Strategies for the Successful Removal of Short-Term Indwelling Catheters

Introduction

This paper aims to evaluate current strategies for the removal of short-term indwelling catheters. The main purpose is to identify the most effective approaches, which are currently used by healthcare professionals. First, it should be noted that catheterization is one of the most common operations and thousands of patients have to pass through it; yet, this procedure often entails many complications like the urinary tract infection (UTI) or prostatitis (Milan & Ivan, 2009, Konno, 2008).

Thus, the key objective is to minimize these risks and assist those people who have to undergo this surgical operation. It should be borne in mind that that the short-term catheterization normally ranges from one to fourteen days and practitioners have to determine when and how this device should be removed. The major questions are the timing of removal (in midnight or early morning) and the duration of catheterization (one day or longer).

This systemic review relies on the analysis of the most recent quantitative researches conducted in this field. It is rather difficult to give preference to any particular technique because there is a vast variety of cases when this tube has to be inserted into the body, for instance, after childbirth or during abdominal abscess. Furthermore, the decision depends on the age and sex of the person. The scholars also warn medical workers against the possibility of catheterization and emphasize the importance of adequate assessment (Reilly et al, 2006).

This review will focus on the most widespread situation, namely urine catheterization. There is a great number of works dedicated to this issue and judging from the results of these studies it is quite possible to recommend early removal of this tube, namely within the first three days because such method reduces the period of hospitalization and helps to eliminate the risks of UTI (Robinson et al, 2007, p 170).

The duration of catheterization

The risks of prolonged catheterization

First, it should be noted that long catheterization is usually used for elderly people (Konno, 2008). In his article, Rie Konno focuses on the possibility of urinary tract infection and proposes different methods of coping with this problem. First, the author states that the incidence of bacteria increases by 5 percent with each day of catheterization among both males and females. He stresses the idea that medical workers should avoid unnecessary or prolonged usage of this device because it is both dangerous and uncomfortable to the patient. Sherry Robinson and her co-authors tell that approximately 37 % of all patients who have undergone catheterization now have been infected with UTI (Robinson et al, 2007, p 159).

The scholars report that early removal of catheters minimizes the possibility of urinary tract infection at 27 percent. These findings are quite consistent with a meta-analysis, made by Fernandes and Griffiths, who say that in the course of five trials early removal of catheter decreased the risk of infection and significantly diminishes the period of hospitalization approximately at two days (2006). This opinion is partially supported by Karin Glavind and her co-authors. The scholars suggest removing the catheter or vaginal pack within three hours after the surgery with careful postoperative monitoring (Glavind, et al, 2007, p 125).

Karin Glavind et al say that more than 6 percent of women whose catheter was removed within one day had to be re-operated. In sharp contrast, those patients whose catheter was removed within three hours had fewer complications. Nonetheless, they also warn medical workers against the risks of catheterization. The authors still argue that there is no conclusive evidence about the advantages and disadvantages of early removal. Moreover, medical workers stress the importance of further studies that would confirm or refute the initial hypothesis. However, they concur that the dangers of UTI are much more potent, so they believe that removal is much more preferable.

The benefits of early removal

The benefits of early removal of the indwelling catheter are numerous. First, many researchers report a higher degree of satisfaction in those patients whose catheter was removed soon after the operation. More than seventy percent of all patients were much more content with the process of treatment in case of early removal (Fernandes & Griffiths 2006). The researchers say that people tend to feel rather uncomfortable having to wear this device. They mustn’t experience any psychological discomfort. Undoubtedly, this is not the most important criteria for decision-making but doctors should consider it (Fernandes & Griffiths 2006).

Still, there is no unanimity among scholars about the timing. Practically all of them support the idea of early removal of the short-term catheter, but at the same time, all of them set stress on the possibility of relapse. Hence, they say that it is of crucial importance to assess the patients state before taking any actions. The research, carried out by a group of scientists under the direction of Sherri Robinson, has indicated that these devices are immensely overused in hospitals (Robinson et al, 2007, p 161).

The results of their studies show that approximately 40 percent of the use of catheters was not justified (2007, p 159). They argue that urinary tract infection is most likely to be caught during the first five days after the operation. This is why medical workers should take the catheter away as soon as possible. The question arises of how to decide whether this tube can be removed or not. It is necessary to measure bladder distention, the amount of urine in the bladder, time of the last void, and so forth (Reilly et al, 2006, p 280). Therefore, they suggest that early removal of the catheter is quite acceptable especially if the patients illness is not very severe but it is very difficult to safeguard this person against future hospitalization (Reilly et al, 2006).

