing documentation for 29% of the patients. The study points to the necessity for systematic assessment to detect and prevent UTI among older patients with hip fracture.

Age Factors↗
PubMed2005

Controlling antimicrobial use and decreasing microbiological laboratory tests for urinary tract infections in spinal-cord-injury patients with chronic indwelling catheters.

PURPOSE: The effect of replacing the indwelling catheter of patients suspected of having a urinary tract infection (UTI) before collecting a urine sample on the number of organisms isolated in cultures and on drug and microbiology laboratory costs was studied. METHODS: Data were collected for all patients hospitalized in two spinal cord injury (SCI) units between October 2001 and March 2002 who had an indwelling catheter or suprapubic catheter and were suspected of having a UTI. Urine samples were obtained through a port of the indwelling catheter in one SCI unit, while the indwelling catheter was replaced immediately before each urine sample was obtained in the second SCI unit. Patient demographics, history of antimicrobial use, bacterial isolate sensitivity data, and current antimicrobial treatment were recorded. RESULTS: A total of 85 patients, 41 in the control group and 44 in the intervention group, were enrolled during the six-month study period. In the control and intervention groups, 93 and 79 organisms were isolated, respectively, with an average of 2 isolates per patient in the control group and 1 per patient in the intervention group. Patients in the control group had significantly more multidrug-resistant organisms in their urine, with 34 isolated from 26 patients (63%) (p < 0.001). Changing the indwelling catheter decreased antimicrobial and microbiology laboratory costs, resulting in a cost saving of $15.64 per patient. CONCLUSION: Replacement of the indwelling catheter before collecting a urine sample for culture and conducting susceptibility testing reduced the pathogens identified, the number of toxic antimicrobials prescribed to treat the infection, and the costs of antimicrobials and microbiology laboratory technician time.

Administration, Oral↗
PubMed1995

Problem solving and troubleshooting: the indwelling catheter.

Long-term use of an indwelling catheter is seldom free of problems, and the complications associated with indwelling catheters cause significant morbidity and mortality. Often there are alternatives to long-term catheterization; it is assumed in this article that the patient will have been appropriately assessed for other methods of continence control. In this article, leakage around the catheter (bypassing) is discussed. This problem is multifactorial: irritation caused by the catheter balloon, improper sizing of catheter, confusion of the patient, bacteriuria, constipation or fecal impaction, blocked catheters, problems related to materials used in catheter construction, and improper positioning of the catheter are all potential problems contributing to leakage in the patient with an indwelling catheter. Emphasis is placed on etiology because understanding the underlying problem is crucial to implementing effective treatment.

Aged↗
PubMed1997

A randomized study to compare biodegradable self-reinforced polyglycolic acid spiral stents to suprapubic and indwelling catheters after visual laser ablation of the prostate.

PURPOSE: A randomized controlled study was done to evaluate the efficacy of the self-reinforced polyglycolic acid spiral stent compared to a suprapubic catheter, and combined suprapubic and indwelling catheters in the prevention of urinary retention after visual laser ablation of the prostate. MATERIALS AND METHODS: We studied 72 men with benign prostatic hyperplasia who underwent placement of a suprapubic catheter and visual laser ablation of the prostate. In 27 men in group 1 the self-reinforced polyglycolic acid spiral stent was inserted into the prostatic urethra after visual laser ablation of the prostate, while 23 in group 2 received no other devices. In 22 men in group 3 an indwelling catheter was left in situ for an average of 6.5 days. RESULTS: Voiding began 1 or 2 days postoperatively in 20 of 27 patients (median 1 day) in group 1, and 8 of 23 (median 6 days) in group 2. In 16 of 22 men in group 3 voiding began 1 or 2 days (median 6) after removal of the indwelling catheter. Improvements in patient weighted symptom score, mean peak urinary flow rate and post-void residual volume were significant (p < 0.001) at 6 months of followup in all groups. The overall infection rate was 30%. CONCLUSIONS: The self-reinforced polyglycolic acid spiral stent is superior to the suprapubic catheter alone, and to combined indwelling and suprapubic catheters for the treatment of postoperative urinary retention after laser therapy, offering possibilities for shorter catheterization time.

Aged↗
PubMed1997

Unchanged insulin absorption after 4 days' use of subcutaneous indwelling catheters for insulin injections.

