Catheter-related problem---UTI
Catheter-related problem---UTI
致病菌 Extogenous organisms（e.g.serratia spp. And Pseudomonas aeruginosa）found in the environment and on hand Endogenous faecal or urethral microorganisma（e.g.Gram-positive cocci and Klebesiella）
途徑 Transurethra catheterization Transvesical catheterization（ suprapubic catheterization ）
What is suprapubic catheterization？

恥骨上導尿管：在膀胱脹滿水之後由恥骨上正 中央插入導引器然後插入導尿管
Complications associated with urinary catheters
Short-term catheterization

Trauma and inflammation Urethritis bacteriuria：尿道周圍有革蘭氏陰性桿菌及腸 球菌移生，80%會產生菌尿症，女性病人菌尿 症中70-80%是因導尿管外壁與尿道黏膜空隙 之細菌侵入。導尿管短期置放之菌尿症通常為 單一菌種，但有15%是多菌且同時為膿尿， E.Coli是常見細菌
urethral
Consider suprapubic or urethral catheterization
suprapubic
specific care Strict asepsis on insertion Strict asepsis on insertion
urethra
specific advantages Reduced risk of infection Enable sexual intercourse Nurse able to carry out procedure
Catheter-related problem---UTI
危險因素：

引流袋污染 糖尿病 女性患者 抗生素使用 頻頻測量尿輸出量 腎功能不良 技術不良
Catheter-related problem---UTI
致病機轉 細菌由會陰部或尿袋移生後經由導尿管 外壁或內壁上行 女性之感染途徑為經由直腸正常菌叢污 染尿道周圍 男性主要為管路內經由外來細菌污染 尿道口之細菌可經由插入導尿管時帶入 膀胱
Complications associated with urinary catheters
Long-term catheterization
1. 菌尿症是很常見，一般多於6週內發生 2. 有症狀泌尿道感染、發燒、急性腎盂腎炎、菌血症、 甚至死亡 3. 導尿管阻塞、尿路結石、局部尿道周圍感染、慢性腎 炎、腎衰竭、甚至術年後發生膀胱癌 4. 男性長期導尿管放置可導致尿道炎、尿道廔管、副睪 炎、陰囊膿瘍、攝護腺炎或攝護腺膿瘍 5. 長期導尿管之病人尿中有95%為多重菌感染，菌種為 E.coli、P.aeruginosa、P.mirabilis，少數為Providentia stuartii及M.morganii
of catheterization

10% of patients in hospital（Mulhall et al,1988） 25% of patients in hospital（Saint et al,1999） 4% of patients receiving nursing services at home（Getliffe and Mulhall,1991）
Maintaining a closed urinary drainage system
Maintaining a closed urinary drainage system
Maintaining a closed urinary drainage system
DO


Bypassing UTI Blocked catheter Inadvertent catheter removal
Catheter-related problemBypassing
Common causes of bypassing Constipation Kinked tubing Catheter size and length/balloon Detrusor instability Trigone irritation blockage
Consider suprapubic or urethral catheterization
suprapubic
Specific
urethral
disadvantages
Altered body image
Altered body image
Potential leakage from and Impedes sexual intercourse around site Requires a registered Higher risk of infection medical practitioner to insert
Selection of catheters
Which material For short-term use （1-28days）: Latex, PVC, PTFE-coated latex foley catheter For long-term use of up to 12 weeks,select one of the following: hydrogel-coated latex foley catheter pure silicon Foley catheter silicon-coated latex Foley catheter
Maintaining a closed urinary drainage system
DON’T Don’t allow any tension on the tubing that could dislodge the catheter or damage the urethra Don’t allow tubing to loop below the drainage bag Don’t attach the drainage to a bed rail or allow it to rest on the floor Don’t allow the patient to lie on the tubing
Catheter-related problem-UTI
直接影響導尿管造成感染之因素：放置時間長短


Detect significant microbial counts-3days after catheterization（Bach et al,1990） The risk of developing bacteriuria Garibaldi et al （1974）： 8.1% for each day Mulhall et al（1988）：5-8% for each day Sedor（1999）：5% for each day Bacteriuria is virtually inevitable within 3-4 weeks （Jewes et aal,1988）
病患留置導尿前之護理


評估病患留置導尿的適應症 選擇合適的導尿管 評估病患留置導尿前的排尿情形 病患留置導尿前之護理指導 正確置入導尿技術
病患留置導尿的護理




維持導尿管引流系統的功能 適當固定導尿管，預防拉扯及創傷 預防泌尿道的感染 評估留置導尿管對病患及家庭的影響， 並協助處理 預防便秘 尿液滲漏的處理
Indications for use of urinary catheters
Short-term catheterization Urologic surgery Surgery on contiguous structures Critically ill patients requiring accurate measure of urinary output Acute urinary retention
suprapubic catheterization
suprapubic catheterization
indications for suprapubic catheterizattion




Urethra trauma Clients who require long-term catheterization and who are sexually active Following pelvic or urological surgery Some gynaecological conditions,e.g.colposuspension Long-term catheterization for incontinence Clients who are unable to tolerate urethral catheterization Some wheelchair-bound clients
Indications for use of urinary catheters
Long-term catheterization




Bladder outlet obstruction not correctable medical or surgically Intractable skin breakdown caused or exacerbated by incontinence Some patients with neurogenic bladder and retention Palliative care for terminally ill or severely impaired incontinent patients for whom bed and clothing changes are uncomfortable Preference of a patient who has not responded to specific incontinence treatments