Management Of Long-term Catheters Research Articles

Long-term catheter management in the community: a population-based analysis of user characteristics, service utilisation and costs in England.

Long-term urinary catheters are problematic and burdensome for patients, carers and health services. Nursing practice to improve the management of long-term urinary catheters has been held back by a lack of evidence to support policy and practice. Little is known about who uses a catheter long term and the resources and costs needed for their management. Understanding these costs will help to target innovations to improve care. There have been no substantial innovations to urinary catheters or their management recently and no publications to characterise users and costs. To describe long-term catheter users and explore catheter-related service use and costs in England. Descriptive information on the characteristics of catheter users and their use of services was obtained from: General Practice records (n = 607), district nursing records (n = 303), questionnaires to patients (n = 333) and triangulated, 2009-2012. Annual service costs (British pounds 2011) were computed. Most catheter users (59.6%) were men, nearly three-quarters (71.2%) were over 70 years and 60.8% used a urethral catheter. Women tended to be younger than men and more likely to use a suprapubic catheter. The services used most frequently over 12 months were general practitioner (by 63.1%) and out of hours services (43.0%); 15.5% accessed Accident and Emergency services for urgent catheter-related care. Hospital use accounted for nearly half (48.9%) of total health service costs (mainly due to inpatient stays by 13.6% of participants); catheter supplies/medications were next most costly (25.7%). Half of all costs were accounted for by 14.2% of users. The median annual cost of services used was £6.38, IQR: £344-£1324; district nursing services added approximately a further £200 per annum. Finding better ways to reduce catheter problems (e.g. blockage, infection) that cause unplanned visits, urgent or hospital care should be a priority to improve quality of life for long-term catheter users and reduce health service expenditure.

Successful treatment with short-course Daptomycin lock and systemic therapy in two cases of catheter-related bloodstream infections due to uncommon pathogensing catheter-related bloodstream infections due to uncommon pathogens

Short-course Daptomycin lock and systemic therapy for treating catheter-related bloodstream infections due to uncommon pathogens. Treatment of catheter-related bloodstream infections (CRSBI) is one of current major challenges in management of long-term catheters. Daptomycin has proved its efficacy as lock therapy for treating CRSBI due to coagulase negative Staphylococci. Here we describe two cases of successful treatment with short course Daptomycin as lock and systemic therapy for CRSBI due to uncommon pathogens, thus bringing new insights about strategies for a conservative management of devices.

Importance of pH monitoring in the care of long-term catheters.

One of the main complications encountered by patients with long-term in-dwelling catheters is that of catheter blockage as a result of encrustation. This is usually managed at a district nurse level by the administration of catheter maintenance solutions (CMSs) or frequent catheter changes. However, catheter changes and maintenance solutions are often only employed after blockage has occurred. Regular recording of catheter care and urinary pH monitoring can be utilized to optimize the management of long-term catheters and plan catheter changes and CMS administration in a prophylactic manner. This article reviews the literature regarding CMS and urinary pH and demonstrates how the introduction of continued and formalized recording of catheter care and pH monitoring can improve long-term catheter management.

Bladder washouts in the management of long-term catheters

It has been estimated that 40-50% of patients with long-term catheters can suffer with catheter blockage. This not only causes distress to the patient but also increases the demands on community nurses' time and resources. Infection with bacteria such as Proteus causes the urine to become alkaline. Crystalline deposits can then form inside the catheter lumen which causes blockage. Nurses often manage blocked catheters with the use of bladder 'washouts' or bladder instillations. However, the literature is confused over the terminology of 'bladder washouts', instillations and irrigation and a great deal of controversy surrounds the effectiveness of these procedures. Crisis management of catheters occurs when nurses wait for catheters to become blocked before changing them; this often occurs at inconvenient times and patients frequently have to wait several hours before help is available. To avoid crisis management, nurses should aim to assess individual patients' 'pattern of catheter life' and plan changes accordingly. This would improve patient care and allow nurses to utilize their time more effectively.

