Penile urinary sheaths: a continence management system for men.

Urinary leakage is prevalent in men. To contain and manage this leakage, men are often advised about urinary devices. However, sometimes this advice does not include penile sheaths. Penile sheaths are a good way of managing urinary leakage if an individual is suitable for sheaths. This article will explore this suitability, advantages to using a sheath, reasons why sheaths may not be suitable, and will discuss optimum fitting to ensure the sheath is a secure drainage device.

Intermittent catheterisation.

When an individual has voiding difficulties, the person may require a urinary catheter. Enabling the person to choose an appropriate method of catheterisation and supporting them can have an enormous impact on the individual's health and wellbeing. Indwelling urethral catheters are suitable for some people but for others they can affect a person's lifestyle and lead to depression. Intermittent catheterisation can work well for some people. Intermittent self-catheterisation has been used to manage urinary retention for over 3500 years. It remains the 'gold standard' in terms of bladder drainage, but it is under-used and indwelling catheters remain more common. This article examines the history of intermittent catheterisation, indications for self-catheterisation and how to support people to use self-catheterisation.

Understanding the challenges faced by men learning to live with clean intermittent self-catheterisation.

Clean intermittent self-catheterisation (CISC) is considered the preferred option to an indwelling catheter for emptying the bladder in people with a range of voiding dysfunctions. CISC has a lower risk of complications and urinary tract infections. This narrative review of previous qualitative research explores the quality-of-life impacts and highlights the challenges that men face. It will provide nurses who teach CISC with some useful insights into the male experience and the issues of concordance and adherence. This will help to better inform and guide clinical practice in this specialist area of nursing practice.

Preventing Catheter-Associated Urinary Tract Infections with Incontinence Management Alternatives: PureWick and Condom Catheter.

Catheter-associated urinary tract infections (CAUTI) have a high financial and human impact on patients and society at large, making CAUTI prevention strategies essential. A shift has occurred where nurses play an increased role in infection prevention. Nurses promote staff and patient education on CAUTI prevention, identification of appropriate urinary incontinence management, and implementation of bundles and patient care strategies to minimize complications from urinary incontinence management. Because they understand the severity of CAUTI and current recommendations, nurses at the bedside are in the best position to identify appropriate indications of indwelling urinary catheters and external urine collection devices for patients.

External Female Urinary Catheter: Implementation in the Emergency Department.

The emergency department is a care environment in which indwelling urinary catheters are placed frequently; however, the significance of the role of the emergency department in catheter-associated urinary tract infection prevention has been overlooked. The use of an external female urinary catheter is an alternative to placing an indwelling urinary catheter for female patients in the emergency department who are incontinent of urine or are immobile. The purpose was to describe the implementation of an initiative to decrease the number of indwelling urinary catheters and increase the use of external urinary female catheters in non-critically ill women who visited the emergency department at a 451-bed Magnet-designated community hospital in the Southeast. For this clinical implementation project, the Plan, Do, Check, Act framework was used to develop the initiative, and outcome data were collected retrospectively and included an indirect calculation of the number of indwelling urinary catheters placed in the emergency department. A total of 187 external catheters were used in place of indwelling catheters in female patients over a 3-month period. No skin irritation or breakdown was observed. This project demonstrated the initial staff acceptability and feasibility of external female urinary catheter use in the ED setting.

[Applying Team Resource Management to Reduce the Urinary Catheter Usage Rate in Our Intensive Care Unit].

BACKGROUND & PROBLEMS: According to the literature, 74%-84% of patients in adult critical care units have an indwelling catheter. The majority of medical and healthcare infections are urinary tract infections, which are related to urinary catheter usage. Furthermore, critical infections may cause bacteremia, which increases the risk of mortality. Prior to this project, over three-quarters (78.7%) of patients in our unit used a urinary catheter, which is a rate that is higher than all other intensive care units of our hospital's internal medicine department. Due to Foley placement, removal and care of catheters requires collaboration of teamwork. Thus, the concept of team resource management may be applied to improve the situation. PURPOSE: The aim of this study was to reduce the urinary catheter usage rate in our intensive care unit to less than 69.3%. RESOLUTIONS: This project summarized the reasons for the high catheter usage rate in this unit on 2017/1/3 and implemented several approaches to improve the situation from 2017/2/1 to 2017/6/30. These approaches included affixing reminder labels to indwelling catheters, using an ultrasound bladder scanner as a substitute for intermittent catheterization, evaluating indwelling catheters, establishing flow planning for post-catheter removal, holding cross-team meetings, and adopting a reward system. During the improvement period, we held collaborative conference meetings weekly to discuss solutions, evaluate end-of-the-month progress, and set reward policies. RESULTS: We lowered the average urinary catheter usage rate from 78.7% on 2017/3/1 to 57.8% on 2017/6/30, achieving a 26.5% reduction in catheter usage. CONCLUSIONS: This project both effectively reduced the unnecessary use of urinary catheters and significantly strengthened team spirit in our unit, thus improving the quality of medical care provided.

