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Intermittent Catheterization: Clean vs. SterileLaura McDonald and Robyn BegalkeNFDN 2003 A04Assignment 1: Research of Best Practice and Application to Nursing CareNorQuest CollegeDr. Harrison ApplinMarch. 9, 2015Intermittent Catheterization: Clean vs. SterileIntroductionIntermittent catheters are commonly used for patients with a neurogenic bladder that may have been a result of spinal chord injury or other neurological disease processes. People that are affected with a neurogenic bladder experience inability to begin voiding or the inability to empty the bladder of all urine. Intermittent catheters can be inserted frequently throughout the day to avoid complications arising from urinary retention, which may include urinary tract infections (UTI). UTI’s occur when a bacterium is introduced into the urethra or bladder and can lead to cystitis, progressive renal deterioration or sepsis (Lemke, Kasprowicz, & Worral, 2005). Although intermittent catheters are preferred, there can be complications associated with them, especially when patients use them long term. Clean or sterile technique can be used for this procedure. It is important for the nurse to use best practice while performing catheter insertion, care, and client teaching to reduce the risk of complications.Current Best PracticeThe use of a sterile technique is favoured in the hospital setting to reduce the incidence of nosocomial infections. Today, “in hospitals, sterile intermittent catheterization is preferred over a non-sterile procedure because fewer cases of bacteriuria and UTI occur” (Newman & Willson, 2011, p. 12). Due to increased exposure to harmful bacteria with intermittent catheterization the risk for developing a UTI becomes high. Sterile technique includes the use of sterile equipment (one-use catheter, sterile insertion kits and sterile gloves) and maintaining a sterile field. In a home setting clean technique is considered best practice. In the past patients have been encouraged to save and re-use catheters after cleansing them. “New guidelines released in the past three years have recommended changes to the practice of re-using catheters” (Newman & Willson, 2011, p. 12). The re-use of catheters is no longer considered best practice and the patient is encouraged to use a new catheter each time to minimize the risk of cross contamination. Reintroducing a used catheter into a sterile cavity such as the bladder can be the portal of entry for harmful microorganisms. Although sterile technique is considered best practice for UTI prevention, it is not realistic for patients to perform this technique in the home setting due to cost and inefficiency. Clean technique while re-using catheters is “less time consuming and decreases the cost of intermittent catheterization” (Lemke, Kasprowicz, & Worral, 2005). This practice although convenient for the patient may put their health at risk which is why its beneficial to use clean technique with a new catheter each time in the home setting. Previous Best Practice In the past, patients have been able to perform intermittent self-catheterization using clean technique. In the health care setting “the nurse must use aseptic technique to minimize the risk of cross-contamination. However, the patient may use “clean” technique at home, where the risk of cross-contamination is reduced” (Day, Paul, Williams, Smeltzer & Bare, 2010, p. 1499). Clean technique involves re-using the same catheter more than once and rinsing it well with tap water after it has been soaked in a cleaning solution, and inserting the catheter using clean gloves in a clean setting in the home (Day et al., 2010). The re-use of catheters increases the risk of infection because the catheter is not sterile after the first use. How Best Practice Protects the Medical-Surgical ClientBest practice protects the client from pain, damage, harm, or infection. With intermittent catheters, they are being inserted on average “every 4-6 hours” (Day et al., 2010, p. 1500). Since “the catheter is a foreign body in the urethra and produces a reaction in the urethral mucosa” (Day et al., 2010, p. 1498) it is important to ensure best practice to minimize complications. Nurses have the responsibility to research evidence based practice to verify that clients are receiving safe competent and ethical care. Knowledge based practice is to ensure that we use relevant information, review current nursing research and evolve our own practice. Service to the public and self-regulation is used to create a safe and supportive environment for all clients, to work collaboratively with other members of the health care team and to follow the current standards. Ethical practice allows us to advocate for our clients, to take responsibility for our decisions and to maintain the reputation of our profession. By ensuring that best practice using sterile technique in the medical-surgical setting and clean technique with one-use catheters at home is performed and taught, the safety of the client is protected.Teaching to Protect the Medical-Surgical ClientThe patient should be educated about how to insert and maintain intermittent catheters using best practice by the health care provider. The education should include technique, cleansing and storage instructions and the signs and symptoms of any complications that may arise from frequent catheterization or urinary retention. This can be achieved through creating an individualized teaching plan for the client implemented by the nurse. An effective teaching method with this type of skill would be providing a demonstration for