PC- Nurse-Driven Urinary Catheter Removal

fortnecessityusefulDéveloppement de logiciels

14 déc. 2013 (il y a 3 années et 8 mois)

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Purpose
:
Reduce catheter associated
urinary tract infections (CAUTI).



Definitions: CAUTI


A nosocomial
infection that can develop in patients with
an indwelling urinary catheter.



Policy
:
Patients meeting specific
assessment criteria will have the urinary
catheter removed by a nurse.


Procedure
:


1.
Assess
the
need to continue urinary catheter as
part of their ongoing assessment using the
Nurse
-
Driven Urinary Catheter

Assessment.

(See
Addendum A).

2.
If none of the specified indications for continued
catheter use are met, the catheter will be
discontinued by the nurse.

3.
C
ontinue
to reevaluate and assess the need to
reinsert the urinary catheter following removal
of the urinary
catheter
.


4.
C
ontact
the patient’s physician for further
orders if patient is unable to void following
catheter removal.


Patient/Family Education


Patient and/or family will be educated on:

1.
Risk of complications associated with urinary
catheters.

2.
Importance of adequate fluid intake after removal
of urinary catheter .

3.
Measurement of intake and output to be done to
assess the patient’s ability to empty bladder after
removal of urinary catheter.



Documentation
: Nurse to document
assessment and removal of urinary catheter
and continued reassessment post
removal,
in
the
patient’s medical
record.



Aggressive treatment
with diuretics


Accurate monitoring of
urinary output


Management of urinary
incontinence in patient
with Stage III or greater
pressure ulcers


End of life/comfort care



Gross hematuria within
last 24 hours

Urologist involved in
case/catheter placed by
urology/difficult
catheterization


Post op/post procedure
(less than 48 hours prior)


Presence of epidural
catheter


Spinal cord
injury/significant
immobilization issues

Chronic long term
indwelling catheter


History of urinary
retention

MD order to continue
urinary catheter




Indications present? Yes or No

Assess Patient for Indications

for Continued Catheter Use
:



Continue catheter care per policy.


Ensure compliance with catheter “bundle”:


Securing device used. (example: stat
-
lock)


No dependent loops in tubing.


Secure tubing to bed.


Bag not overfilled or touching floor.


If spinal cord injury, assess readiness for bladder
training.

And re
-
evaluate need at each
subsequent SBAR Handoff

If Yes…

Are any indications present?

Patient care to include:


Frequently
offer
BR/commode/bedpan/urinal.


Encourage
mobilization/activity and
PO
fluids
as
indicated.


For
men, consider external (condom) cath.


Bladder
scan if unable to void in 6 hours.



If
< 300 ml, recheck in 4 hours.




If > 300 ml, straight cath X1.


Re
-
scan
if unable to void in 6 hours.


If
>300 ml, call MD for catheter reinsertion order
.

RN may remove catheter without
MD order

If No…

74 yo female

ED admission to Med/surg nursing unit

Dx: ALOC, Laceration to forehead due to fall at
home

Hx: Diabetes type II, osteoarthritis, mild HTN,
lives alone & independent.

Labs: normal CBC, Na
+

125, K
+

3.8

UA: normal, obtained from urinary cath while in
ED

CAT Scan: Negative for stroke


Admission to nursing unit from ED


Received on unit @ 1900


Vitals stable


Lethargic, c/o of headache, oriented to self
only


Unsteady gait, hands tremulous


Urinary catheter in place

The next day on Med/surg


Awake, alert x4


Gait slow but balanced


Classified as a high fall risk due to
medication and age.


Able to rise from chair w/o help


Asking, “why do I still have this tube?”




Assessment Questions:


Does the patient’s condition warrant a urinary
catheter?

¾

Is the patient able to make needs known?


Does patient have history of retention?


Does the patient have a Stage III or greater
pressure ulcer and is incontinent?


Is the patient receiving large doses of diuretics?


Do you have an order for urinary catheter?





According to the policy,

Nurse Driven Urinary Catheter Removal
,


you can discontinue the catheter without the
need of calling the Physician, for a d/c
urinary catheter order.


Instruct patient and family of the:


Importance of calling for
assistance for toileting



Importance of fluid intake as
indicated



Importance of activity: up in
chair, ambulating in room and
around unit



Reinforce safety precautions:
“Call don’t Fall”

Patient education post catheter removal

Reference /
Regulations



Brosnahan
, J.E. & Kent, B. (2004). Short
-
term indwelling
catheters (a systematic review): Evidence for a primarily nursing
decision.
Worldviews on Evidence
-
Based Nursing, 1,
(4), 228.


Gotelli
, J.M.,
Merryman
, P., Carr, C.,
McElveen
, L., Epperson, C.,
Bynum, D. (2008). A quality improvement project to reduce the
complications associated with indwelling urinary catheters.
Urologic Nursing, 28
(6), 465
-
467, 473.


Griffiths, R., & Fernandez, R. Strategies for removal of short
-
term
indwelling urethral catheters in adults.
Cochrane
Database of
Systematic Reviews 2007,
Issue 2, Art. No.: CD004011.


Topal
, J., Conklin, S., Camp, K., Morris, V.,
Balcezak
, T., &
Herbert, P. (2005). Prevention of nosocomial catheter
-
associated
urinary tract infections through computerized feedback to
physicians and a nurse
-
directed protocol. American Journal of
Medical Quality, 20, (3), 121
-
126
.


Greenspan, Robert E MD, MEDICINE: Perspectives in History and
Art | ISBN
-
10 0972448608 | ISBN
-
13 978
-
0972448604