Barriers and facilitators to implementation of a multifaceted nurse-led intervention in acute care hospitals aimed at reducing indwelling urinary catheter use: A qualitative study.

BACKGROUND: It is essential to evaluate the ways in which practice changes are implemented and received in and across contexts, identifying barriers and enablers, and mechanisms for enhancing success. AIM: To provide insights into the experiences of clinicians in implementing a multifaceted bundled urinary catheter care intervention in four acute care hospitals in New South Wales, Australia. METHODS: The catheter care bundle was implemented using a pre- and postintervention study design. The intervention was implemented in all adult inpatient wards, emergency departments and operating theatres of four hospitals. The bundle consisted of an integrated set of evidence-based practices to assist clinicians in making better informed decisions related to catheter insertion, care and removal practices. Focus groups at each participating hospital evaluated the implementation processes from the clinicians' perspective, identifying barriers and enablers to successful implementation. RESULTS: Eight focus groups were held with 35 participants. Four key inter-related themes were identified: early and sustained engagement with key stakeholders; good planning but remaining flexible; managing the burden of practice change; and adopting and sustaining practice change. These themes capture and highlight the complexity and the challenges associated with implementation of the practice change across contexts and the project timeline. CONCLUSION: It is imperative to understand the challenges associated with complex practice change and ways in which implementation can be optimised. This study identified barriers and enablers experienced by staff implementing the bundled intervention. The themes encapsulate factors central to success of practice change within the complex, multilayered healthcare environment. RELEVANCE TO CLINICAL PRACTICE: Key challenges highlight the need for forward planning, strategic engagement of key players, continuing monitoring and feedback together with adequate resourcing tailored to result in sustainable normalisation of the intervention over time. The COREQ checklist for qualitative studies has been used in reporting this study.

Use of catheter maintenance solutions by community nursing staff: an assessment.

This article discusses catheter maintenance solutions, the way they are supposed to be used and the way they actually are being used in primary and community care in the UK. It discusses the knowledge that community nursing staff have regarding these solutions and the need for further education. Appropriate assessment from a suitably trained individual is recommended, resulting in both usage and cost being dramatically decreased, offering more appropriate management and the likelihood of decreasing the incidence of catheter-associated urinary tract infections (CAUTI). The literature surrounding catheter maintenance solutions is investigated, and the lack of available evidence is highlighted. Preliminary research exploring primary and community care nurses' knowledge of catheter maintenance solutions is also discussed.

Outcomes of a Nurse-Led Difficult Urinary Catheter Team in an Academic Medical Center.

BACKGROUND: Catheter insertion for complex patients by inexperienced nurses can lead to avoidable iatrogenic urethral injury and catheter-associated urinary tract infection (CAUTI). PURPOSE: The study aim was to evaluate a comprehensive nurse-led difficult urinary catheterization (DUC) Program to reduce patient CAUTIs. METHODS: A retrospective cohort study design was used to evaluate the DUC Program's effectiveness during 2013 to 2017. Measures included RN DUC consultations, protocol adherence, patient CAUTIs, and urology consults. RESULTS: The RN DUC team consulted 435 patients with a 92% insertion success rate. The DUC protocol adherence was 66.1%. Patient CAUTIs decreased from baseline (169) to year 4 (24) (odds ratio: 0.1889, 95% confidence interval = 0.1231-0.2898, P < .001). Urology consults decreased from baseline (40) to year 3 (21), however, increased in year 4 (80) when a urology residency program was started. CONCLUSION: This comprehensive program was effective in improving catheter insertion technique, eliminating urology consults, and reducing CAUTIs when combined with organizational prevention measures.