OBJECTIVE: Since 1985, we have used indwelling catheters (Insuflon, Maersk Medical, Lynge, Denmark; Chronimed, Minnetonka, MN) to lessen pain when injecting insulin. However, some patients experience a rise in blood glucose after using indwelling catheters for a few days. We therefore studied the absorption of 125I-labeled insulin when using indwelling catheters. RESEARCH DESIGN AND METHODS: Five men and five women participated (age 18-25 years, C-peptide negative, HbA1c 9.0 +/- 1.0% [mean +/- SD, DCA-2000 method], diabetes duration 5-21 [median 9.5] years). After thyroid blockage with potassium iodide, we injected 5IU of 125I-labeled short-acting insulin subcutaneously in the abdomen ("ordinary injection") and 5 IU on the contralateral side through an indwelling catheter ("catheter injection"). The injection/insertion area was free of lipohyper- and lipohypotrophies. Disappearance rate was measured for 180 min with a gamma camera. The patients injected all premeal injections of short-acting insulin through the same indwelling catheter in the following 4 days. The investigation procedure was repeated day 3 and 5. RESULTS: We found no statistically or clinically (95% CI) significant difference in residual activity of 125I-insulin after 60 min or in time for 50% of the injected depot to disappear (T-50%) among catheter injections on day 1, 3, and 5; ordinary injections on days 1, 3, and 5; or catheter and ordinary injections on days 1, 3, and 5, respectively. HbA1c correlated both to T-50% (r = 0.73, P = 0.016) and residual activity of 125I-insulin after 60 min (r = 0.69, P = 0.028), indicating that patients with a slower absorption will have a less ideal metabolic control when using premeal bolus injections. CONCLUSIONS: We conclude that using indwelling subcutaneous catheters for insulin injections for up to 4 days does not affect the absorption of short-acting insulin.

Absorption↗
PubMed1988

Effects of indwelling catheters on the urethral mucosa (polypoid urethritis).

Indwelling catheters are almost invariably associated with characteristic mucosal lesions of the urinary bladder, commonly referred to as polypoid cystitis. In the present study, 20 male patients with indwelling catheters (due to benign prostatic hyperplasia) for 1-12 months were studied. Three non-catheter bearing male patients served as controls. Biopsies were taken from the posterior urethra in all patients and from the bladder in 16 of the 20 patients with indwelling catheters. All patients with catheters had endoscopic lesions in the urethra. The lesions varied from polypoid to bullous or oedematous, with or without hemorrhagic discoloration. In 11 of 20 patients the urethral lesions were histologically almost identical to polypoid cystitis. In the remaining 9 patients the reaction was less pronounced, and oedema, with or without mucosal hemorrhage, dominated. Due to the similarity between the catheter associated bladder lesions and the urethral lesions we suggest the term polypoid urethritis for the urethral lesions. There was no correlation between type of catheter used or how long it was used and the mucosal lesions. The results suggest mechanical irritation and/or pressure exerted by the catheter on the mucosa is responsible for the development of polypoid urethritis.

Aged↗
PubMed1978

The management of indwelling catheters.

Eighteen geriatric patients with indwelling catheters were observed for a total of 393 weekly urine specimens. The effects of a 1 week course of antibiotics/chemotherapeutic agent followed by urinary antiseptics for 6 weeks, and also of regular bladder washouts, were noted. All urine specimens were infected except 24% during antibiotic treatment and 9% during antiseptics and 6% after washouts. Only washouts reduced the extent of catheter blockage. There was little difference in the time in situ between silastic and latex Foley catheters--only 31% of silastic remaining for longer than 4 weeks. Bard-Roberts catheters were the least satisfactory. Catheter leakage was not affected by urinary pH. Further development in long-term catheter management are needed.

Anti-Bacterial Agents↗
PubMed1990

Absence of significant bacteremia during urinary catheter manipulation in patients with chronic indwelling catheters.

The objective of this study was to quantify the microorganisms present in blood at urinary catheter removal and at reinsertion in patients with chronic indwelling urinary catheters. This was a prospective study during a 4-month period at a university-affiliated geriatric medical center. Our subjects were 33 patients with chronic indwelling urinary catheters and positive urinary cultures; the urinary catheter was usually changed once a month. A peripheral vein line was used for blood withdrawal and urinary cultures and quantitative blood cultures (Isolator) were performed during and shortly after urinary catheter removal and insertion. All patients had significant bacteriuria (greater than 10(5) cfu/mL) with an average of 2.3 microorganisms. Among the 46 sequential quantitative blood cultures performed, only two patients had bacteremia from the urinary source and at a very low concentration; one patient had 0.13 cfu/mL Str. faecalis in blood 5 minutes after removal of the urinary catheter, and the other 0.1 cfu/mL Proteus mirabilis 5 minutes after reinsertion of a new urinary catheter. None of the patients had any subjective or objective clinical problem during the 36 hours after the urinary manipulation. Clinical symptoms and bacteremia are rare events, and prophylactic antibiotics do not appear necessary during urinary catheter removal and reinsertion in elderly institutionalized patients. Further studies are necessary to identify risk factors in the rare instances of patients with bacteremia.

Aged↗
PubMed2005

Removing indwelling catheters: trial without catheter in the community.

