When our body have complications with emptying urine from your bladder because of some medical issues, a health care provider will prescribe a Foley Catheter. The Foley Catheter will act as a conduit to drain your bladder. The drainage system of a catheter consists of two things; a Foley Catheter and a urinary drainage bag. A Foley catheter is a hollow and thin tube made of a smooth and elastic fabric. The tool is usually laid to the bladder via the urethra. A small water-filled balloon is inflated in the bladder to prevent the Catheter from falling off. One can, therefore, be able to go about his or her normal activities with ease. In this case, during urination, the urine drain out of the bladder and then into the bag that is attached to the catheter.
A survey conducted by the clinical nurse specialist (CNS) shows that out of eight inpatients having indwelling urinary catheters, one patient did not attain the criteria recommended during the time of inserting the Catheter. Two of them, however, did not convene the indications during the survey. The result also showed that almost 100% of the nursing personnel did not comply with securing of the outlet pipe to the bed sheets. An estimated 75% of the employees were not compliant on how to position the pipe to promote urine drainage without using dependent loops. Tamper-evident seals had also been proved broken from the catheters.
The findings show that there is a high possibility of infections in the urinary tract associated with the Catheter, which is caused by the following risk factors: Tamper-evident seals which are already broken, orientation of the catheter sack higher than the position of the bladder which should not be the case, and long-time exposure (Gray, 2010).
Following the above survey, it was, therefore, necessary to conduct a nurse-driven urinary catheter protocol. The step was mainly to help minimise on the duration of catheter use by patients. The initiative targeted mostly the nurses because they are the ones who spend a lot of time with the patients. It was also assumed that the nurses will be the most reliable asset in affecting the use of catheter (Chen et al., 2013). The drive was also going to be helpful as it would reduce the cost of training physicians.
The following rationale and guidelines are recommended following the survey which with time became the protocols for catheter use by nurses.
There should be a periodic operational use for selected surgical processes.
Acute urinary hindrance and retention be managed at a closer look.
Checking of urine output in patients who are critically in poor health.
The sick that are incontinent be assisted in the healing of pressure ulcer.
Consider patients who require prolonged immobilization.
Care to patients who request for comfort during their end-of-life.
There are also additional indicators that helped in formulating the nurse-driven protocol, and they include;
Dysfunctioning of the Neurogenic bladder.
Bladder injury and recent surgery involving structures in continuity with the bladder.
Prolonged use of the epidural catheter.
Inpatients have a severe indwelling urinary catheter.
Some challenges came about during the implementation of this protocol. At first, it was hard to convince the nurses that not every patient requires an indwelling catheter regardless of the ease of patient and staff. The situation called for an extensive education to enlighten the nurses on the importance of this protocol, and after a month or so, the nurse-driven protocol went into effect (Alexaitis & Broome, 2014).
Indications and alternatives on catheter use were revised following the survey and were to be followed by all nursing staff. The contract gives nurses the mandate to discontinue urinary catheters without an order from a physician if they do not meet appropriate indications. The practice was not carried out by nurses earlier on before the protocol was formed. Further, this protocol is highly recommended as it reduces the incidence and span that catheter is in use. The result will be positive in such a way that it will also minimise the impact of Cather associated urinary tract infection and improve the value of care to the affected patients (Institute for Healthcare Improvement, 2011).
Nurses get training on the appropriate placement of the urinary catheter with a large emphasis on compliance with aseptic insertion techniques. The procedure intends to reduce the number of microorganisms getting into the bladder during insertion of the urinary catheter. The protocol calls for the nurse to consider the following actions so as to promote efficient aseptic catheter insertion;
Follow the steps of the written hospital policy on the steps for the indwelling catheter placement. If there is none, establish a systems but with consultation from advanced trained nurses. The procedures you use should be in line with those listed in the detailed checklist for males and females.
Always ensure that all necessary components required to carry out the placement comply with the aseptic technique and that they are all available.
The nurses` annual competency requirement will be based on the periodic assessment of their compliance with placing the urinary catheter using aseptic technique.
The protocol also recommends that nurses or physicians use the smallest catheter as this will help reduce trauma to the patients.
Every patient has his/her needs, and it is, therefore, important to consider ones` needs, and it is, therefore, important to consider ones` needs before placing a catheter. These include; predicted span of catheterisation, urine frequency, catheterisation type and indicators for catheterisation (Geng et al., 2012). After a succeful removal of the catheter, the protocol recommends that a bladder scanning be carried out to check whether the patient is uncomfortable at any given time and also to keep record of volume output of urine with each catherization. If the bladder scan volume is above 600 cc, the nurse is required to notify the physician (Huber, et al., 2015).
Alexaitis, I., & Broome, B. (2014). Implementation of a Nurse-Driven Protocol to Prevent Catheter Associated Urinary Tract Infections. Journal of Nursing Care Quality, 29(3), 245-252.
Chen, Y., Chi, M., Chen, Y., Chan, Y., Chou, S., & Wang, F. (2013). Using criteria based reminder to reduce the use of indwelling urinary catheters and decrease urinary tract infections. American Journal of Critical Care, 22(2), 105-114.
Gray, M. (2010). How to reduce Catheter-associated Urinary tract infection in the Critical Care unit. AACN Advanced Critical Care, 21(3), 247-257.
Geng, V., Cobusse-Boekhorst, H., Farrell, J., Gea-Sanchez, M., Pearce, I., Schwennesen, T., et al., (2012). Evidence-based guidelines for best practice in urological health care.
Institute for Healthcare Improvement (IHI). (2011). How-to Guide: Prevent catheter-associated urinary tract infections.
Huber, K., Sood, G., & Maygers, J. (2015). Get Those Foleys Out: Successful Reduction of Catheter Utilization through Use of a Nurse Driven Foley Discontinuation Protocol. American Journal of Infection Control, 43(6).
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