Implementation of a Nurse-Driven Protocol for Catheter Removal to Decrease Catheter-Associated Urinary Tract Infection Rate in a Surgical Trauma ICU.

INTRODUCTION: Early removal of urinary catheters is an effective strategy for catheter-associated urinary tract infection (CAUTI) prevention. We hypothesized that a nurse-directed catheter removal protocol would result in decreased catheter utilization and CAUTI rates in a surgical trauma intensive care unit (STICU). METHODS: We performed a retrospective, cohort study following implementation of a multimodal CAUTI prevention bundle in the STICU of a large tertiary care center. Data from a 19-month historical control were compared to data from a 15-month intervention period. Pre- and postintervention indwelling catheter utilization and CAUTI rates were compared. RESULTS: Catheter utilization decreased significantly with implementation of the nurse-driven protocol from 0.78 in the preintervention period to 0.70 in the postintervention period (P < .05). As a result of the bundle, the CAUTI rate declined significantly, from 5.1 to 2.0 infections per 1000 catheter-days in the pre- vs postimplementation period (Incident Rate Ratio [IRR]: 0.38, 95% confidence interval: 0.21-0.65). CONCLUSIONS: Implementation of a nurse-driven protocol for early urinary catheter removal as part of a multimodal CAUTI intervention strategy can result in measurable decreases in both catheter utilization and CAUTI rates.

Práticas baseadas em evidências: cateterismo vesical contínuo na prática clínica / Evidence-based practices: continuous bladder catheterism in clinical practice

Objetivo: analisar aspectos da técnica de inserção do cateter vesical contínuo em unidades de internação clínica de um hospital. Método: trata-se de um estudo qualitativo, descritivo, exploratório. Procedeu-se à coleta de dados mediante entrevista semiestruturada, gravadas, transcritas e submetidas à técnica de Análise de Conteúdo na modalidade Análise Categorial. Resultados: elencaram-se as categorias: << Prática profissional frente ao cateterismo vesical contínuo >>; << Domínio e busca de conhecimento técnico-científico >> e << Sugestões para melhoria do cuidado ao paciente em uso de cateterismo vesical contínuo >>. Conclusão: conclui-se que o procedimento tem sido realizado de forma distinta e não uniforme, sendo relevantes a sua padronização e a necessidade premente de mais evidências e estudos sobre o tema. Observa-se que o procedimento de cateterismo vesical contínuo, assim como outros, enfrenta uma dicotomia entre a prática, o ensino e as evidências científicas sobre o assunto.(AU)

Objective: to analyze aspects of the continuous bladder catheter insertion technique in clinical inpatient units of a hospital. Method: this is a qualitative, descriptive, exploratory study. Data were collected through semi-structured interviews, recorded, transcribed and submitted to the Content Analysis technique in the Categorical Analysis modality. Results: the categories were listed: << Professional practice in the face of continuous bladder catheterization >>; << Domain and search for technical and scientific knowledge >> and << Suggestions for improving patient care using continuous bladder catheterization >>. Conclusion: it is concluded that the procedure has been performed in a different and non-uniform way, with its standardization and the pressing need for more evidence and studies on the subject being relevant. It is observed that the continuous bladder catheterization procedure, like others, faces a dichotomy between practice, teaching and scientific evidence on the subject.(AU)

Objetivo: analizar aspectos de la técnica de inserción continua de catéter vesical en unidades de internación clínica de un hospital. Método: este es un estudio cualitativo, descriptivo, exploratorio. Los datos fueron recolectados a través de entrevistas semiestructuradas, registradas, transcritas y enviadas a la técnica de Análisis de Contenido en la modalidad de Análisis Categorial. Resultados: se enumeraron las categorías: << Práctica profesional frente a la cateterización vesical continua >>; << Dominio y búsqueda de conocimientos técnicos y científicos >> y << Sugerencias para mejorar la atención al paciente mediante cateterismo vesical continuo >>. Conclusión: se concluye que el procedimiento se realizó de manera distinta y no uniforme, con su estandarización y la urgente necesidad de más evidencia y estudios sobre el tema que sean relevantes. Se observa que el procedimiento de cateterización vesical continua, como otros, enfrenta una dicotomía entre la práctica, la enseñanza y la evidencia científica sobre el tema.(AU)

Guidelines for difficult urethral catheterization in males.