Indwelling urinary catheters are inserted to drain the bladder for a variety of reasons, but are an intervention of last resort. Unless contraindicated, patients with an indwelling catheter should therefore have at least one trial without catheter to assess if they can pass urine without having a catheter in situ. The commonest method in undertaking trial without catheter is to remove a indwelling urethral catheter and monitor urinary output over a period of time. Another method is when the catheter is not removed in patients who have a suprapubic catheter. Instead the catheter is clamped, and urethral urine output monitored. This is followed by immediately measuring any residue of urine drained via the supra-pubic catheter. This article looks at undertaking a 'trial without catheter' using both methods and examines the arguments concerning when to remove catheters, midnight or early in the morning.

Clinical Trials as Topic↗
PubMed1992

Complications associated with indwelling catheters.

Between 1983 and 1985, 170 consecutive patients received doxorubicin-containing adjuvant chemotherapy through central venous catheters, and four via a long indwelling catheter in the antecubital fossa. The objective of this retrospective study is to determine the acute and chronic complications associated with indwelling catheters. Ninety-four (56%) patients did not experience any complications. The incidence of acute complications was 2%, which included three pneumothorax. Twenty-nine (17%) patients experienced chronic complications. Of those, 20 (12%) developed infectious complications, and 9 (19%) developed thrombus. In addition, 12 (7%) developed multiple complications, and 32 (19%) patients had other local complications at the catheter site, which included allergic reactions and catheter breakage. Each of these complications was resolved with appropriate treatment. None of the patients died from complications of the indwelling catheter.

Bacterial Infections↗
PubMed2002

Indwelling catheters used from the onset of diabetes decrease injection pain and pre-injection anxiety.

OBJECTIVES: To investigate the use of indwelling catheters as injection aids at diabetes onset to reduce injection pain and pre-injection anxiety. STUDY DESIGN: Forty-one patients aged 8.1 +/- 3.7 years (range, 1-15) participated in this open, controlled randomized study. A 10-cm VAS with faces was used for scoring. A local anesthetic cream was used before all insertions. The control group used insulin pens with standard needles. After one week, the indwelling catheter group could choose regular injections but were included in the "intention to treat" analysis. RESULTS: Injection pain and anxiety decreased from day 1 to 15 in both groups (average, 4.1 injections/day). Pain was significantly lower for indwelling catheter injections when scored by parents (median, 1.2 cm vs 2.7 cm; P =.002), children/teenagers (0.8 cm vs 1.5 cm; P =.006), and nurses (1.4 cm vs 3.0 cm; P =.002). Parental pre-injection anxiety was also lower (1.2 cm vs 2.9 cm; P =.016). Taking injections, including inserting catheters, was found to be less problematic with an indwelling catheter (1.6 cm vs 3.3 cm;P =.009). During the 6-month follow-up, injection pain and injection problems were significantly lower in the catheter group. Mean catheter indwelling time was 3.7 days. Median pain for catheter insertion was 2.1 cm and for glucose testing was 0.9 cm. Sixteen of 20 patients continued to use indwelling catheters after 2 weeks, and 9 of 20 after 6 months. CONCLUSIONS: We found an evident relief of pre-injection anxiety and injection pain when using indwelling catheters for introducing insulin injections at the onset of diabetes.

Adolescent↗
PubMed1980

Experimental endocarditis in rabbits. 4. Experiments with Serratia marcescens: on the significance of serum susceptibility and proteolytic capacity of the strains and the influence of an indwelling catheter.

In order to investigate the course of Serratia marcescens endocarditis in groups of rabbits with and without an indwelling catheter, 130 rabbits were pretreated to produce left-sided endocarditis. Three clinical isolates of S. marcescens were used to infect the rabbits, i.e. CDC O13 (serum sensitive, proteolytic), SM 104 (serum resistant, proteolytic) and SM 55 (highly serum resistant, non-proteolytic). Ten rabbits with an indwelling catheter were challenged with CDC O13 and none of them died or showed evidence of endocarditis 28 days later. In groups of rabbits with indwelling catheters which were challenged with SM 104 or SM 55 there was a high incidence of endocarditis (19/20, 18/20, respectively), while groups without catheters inoculated with the same strains had a lower incidence (5/20, 15/20, respectively). In contrast to earlier observations with Streptococcus faecalis, the clinical and pathological data were not significantly influenced by the presence or absence of proteolytic capacity of the infecting strains. The results indicate that the ability of S. marcescens to establish endocarditis depends significantly on the degree of serum resistance of the strains. This difference was only demonstrable in experiments without an indwelling catheter during the infection period. The distrurbing influence of an indwelling catheter is discussed, and it is concluded that experimental models using indwelling catheters are inappropriate for studies on the pathophysiology of endocarditis.

Animals↗