Problems of long-term spinal opioid treatment in advanced cancer patients

Epidural and intrathecal techniques are well established techniques in cancer pain. However, several questions remain unresolved. The several problems of long-term spinal opioid treatment in advance cancer patients were reviewed. Indications for the use of spinal opioids include patients treated by systemic opioids with effective pain relief but with unacceptable side effects, or unsuccessful treatment with sequential strong opioid drug trials despite escalating doses. Therefore, the previous aggressive treatment with systemic opioids would leave as failures patients with difficult pain syndromes unresponsive to opioids. The choice of external or totally implanted delivery systems is based on different clinical considerations. The use of externalized tunneled intrathecal catheters has not been associated with higher rates of complications and is easier to place and use at home in debilitated patients late in the course of their disease. The intrathecal administration has a lower incidence of catheter occlusion, lower malfunctioning rate, lower dose requirement, and more effective pain control. Due to the lower daily doses and volumes, intrathecal treatment proved to be more suitable for treatment at home by a continuous infusion than the epidural treatment. Advantages of infusion techniques are more evident when using local anesthetics, since intermittent administration of bupivacaine often results in motor paralysis and hemodynamic instability. Morphine is the opioid of choice. An epidural dose of 10% of the systemic dose is often used. However, intrathecal administration of opioids and bupivacaine may substantially improve pain relief in patients unresponsive to high epidural doses of these drugs, Bupivacaine-induced adverse effects, including sensory deficits, motor complaints, signs of autonomic dysfunction or neurotoxicity have been reported to not occur with bupivacaine doses less than 30–60 mg/day. Adjuvant drugs may further improve analgesia. Different ranges of technical complication rates have been reported in the literature, most of them being associated with epidural catheters. Subcutaneous tunneling and fixation of the catheter, bacterial filters, minimum changes of tubings, careful exit site care weekly, site protection and monitoring of any sign of infection to prevent infection, and training for family under supervision, are recommended. Areas for additional research include the use of spinal adjuvants, the ideal spinal morphine-bupivacaine ratio, methods to improve spinal opioid responsiveness and long-term catheter management with appropriate home care programs.

Catheter-Related Sepsis

We studied the infectious risk of different methods of managing vascular catheters during long-term use. Consecutive surgical ICU patients requiring triple lumen catheters, pulmonary artery catheters, or arterial catheters for greater than 7 days were prospectively randomized to one of three management groups: a) percutaneous (PERC) puncture with every 7-day catheter change at a new site, b) no weekly change (NWC) with a new site when changed, or c) guidewire exchange (GWX) with every 7-day catheter change at the same site. In all groups, a catheter change was mandatory for a positive blood culture, skin site infection, or sepsis without a likely source. Cultures were obtained when clinically indicated and at the time of every catheter change. Catheter-related sepsis (CRS) was defined as a positive blood culture and catheter culture with the same organism. A total of 112 patients met evaluation criteria. There were no intergroup differences in age, primary diagnosis, severity of injury or illness, number of study days, number of protocol violations, route of catheterization, number of catheters present/patient day, catheter sepsis rate, or bacteremia rate. The NWC group demonstrated an increased number of days/catheter, fewer catheter/subcutaneous tract segment cultures/patient, and a reduced incidence of catheter tip colonization. These results occurred in a setting where the number of CRS episodes/patient was 0.17 for GWX, 0.22 for PERC, and 0.16 for NWC. We conclude that there is no difference in infectious risk between these three methods of long-term catheter management. The method with the least complications and expense should be used.(ABSTRACT TRUNCATED AT 250 WORDS)

Catheter-related sepsis

We studied the infectious risk of different methods of managing vascular catheters during long-term use. Consecutive surgical ICU patients requiring triple lumen catheters, pulmonary artery catheters, or arterial catheters for greater than 7 days were prospectively randomized to one of three management groups: a) percutaneous (PERC) puncture with every 7-day catheter change at a new site, b) no weekly change (NWC) with a new site when changed, or c) guidewire exchange (GWX) with every 7-day catheter change at the same site. In all groups, a catheter change was mandatory for a positive blood culture, skin site infection, or sepsis without a likely source. Cultures were obtained when clinically indicated and at the time of every catheter change. Catheter-related sepsis (CRS) was defined as a positive blood culture and catheter culture with the same organism. A total of 112 patients met evaluation criteria. There were no intergroup differences in age, primary diagnosis, severity of injury or illness, number of study days, number of protocol violations, route of catheterization, number of catheters present/patient day, catheter sepsis rate, or bacteremia rate. The NWC group demonstrated an increased number of days/catheter, fewer catheter/subcutaneous tract segment cultures/patient, and a reduced incidence of catheter tip colonization. These results occurred in a setting where the number of CRS episodes/patient was 0.17 for GWX, 0.22 for PERC, and 0.16 for NWC. We conclude that there is no difference in infectious risk between these three methods of long-term catheter management. The method with the least complications and expense should be used.(ABSTRACT TRUNCATED AT 250 WORDS)

The nursing management of patients with long-term indwelling catheters.

A survey of 107 hospitalized and home-based patients showed up considerable variations in nursing management of indwelling catheters. CSU records of hospitalized patients showed a wide range of infecting organisms. Antibiotic treatment was found to be unimportant. Three types of male Foley catheter were in general use: 100% silicone, silastic and latex with teflon-treated coatings. Difficulties were reported in obtaining the 100% silicone catheters. Sixty-eight per cent of the patients used leg bags and the drainage bag supporting systems in use were felt to be inadequate. Catheter bypassing was a problem for 40% of the patients. Nurses adopted many procedures to cope with bypassing. Results show that some patients were needlessly catheterized. The study emphasizes the need for further investigations and better policies for management of long-term catheters.

Long-term urethral catheter drainage.

Long-term catheter management is best conducted by specially trained community staff, provided there is close liaison with the urologist. Patients, hospital staff, and the primary health care team all benefit. The scheme is cost-effective, more convenient for patients and relatives, and reduces the need for emergency calls to the general practitioner and hospitals. We advocate development of similar schemes in other districts.

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.