Urethral characterization can be difficult for patients and providers alike. This article describes an evidence-based protocol for difficult urethral catheter insertions in male patients.

Variations in indwelling urinary catheter use in four Australian acute care hospitals.

AIMS AND OBJECTIVES: To identify the point prevalence of indwelling urinary catheters (IDCs) in adult inpatients in acute care hospitals, and to describe the indications for IDC insertion based on patient age, gender, specialty and hospital. BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) are preventable healthcare-associated infections. IDC duration is the strongest predictor of CAUTI, and little is known about characteristics of patients who receive an IDC. DESIGN: Two single-day point prevalence surveys collected baseline patient data as part of a larger pre-post control-intervention study. METHODS: Surveys were conducted at four acute care hospitals in NSW, Australia, for all adult patients. Data collection included IDC presence, insertion details and urine culture collection. Point prevalence data were linked with electronically extracted patient demographic data. This study is presented in line with STROBE checklist (See Supplementary File 1). RESULT: Data from 1,630 patients were analysed, with 196 patients (12%) identified as having an IDC on the survey dates. IDC prevalence rates were higher in males (13%) than in females (11%). Critical care had the highest rate of patients with IDCs (42%). Urine cultures were collected in 70 patients with an IDC (43%). CONCLUSIONS: Findings indicated similar rates of IDC use in males and females, and there was no significant difference in age between patients with or without an IDC. However, indication for IDC varied by patient age and gender. High rates of urine culture collection may represent routine collection. RELEVANCE TO CLINICAL PRACTICE: IDC use is found across genders, all age groups and specialties. Nurses should be aware that any of their patients may have an IDC and be particularly aware of certain indications based on patient age and gender. Routine urine culture collection is not advised, and instead, nurses should be guided by clinical decision-making tools.

Supporting patients with long-term catheterisation to reduce risk of catheter-associated urinary tract infection.

More than 90 000 of the UK adult population are estimated to have a urinary catheter, with 24% likely to develop symptoms of catheter-associated urinary tract infection (CAUTI). The consequences of having a CAUTI are reduced quality of life, risk of hospitalisation and increased mortality. The authors undertook a literature review of primary research studies to identify how nurses could support patients to maintain effective catheter care to reduce the risk of CAUTI. Four themes emerged: education, knowledge, empowerment and communication. The authors therefore conclude that consistent knowledge, clear communication and treating patients as partners in the decision-making process can help build trust and allow empower patients. This will enable patients to make safe and healthy decisions about their catheter, particularly with regard to personal hygiene and optimal fluid intake, to reducing the risk of CAUTI.

Parental home removal of urethral catheters after urological surgery-a prospective benchmarking study.

INTRODUCTION: Many urological operations require placement of a urethral Foley catheter. The catheter often needs to remain in situ for a period of time after discharge; and patients subsequently require either a further hospital admission or community nurse review for catheter removal. Parents can easily remove the catheter at home by cutting the balloon port. This disrupts the valve and hence deflates the retaining balloon, thereby facilitating spontaneous passage of the catheter. The authors introduced this practice to their institution. AIM: The aim was to assess safety and success of parental home catheter removal. METHODS: A prospective data study was performed in a large pediatric urology center over a 12-month time period. Patients <16 years after single-stage hypospadias repair or other penile surgery were included on a voluntary basis. Parents of eligible patients were instructed verbally and with an information leaflet, including date for removal. Telephone follow-up after removal was undertaken to assess the outcome. RESULTS: Thirty-eight patients were included over a 12-month time period. Patient age ranged from 9 months to 12 years (median age 2.5 years). The majority (82%) of patients had required a catheter after hypospadias repair. Home catheter removal was successful in 92% cases. Three children required professional support for catheter removal. Median time until catheter passage was 3 h (range 0-24 h). Considering that cost for day case admission for catheter removal averages at 130£ per patient, home catheter removal saved the NHS 4550£ in the time period. DISCUSSION: This is the first study to report the safety and feasibility of parental home catheter removal by cutting the balloon port valve in the pediatric population. It offers a number of distinct advantages compared with traditional methods for removal. These include, namely, (i) positive patient experience: catheter removal in a familiar environment by a relative minimizes stressful experiences for the family; (ii) minimal trauma to healing tissues through spontaneous catheter passage; and (iii) health care-related cost savings. This was an initial benchmarking study, so patient numbers were relatively small. Nevertheless, it shows that the method is safe and received positive parental feedback. CONCLUSION: Parental home removal of a urethral catheter is a feasible and safe alternative to catheter removal by a health-care professional. It minimizes parental anxiety and inconvenience related to the catheter removal appointment and allows for significant cost savings.

