Aseptic Technique in Catheterisation: Nursing Practice

Aseptic technique is a general term that involves the practice of procedures and processes in the care and treatment of patients, by reducing the introduction of micro-organisms to the patients. Asepsis is of two kinds, general asepsis, and surgical asepsis. General asepsis concerns the procedure and processes involved in the care and treatment of patients outside the operation theatre, while surgical asepsis involves the procedure and processes for the prevention of infection at the surgical site of patients.

Urinary Catheterization is a general asepsis procedure that involves the insertion of intravenous catheters or urinary catheters in patients. The use of the aseptic technique in catheterization is primarily employed to minimize the risk of infections to the patients after the procedure has been accomplished and also to reduce the risk of infectious micro-organisms to service providers.

The urethral catheter tube traditionally consisted of a tube that was inserted into the urinary bladder through the urethra and was drained into an open container. In the 1950s, a closed system of the catheter was introduced which is in use until today (Warren, 1992).

The Aseptic technique is the method of maintaining sterility and avoiding contamination of surgical items during surgical procedures when an object is being introduced into the body. In this essay, the researcher aims to examine urinary catheterization, the equipment used, and the aseptic techniques employed when using catheters along with the inspection of the several effects in the case of failure in employing the aseptic technique.

Urinary Catheterization is the introduction of a catheter through the urethra into the urinary bladder. Catheters are commonly made of rubber plastics although they may be made from latex, silicone, or polyvinyl chloride.

Catheter Size

It has been recommended that the catheter with the “narrowest, softest tube” is ideal for catheterization (McGill, 1982). In a majority of patients, the use of the catheter with a 5-milliliter balloon inflated with about 5 to 10 milliliters of fluid is considered ideal to minimize irritation (McGill, 1982).

They are sized by the diameter of the lumen using the French scale: the larger the number, the larger the lumen. Either straight catheters, inserted to drain the bladder and then immediately removed, or retention catheters, which remain in the bladder to drain urine, may be used.

In performing Urinary Catheterization, it is important to determine the most appropriate method of catheterization based on the purpose and any criteria specified in the order such as the total amount of urine to be removed or the size of the catheter to be used. There are several catheter choices in the urinary catheterization process.

Suprapubic Catheter v/s Urethral Catheter

Suprapubic catheters are generally preferred over urethral catheters by physicians for gynecologic and urologic and short-term uses (Warren, 1992). The risk for infection is reduced by the use of a suprapubic catheter since there are fewer microbes on the abdominal wall as compared to the perineum. The ease in changing these catheters adds to the comfort and convenience of the patients which makes it more preferable (Warren, 1992).

However, suprapubic catheters increase the risk of cellulitis leakage, hematoma at the site of puncture, the risk of prolapse through the urethral in addition to the added psychological barrier of insertion of the catheter through the abdominal wall.

Silastic Catheter v/s Latex Catheter

The use of Silastic catheters has been recommended for short-term post-surgery catheterization. As compared to latex catheters, Silastic catheters have a reduced risk of urethritis or even urethral stricture (Nacey, Tulloch & Ferguson, 1985). Silastic catheters are used in patients who have an allergy to latex. However, latex catheters are preferred for long-term use due to lower costs (Wood & Bender, 1989).

Potential Complications in Urinary Catheterization

Urinary catheterization is usually performed only when necessary because the danger exists of introducing microorganisms into the bladder. Clients who have lowered immune resistance are at greater risk. Once an infection is introduced into the bladder, it can ascend the ureters and eventually involved the kidneys.

Thus, a strict sterile technique is used for catheterization. Another hazard is trauma, particularly in the male client, whose urethra is longer and more tortuous. It is important to insert a catheter along the normal contour of the urethra. Damage to the urethra can occur if the catheter is forced through strictures or at an incorrect angle.

There are Practice Guidelines in preventing Catheter-Associated Urinary Infections. These necessitate the importance of having an established infection control program and catheterization of clients only when necessary, by using aseptic technique, sterile equipment, and trained personnel.

Aseptic technique is essential when using catheters to prevent infection from entering the body. Through the use of correct technique, sterility can be maintained during the process of installing, using, and removing catheters, and avoid the serious complications of bladder and kidney infections resulting from a failure in aseptic technique.

Urinary catheterization has the potential to cause many health problems in patients due to several complications which may occur. Research has substantiated the formation of ‘universal bacteriuria’ by the end of four days in the employment of open catheterization as compared to thirty days by using the closed catheterization technique (Warren, 1992). Long-term catheterization could result in several problems such as chronic renal inflammation and other urinary tract infections (Warren, 1992).

Urinary Tract Infection

Infection of the urinary tract is one of the most common complications associated with urinary catheterization techniques (Center for Disease Control, 1979). The method and the duration of catheterization determine the risk of the tract infection and are also impacted by the quality of catheter care to the patient. If the infection of the urinary tract continues to persist in patients, complications such as prostatitis, epididymitis, cystitis, pyelonephritis, and bacteremia could arise in patients with high risk (Kunin, 1979).

Obstruction

Obstruction is a complication that is likely to occur when using the catheterization technique. The urinary catheters may be obstructed by several materials including bacteria, proteins, and precipitations of crystals (Warren, 1992). When patients develop blocked catheters, there is increased excretion of calcium and proteins in their bodies (Kunin, Chin & Chambers, 1987).

Leakage

Long-term catheterization has the potential to cause bladder spasms in patients. The force created due to these spasms causes leakage around the catheter.

Colonization

Almost all the patients undergoing chronic catheterization are colonized with bacteriuria within six weeks if the appropriate hygienic conditions are not adopted in the process. This colonization has the potential to give rise to infections and other complications, which may be harmful to the health of the patients.

References:

Center for Disease Control, (1979). National Nosocomial Infections Study Report, Atlanta: Center for Disease Control: 2-14.

Kunin CM, (1979). Detection, prevention, and management of urinary tract infections. 3rd ed. Philadelphia: Lea and Febiger.

Kunin CM, Chin QF & Chambers S., (1987). Indwelling urinary catheters in the elderly. Am J Med; 82:405-11.

McGill S., (1982). Catheter management: it’s the size that’s important. Nurs Mirror; 154 (14): 48-9.

Nacey JN, Tulloch AG & Ferguson AF., (1985). Catheter-induced urethritis: a comparison between latex and silicone catheters in a prospective clinical trial. Br J Urol; 57: 325-8.

Warren JW., (1992). Catheter-associated bacteriuria. Clin Geriatr Med; 8: 805-19.

Wood DR, Bender BS. Long-term urinary tract catheterization. Med Clin North Am 1989;73: 1441-54.

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