Urinary Catheters Study Notes

Urinary Catheters

Concept: Elimination

  • SLOS 1, 2, 3, 4, 5, 6

Objectives

  • To view different types of urinary catheters.

  • To review indications for using a urinary catheter.

  • To discuss the implications of catheter-associated urinary tract infections (CAUTIs).

  • To discuss prevention strategies for CAUTIs.

Types of Catheters

  • Straight Catheters: A type of catheter that allows for urine drainage and is meant for single use.

  • Suprapubic Catheters: Inserted directly into the urinary bladder through the abdomen for long-term urine drainage.

  • Indwelling Catheters (Foley Catheters): Remain in place for an extended period, typically held by a balloon inflated inside the bladder.

  • Condom Catheters: External catheters designed primarily for male patients to manage urine outside the body.

Catheter Lumens

  • A. Urine Drainage:

    • Straight Catheter Cross-section: Shows catheter tip and its mechanism for urine drainage.

    • Balloon: Typically inflated with 5 to 10 mL of fluid to keep the catheter in place.

  • B. Indwelling Retention Catheter:

    • Shows cross-section with balloon inflation and urine drainage.

    • Designed to retain urinary flow within the bladder.

  • C. Triple-lumen Catheter:

    • Inflated balloon typically holding 30 mL, allowing for urine drainage and flow of irrigation solutions into the bladder.

    • Important for specific medical treatments.

Specific Catheter Designs

  • Suprapubic Catheter Configuration:

    • Positioned directly above the pubis for bladder drainage. Includes details on attachment to the urine collection bag.

  • Condom Catheter:

    • External urine management system designed for male users, ensuring ease of use and comfort for the patient.

  • PureWick:

    • A female external catheter providing a new approach for external urine management featuring innovative design.

Indwelling Urinary Catheter (Foley Catheter)

  • Foley Catheter Structure:

    • A specific type of indwelling catheter showing how urine flows down a hollow tube into the bladder.

Indications for Indwelling Urinary Catheter

  • Surgically Indicated Conditions:

    • Used during genitourinary (GU) surgery.

    • Required in prolonged surgical procedures.

    • Necessary for hemodynamic monitoring in critical patients.

  • Clinical Conditions:

    • Large-volume diuresis.

    • Precise measurement of urine output in certain medical circumstances.

    • Management of urinary retention.

    • For patients with incontinence who also have sacral or perineal wounds requiring care.

    • Invasive use in medically unstable patients for monitoring.

Implications of Catheter-Associated Urinary Tract Infection (CAUTI)

  • Statistics and Impacts:

    • Approximately 80% of urinary tract infections (UTIs) are attributed to indwelling urinary catheters.

    • Associated with increased patient pain and discomfort levels.

    • Contributes to heightened rates of hospitalizations and morbidity.

    • Linked to increased mortality risks and prolonged hospital stays.

    • Financial implications as CMS does not reimburse for costs associated with CAUTIs.

Rate of Infection by Catheter Type

  • Surveillance Data:

    • Urethral Catheters show an infection rate of 3% to 10% per day.

    • Suprapubic Catheters show a reduced infection rate of 1.1% to 3.6% per day.

    • Notably, UTIs from suprapubic catheters are not reportable to CMS as CAUTI events.

  • Clinical Outcomes:

    • Suprapubic catheters present an opportunity for minimally invasive approaches with a significant reduction in CAUTI incidence.

  • Economic Benefits:

    • Potential hospital revenue increase between $1,200 and $4,700 per avoided episode of CAUTI-related hospitalization.

QSEN and Evidence-Based Practice (EBP)

  • Case Example:

    • A nursing unit reports a rise in CAUTIs. Investigations reveal some staff resistance to adopting new EBP guidelines for CAUTI prevention. Suggestions include promoting education and coaching to minimize resistance toward EBP care initiatives.

CAUTI Prevention Strategies

  • Best Practices:

    • Insert catheters only for appropriate clinical indications.

    • Ensure a "closed system" is maintained during catheter use.

    • Maintain unobstructed urinary flow.

    • Insert catheters using aseptic techniques and sterile equipment.

    • Conduct continual assessment of catheter placement and functionality with interventions as needed.

    • Limit duration of catheter usage to reduce infection risk.

    • Implement nurse-driven bundles for catheter care and discontinuation.

Catheter Insertion Demonstration

  • Indwelling Urinary Catheter Insertion:

    • Detailed processes for inserting both indwelling urinary catheters in female and male patients, highlighting procedural techniques and precautions.

References

  • NURSINGcom w/Jon Haws, RN.

    • Videos on male and female Foley catheter insertion.

  • Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2023). Fundamentals of Nursing (11th ed.). Elsevier.