the client and then requesting that the client provide a return demonstration. The nurse should evaluate the client’s ability to perform intermittent catheterization and their understanding of the procedure. The return demonstration would enable the nurse evaluate if the client has any sensory, motor or cognitive deficits that would hinder the self-catheterization. The client should also be informed of other health promotion strategies they could implement to enhance their ability to cope with their disease process such as increased fluid intake. It is critical that the nurse inform the client of signs and symptoms of UTI’s because of the high incidence with intermittent catheter patients. Some of the symptoms that can be indicative of a UTI and should be reported by the client are “fever, chills, nausea, vomiting, and malaise” (Potter & Perry, 2014, p. 1117). Ensuring the client has the information they need to be self-sufficient and safe is vital to their care and quality of life. Part B Care PlanPriority Nursing DiagnosisImpaired urinary elimination related to inability to completely void bladder contents secondary to neurogenic bladder as evidenced by urinary retention and increased urgency. Client Centered GoalClient will not have impaired urinary elimination. Outcome (Using SMART) Client will have effective urinary elimination using intermittent catheterization insertion within the next 24 hours. InterventionsIntermittent catheterization according to ordered schedule to ensure bladder is completely voided (Mangnall, 2015, pp. 87-88).Ensure “fluid intake of 2000 to 2500 mL” (Potter & Perry, 2015, p. 1146).Evaluate and maintain the patency of the catheter tubing to ensure adequate urine flow. (Potter & Perry, 2015, p. 1146). Evaluation StatementThe client having an effective voiding pattern of at least four times a day with intermittent catheterization and no urinary retention related complications within the next 24 hours. Potential Nursing DiagnosisRisk for infection related to regular use of an intermittent catheter.Client Centered GoalClient will have no signs of dysuria, hematuria, cloudy urine, fever, frequency and urgency, which may indicate a UTI.Outcome (Using SMART) There will be no signs or symptoms of acute infection including dysuria, hematuria, cloudy urine or fever (Potter & Perry, 2014, p. 1117) within the next 8 hours to one week. InterventionsThe nurse will ensure that sterile technique is used when inserting the intermittent catheter (Potter & Perry, 2014, p. 1137). The nurse must “ensure that urine does not pool in the tubing and cause reflux of urine into the bladder” (Potter & Perry, 2014, p. 1148). The nurse will wash the perineal area with soap and water at least twice a day (Day et. al., 2010, p. 1500). Evaluation StatementThe client will show no signs or symptoms of an infection including dysuria, hematuria, cloudy urine, fever, frequency and urgency within the first 8 hours to one week of care. Educational Nursing DiagnosisKnowledge deficit related to intermittent catheter self-insertion as evidenced by client states “I’m not sure if I understand how to do this because I’ve never done it before.”Client Centered GoalClient will understand how to insert the catheter using correct procedure and accurately perform return demonstration. Outcome (Using SMART)Client will be able to return demonstrate the correct technique for self-insertion of the intermittent catheter with 100% accuracy within one day of teaching. InterventionsProvide a demonstration using visual aids so the client can visualize the correct clean technique from the nurse. (Mangnall, 2015, p. 86). The nurse will provide the teaching for intermittent self-catheterization in an “unhurried manner in a quiet and private area” (Mangnall, 2015, p. 86).The nurse will educate the client about the signs and symptoms of a UTI (Mangnall, 2015, p. 86). Evaluation StatementThis will be evaluated by the patient being able to provide a return demonstration with 100% accuracy within one day of teaching.SummaryIn conclusion sterile technique is best practice while performing intermittent catheterization in a healthcare setting. With clean technique, using one-time use catheters is best practice when performed by the client in their home setting. The use of best practice is the best way to avoid complications and maintain the health of the client. It’s crucial for the nurse to teach the client about infections and proper technique to protect the client from complications. ReferencesDay, R. A., Paul, P., Williams, B., Smeltzer, S., & Bare, B. (2010). Brunner & Suddarth's textbook of Canadian medical-surgical nursing (2nd Canadian ed.). Philadelphia: Lippincott Williams & Wilkins.Lemke, J., Kasprowicz, K., & Worral, P. (2005). Using the best evidence to change practice. Intermittent catheterization for patients with a neurogenic bladder: sterile versus clean: using evidence-based practice at the staff nurse level. Journal Of Nursing Care Quality, 20(4), 302-306Mangnall, J. (2015). Managing and teaching intermittent catheterisation. British Journal Of Community Nursing, 20(2), 82-88.Nazarko, L. (2012). Intermittent self-catheterisation: past, present and future. British Journal Of Community Nursing, 17(9), 408-411.Newman, D. K., & Willson, M. M. (2011). Review of intermittent catheterization and current best practices.?Urologic Nursing,?31(1), 12-48.?Potter, P., & Perry, A. (2013). In J. Ross-Kerr, M. Wood, B. Astle, & W. Duggleby (Eds.), Canadian fundamentals of nursing (5th ed.). Toronto, ON: Elsevier Canada. ................
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