The systemic review of the abovementioned works shows that catheters can be removed within the first three days. The researchers urge practitioners and nurses to take into account such factors as the cause of catheterization, the amount of urine, voiding intervals, and the age of the patient (Reilly et al, 2006). The overarching argument is that early removal can immensely speed up the process of recovery and most importantly eliminate the possibility of urine tract infection, yet there is a great likelihood of catheterization. This is why the overall recommendation is that the removal should be performed within the first three days at maximum.

However, this statement must not be regarded as conclusive as future studies must be carried to verify whether there are any hidden drawbacks of early removal of this short-term indwelling catheter. The information, presented in these articles only lays the foundation for continuous research of these issues.

The timing of removal

The second question which needs to be addressed is when exactly the short-term catheter should be removed. Normally, it is done early in the morning. However, there is evidence that this procedure should be performed at midnight (Fernandes & Griffiths, 2006). If such a method is employed, the volume of the first void significantly increases, especially in comparison with early morning removal. Yet, there is a significant limitation: according to the findings, the patient whose catheter was removed during the night felt very disturbed and disorientated in the morning and there were considerable delays in the first voiding (Fernandes & Griffiths, 2006).

This evidence shows that the physician should objectively evaluate all positive and negative sides: the patients discomfort and a more fluid process of recovery. One of the major benefits of mid-night removal is that the body has more time to adjust itself. Apart from that, the urine accumulates during sleep, and the amount of the first void increases. This subsequently contributes to a better recovery process.

At this stage, scholars cannot fully agree on the point of whether midnight removal is more or less effective. They say that the outcome of the treatment can be impacted by other factors such as the patients previous condition, the care given to him by the hospital staff, and his or her lifestyle. In fact, and it is sometimes rather difficult to find the connection between midnight removal and the patients health (Fernandes & Griffiths, 2006).

Conclusion

This information should be utilized by the healthcare professionals who provide services to the patients who have to undergo catheterization. The research works of many scholars show that it is much more prudent to remove this tube within the shortest period, approximately after twenty-four hours. The longer use of this device will immensely increase the risk of urinary tract infection. But physicians must accurately assess the patient’s readiness for the removal of the catheter.

As for the specific timing, scholars suggest that medical should perform this procedure in the evening or at midnight because it provides sufficient time for the urine to accumulate. These quantitative studies are not conclusive. The thing is that it is practically impossible to establish the link between the removal of the catheter and the outcome of the treatment because it can be shaped by other factors. Therefore, this question still requires thorough examination and discussion.

Reference List

Fernandes, R., & Griffiths, R. (2006). Removal of Short-term Indwelling Urethral Catheters. The JBI Best Practices Reports, 2 (3), 1-32. Web.

Glavind, K., Morup, L., Madsen, H., & Glavind J. (2007). A prospective, randomized, controlled trial comparing 3 hours and 24-hour postoperative removal of a bladder catheter and vaginal pack following vaginal prolapse surgery. Acta Obstetricia et Gynecologica Scandinavica, 89, 1222- 1225.

Konno, R. (2008). Urinary Tract Infection (Catheter-Related): Prevention. Evidence Summaries – Joanna Briggs Institute. Retrieved October 14, 2009, from Evidence-Based Resources from the Joanna Briggs Institute.

Milan, P., & Ivan I. (2009). Catheter-associated and nosocomial urinary tract infections: antibiotic resistance and influence on commonly used antimicrobial therapy. International Urology and Nephrology, 41(3), 461-4. Retrieved October 14, 2009, from ProQuest Health and Medical Complete.

Munn, Z. This Evidence Summary answers the question: What is the evidence regarding the prevention of catheterrelated urinary tract infections (UTIs)?. The JBI.

Nicolle, L. (2005). Catheter-Related Urinary Tract Infection. Drugs Aging, 22 (8), 627 -639.

O’Connell, B., Ostaszkiewicz. J., & Ski S. (2006). Development and Trial of Best Practice Protocol for Management of Urinary Retention in Elderly Patients in Acute and Sub-Acute Settings. Deakin University. Web.

Reilly, L., Sullivan, P., Nini, S., Fochesto, D., Williams, K., Fetherman, K. Reducing Foley Catheter Device Days in an Intensive Care Unit. AACN Advanced Critical Care, 17(3), 272-283.

Robinson, S., Allen, L., Barnes, M. A., & Berry T. (2007). Development of an Evidence-Based Protocol for Reduction of Indwelling Urinary Catheter Usage. MEDSURG Nursing, 16(3), 157-162.

Roodhouse, A J., & Wellsted A. The prevention of in-dwelling, catheter-related urinary tract infections is the outcome of a performance improvement’ project. British Journal of Infection Control, 5(5), 22-24.

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