How many 'sacred cows' still are in your pasture?
How many 'sacred cows' still are in your pasture?
Regular catheter changes is not a best practice
Participants in the Infection Surveillance Project of the Missouri Alliance for Home Care (MAHC) see their bladder catheter infection rates drop when they participate in the project for several reasons that include a staff focus on the issue, comprehensive education, and the exchange of best practices and ideas among the project participants. One of the other frequent topics of conversation is the "sacred cows," or the myths about catheter care that physicians, nurses and patients believe because "this is how we've always done it."
"Early on in the project we discovered through group conference calls that many nurses were increasing the size of the catheters if there was leakage," says Mary Schantz, executive director of MAHC. Scientific evidence shows that you should not use a larger catheter, she adds.
Smaller is better, agrees Lisa Gorski, MS, APRN, BC, CRNI, FAAN, clinical nurse specialist at Wheaton Franciscan Home Health & Hospice in Milwaukee. "There is less irritation, less pressure, and less stress on the urethra," she explains. In fact, a larger catheter can damage the urethra, Gorski adds.
Because patients who experience leakage might reduce their fluid intake to control it, be sure to teach them that it is important to maintain urinary output, Gorski says. "Fluid intake is important to keep urine flowing through the catheter, if the patient is experiencing leakage, it is important to assess for causes. For example, constipation or drinking caffeinated fluids may contribute to bladder spasms," she suggests.
Another longtime practice is the catheter change at regular intervals, says Gorski. Changing the catheter every four weeks, even if the patient is not experiencing any problems, is not necessary, she says. The catheter should be changed based upon patient need, Gorski says. "If the patient is not experiencing problems, reducing catheter changes to every four to six weeks is fine," she says. "If the patient has sediment problems, catheters should be changed more often, before blockage occurs."
Some physicians also are writing orders to irrigate the system on a regular basis, Rita Sansoucie, RN, BSN, staff development director of Phelps Regional Homecare in Rolla, MO. "We can't eliminate flushing completely, but we do share information with the physician to show that we can address some problems with dietary changes, such as adding cranberry juice to the patient's diet."
Some physicians tend to order cultures on a routine basis, but that isn't necessary, Gorski says. "When I first started working at this agency, there was an overreaction to changes in the urine appearance, and cultures were frequently ordered," she says. It is more important to look at the pattern of symptoms that the patient typically has when an infection is present rather than the single symptom of unusual appearance to the urine, Gorski says. Fever or increased confusion along with cloudy urine indicate a possible infection, while cloudy urine alone does not in all cases, she adds.
Good hygiene practices are an important part of education for patients with catheters, but even in this area there are some myths, says Gayle Lovato, RN, MS, infection control practitioner at Inova Loudoun Hospital in Leesburg, VA, and a member of the Association of Infection Control Profes-sional's communications committee. "Some patients still use an antimicrobial cream at the insertion site," she says. There is no evidence that it does any good and it is unnecessary, Lovato says. "The best way to keep the insertion site clean is to use soap and water, and pat the area dry."
Sacred cows are hard to eliminate in any health care setting because people accept longtime practices without asking the reason, admits Lovato. Education and asking questions about the purpose of certain activities is important, she says. "I've been a nurse for 34 years, and I remember that, early in my career in a hospital, the nurses were told to face the open end of the pillowcase away from the door," she says. After some time of doing this, one of the nurses asked the floor nurse who insisted on this practice the reason for keeping the opening away from the door. The nurse answered, "Because my mom did it that way."
Participants in the Infection Surveillance Project of the Missouri Alliance for Home Care (MAHC) see their bladder catheter infection rates drop when they participate in the project for several reasons that include a staff focus on the issue, comprehensive education, and the exchange of best practices and ideas among the project participants.Subscribe Now for Access
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