style=”text-align: justify;”>Urethral catheterization device routine medical procedure used to facilitate direct drainage of urinary bladder
Urethral catheterization or the use of urinary catheter devices is a routine medical procedure that is used to facilitate the direct drainage of urinary bladder in patients. This procedure may also be used as a diagnostic procedure to determine etiology of genitourinary conditions (Agarwal et al, 2009). As a medical procedure nurses and doctors are required to recommend the use of the urinary catheter devices in three situations, which include insertion as an in and out procedure for immediate drainage, for short-term duration, for instance during surgery, and lastly and indwelling catheterization for long-term periods for patients with long-term urinary retention (Hochman, 2014). The main procedural concern is the increased use of indwelling catheters where the situation warrants for more healthy friendly methods, which are not as harmful to the patient as the indwelling catheters.
These indwelling catheter devices have a long association with catheter-associated urinary tract infections (CaUTIs), which are the most common hospital acquired infections (Parker, 2008). CaUTIs account for almost 40% of all the nosocomial infections, while an 80% of these CaUTIs are linked to indwelling urinary catheters (Pellatt, 2009). The fact that these devices are the causatory agents for the most common hospital acquired infections calls for a change of the procedure to more secure and less risky processes, which will ensure the health of patients is not further compromised in the walls of medical facilities, which are supposed to offer treatment to the people who really need it.
The use of catheter has a long history starting from 1300BC in Greek civilizations where many materials including metallic catheters were used to make these tools for use in patients with chronic urinary retention (Siracusano, Ciciliato, & Visalli, 2012). The modern catheters trace their roots back in 18th century when Benjamin Franklin invented the flexible catheter in 1752 following the medical condition of his brother, John, who had bladder stones (Parker, 2008). The catheter was made of metal segments that were joined together with an enclosed wire to provide rigidity during the insertion procedure. However, Davis S. Sheridan invented the modern disposable catheter in the 1940’s, which replaced the re-usable catheters, which carried the risk of transmission of diseases (Pellatt, 2009).
The basis for the use of indwelling catheters is supported by medical literature and practitioners for its advantages in addressing conditions are brought about by bladder problems in patients. For instance, it is important in the treatment of urinary retention, bypassing obstruction in the urinary tract, urinary incontinence, removing of urine in patients with nerve damage, which interferes with bladder control and for bed bound patients too weak to go to the toilet (Agarwal et al, 2009). In 1990’s Walsh and Norman Gibbon invented the standard catheter used today in hospitals since they have more advantages than other catheters previously used.
However, it is important to note that World Health organization requires the use of indwelling catheterization as a last resort if all the other medical interventions prove ineffective (Pellat, 2009). This is due to the known side effects of these devices, which continue to be used in the modern times when safe alternatives are readily available.
The decision for the implementation of these procedures has for a long time been defended with the argument that there are no better alternatives, which can effectively address the issues that the indwelling catheters covers (Siracusano, Ciciliato, & Visalli, 2012). Many alternative procedures have been short down due to their prohibitory costs to patients or outright rejection by the medical practitioners. With the right policies, the use of urinary catheter devices may be reviewed effectively to include the modern developments, which prove more effective, less risky and more cost effective and easier in procedure (Pellatt, 2009). Consequently, ensuring there is good management of indwelling catheters grounded on best evidence based prove is very important in helping improve patient’s outcomes in medical facilities.
In order to address the problem of CaUTIs, various procedures and devices have been recommended by medical practitioner and researchers. Some of these interventions are evidence based though there is need for further research. For instance, the placing of catheter is a fundamental skill taught to all nursing practitioners. In this area, there is contention on whether to use sterile or aseptic techniques for the placement of the catheter. It is argued that maintaining aseptic technique and using sterile equipments during the insertion of catheter are important elements of minimizing CaUTIs and other infections.
Another research found that meatal care with antiseptic cleaners and other ointments was no better than routine perineal care in reduction of CaUTIs and even suggested that antiseptic agents actually increase risk of infection by irritating the urethral meatus (Pellatt, 2009). The current recommendations suggest routine hygiene of the meatal surface is all that is needed to maintain an indwelling catheter. Other suggestions include the used of closed over open catheter devices, securing the catheter to reduce trauma and erosion of the urethra and adoption of ultra thin catheters. Though research is still ongoing on these interventions and many others, they provide a good alternative to the traditional catheter systems and offer solution to the problem of CaUTIs.
The most important alternative to indwelling catheters is the use of Intermittent Catheterization(IC). IC has less risk of CaUTIs since it is not left in place for long times. In addition, the risk of blockage is minimized and incases where it happens ICs are easy to replace. ICs also give patient more freedom and promote physical relations. For instance, though sexual functions are possible with indwelling catheters, ICs present the best alternative and give more freedom to patients (Houser, 2011).
As a practitioner, it is important to encourage the involvement of stakeholders in the adoption of these safer procedures to reduce the cases of CaUTIs, which are common in health facilities. In order to gain support for this noble cause, I would do the following:-
• Lobby for support from other nurses and doctors
• Request a meeting with stakeholders to expression the suggested changes
• Provide medical evidence for the pros and cons of the initial methods against the suggested methods
• Provide financial implications of the suggested changes against the old methods and procedures
In the adoption of these new procedures and tools, there are various difficulties, which are bound to happen. The main challenge is resistance form the hospital administration and key stakeholders who would like to maintain status quo. The difficulty would arise from the costs that come with changing in medical procedures such as the cost of training personnel, acquiring such tools and uncertainty on the effectiveness of these procedures.
The main strategies to use in order overcome the barriers for the adoption of these procedures and tools are twofold. First, it is through the lobbying for support from other medical practitioners in the hospital and presenting the suggested changes for discussion for possible adoption by the stakeholders. Secondly, it is important to continue the lobbying for the support and action of the procedures by providing evidence based support for the new procedures.
Agarwal, R. K., Gould, C. V., Kuntz, G., Pegues, D. A., & Umscheid, C. A. (2009).Guideline for prevention of catheter-associated urinary tract infections 2009. Atlanta, GA: Centers for Disease Control and Prevention].
Houser, O. J. (2011). Evidence Based Practice: An Implememntation Guide for Healthcare Oraganization. New York: MA.
Parker, G. (2008). An Overview of female intermittent catheteisation. Continence essentials , 60-65.
Pellatt, G. (2009). Urinary elimination: Part 2-retention, incontinence and catheterization. British Journal of Nursing , 480-485.
Siracusano, S., Ciciliato, O. G., & Visalli, F. (2012). Catheters and Infections. New York: University Press.