Evaluating the Usability of a Second-Generation Virtual Reality Game for Refreshing Sterile Urinary Catheterization Skills.

BACKGROUND: Virtual reality (VR) allows risk- and anxiety-free practice, mediated by consistent objective feedback. PURPOSE: This study evaluated the usability of a VR game system for sterile catheterization practice. Participant enjoyment, engagement, likelihood to practice, and comfort using VR are reported. METHODS: Thirty-one students and faculty tested a VR game using Oculus Rift devised to allow practice of placing a urinary catheter in a virtual patient. Data were collected via an electronic survey using the System Usability Survey (SUS) and a User Reaction Survey (URS). RESULTS: The SUS score was 64.03. Seventy-five percent of participants rated the game as positive overall on the URS. Left-handed players had more difficulty playing the game. Players with prescription glasses could not comfortably place the Oculus Rift over their glasses to play. CONCLUSIONS: The VR game shows promise for refreshing sterile catheterization skills.

Reducing catheter-associated urinary tract infections through best practice: Sherwood Forest Hospitals' experience.

A programme to standardise catheterisation practice was introduced in Sherwood Forest Hospitals NHS Trust in 2016, with the aim of reducing the incidence of catheter-associated urinary tract infections (CAUTIs). The initiative involved the use of a catheterisation pack (Bard®Tray). Within the first year following its introduction, the CAUTI rate had been reduced from 13.3% to 2.1% (between July 2016 and June 2017), which is a reduction of more than 80%. Standardisation has also brought cost savings for the Trust of about £33 000 a year. The Trust has maintained its standardisation approach and CAUTI rates remain at around 2%.

Clinical evaluation of the multifunctional suprapubic catheter in patients requiring permanent suprapubic cystostomy: A prospective randomised trial in a single centre.

AIMS AND OBJECTIVES: To assess the clinical effect of the multifunctional suprapubic catheter (MSC) on occurrence of cystospasm, catheter occlusion, the catheter-related urinary tract infection and remission of overactivity bladder, by comparing with the conventional suprapubic catheter (CSC) in patients with permanent suprapubic cystostomy. BACKGROUND: The conventional suprapubic catheter usually presents with high incidence of catheter-associated complications. DESIGN: A prospective randomised clinical trial in a single centre. METHODS: Between January 2014 and January 2015, a total of 91 consecutive patients with permanent suprapubic cystostomy were prospectively randomised into two groups: the MSC group (n = 43) and CSC group (n = 48). RESULTS: Our results showed that the total times of cystospasm in the MSC group were significantly less than that in the CSC group during the follow-up time (p < .001). In addition, the mean spasmodic duration per time in the MSC group was significantly shorter than that in the CSC group (p < .001). Besides, catheter occlusions were observed in 23 (25.27%) patients, including 5 (11.63%) in the MSC group and 18 (37.50%) in the CSC group (p = .005). The lower rate of positive urine culture was also found in the MSC group but with no significant difference (p = .540). Furthermore, the urodynamic measurement data demonstrated that the patients in the MSC group had a greater remission rate of overactivity bladder after catheter change (p < .001). CONCLUSIONS: The present data showed that the multifunctional suprapubic catheter could significantly reduce the incidence of catheter occlusion, ameliorate the symptom of cystospasm and relieve the overactivity bladder, but have no influence on the catheter-related urinary tract infection. RELEVANCE TO CLINICAL PRACTICE: The application of our self-devised multifunctional suprapubic catheter may result in better management of the patients with permanent suprapubic cystostomy.