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Thread: Flush

  1. #1

    Flush

    My catheter gets irragated with 60cc salt water a night. Is this good/bad, recommended, safe?
    Marie
    Unbroken by the grace of God

  2. #2
    Generally the purpose of irrigating a catheter with a small amount of salt water routinely is to keep the catheter from clogging. So, if you have problems with that it is a good thing. On the other hand, opening what is to be a sterile system every day is not always the best thing. So, you have to make a choice based on your particular needs.


    JM

  3. #3
    Who else irragates their catheter and how often is it done?
    Marie
    Unbroken by the grace of God

  4. #4
    Routine irrigation is discouraged as it is more likely to cause infections. Unless your catheter is clogged, it should be maintained with as little disconnection as possible. Does your facility have an infection control nurse or consultant? I would insist that they review their policy of routinely doing this. Where I work, we looked at the literature and stopped doing this in the early 1980s.

    Here is the CDC document you may want to show to them:

    Irrigation
    Irrigation should be avoided unless obstruction is anticipated (e.g., as might occur with bleeding after prostatic or bladder surgery); closed continuous irrigation may be used to prevent obstruction.

    To relieve obstruction due to clots, mucus, or other causes, an intermittent method of irrigation may be used. Continuous irrigation of the bladder with antimicrobial has not proven to be useful (28) and should not be performed as a routine infection prevention measure. Category II

    The catheter-tubing junction should be disinfected before disconnection. Category II

    A large-volume sterile syringe and sterile irrigant should be used and then discarded. The person performing irrigation should use aseptic technique. Category I

    If the catheter becomes obstructed and can be kept open only by frequent irrigation, the catheter should be changed if it is likely that the catheter itself is contributing to the obstruction (e.g., formation of concretions). Category II
    http://wonder.cdc.gov/wonder/prevgui...6/p0000416.asp

    (KLD)

  5. #5
    KLD,

    I was told that flushing my catheter was to prevent clots from forming in the tubing thus preventing proper flow. I have sediment that builds in the tubing over time. Besides drinking more (which I need to do) what are alternatives to treating this with flushing? I showed the nursing director and doctor the CDC webpage link that you sent me. They said that the information was not up to date and that the references are dated back to the 40's. Would you send me some more up to date recommendations on preventing UTI's using Foley catheter? What is the accepted practice for Foley catheter care in your area? If flushing is needed how often does it need to be done?
    Marie
    Unbroken by the grace of God

  6. #6
    Hi,

    I am unsure what type of "clots" you are referring to.

    If a "blood clot" is the concern-this is not normal-unless there is excessive trauma, kidney stone or an infection. By irrigating, you would be masking a more serious problem that requires further investigation.

    Some patients do develop sediment, which is usually successfully treated by increasing fluids and changing catheters more frequently. By irrigating, you are breaking the closed system and introducing a foreign substance into the bladder.

    As stated above, the CDC guidelines are generally considered the experts and are adopted by the institutions I am affiliated with. Theories of preventing UTI are constantly changing based on new scientific evidence and the info above are consistent with current findings. You may want to check out this site and also refer to the references at the end of the articles.

    http://www.aafp.org/afp/20000115/369.html

    AAD

  7. #7
    Nurse,

    Thank you very much. I am going to do a follow up with my doctor. Also, I understand you are supposed to keep a closed drainage system. When I take showers and when I am put to bed the leg bag is detached and the beg bag is attached to my catheter. When the connection is broken it is done only with the use of sterile gloves. Are there additional sterilization procedures that should be followed?

    They change my Foley once a month on the first of the month regardless of how it looks. I do not have blood clots but when the Foley is changed there are dried blood scabs. I was told this is normal because of the irritation caused by changing the Foley. Can you verify that? Also should my Foley be changed when it appears dirty not on an arbitrary date which would also affect flushing issues? With the SCI's that you have worked with, on average how often were their catheters changed?
    Marie
    Unbroken by the grace of God

  8. #8
    Dr Young,

    Would it be possible for you to respond to this thread with any supporting documentation. This policy affects not only myself but a number of SCI's living at the facility.
    Marie
    Unbroken by the grace of God

  9. #9
    Nurse,

    Did you miss my post. I did two and see how it would have gotten over read. Just a big concern. Thanks.

    Quote Originally Posted by quadmarie
    Nurse,

    Thank you very much. I am going to do a follow up with my doctor. Also, I understand you are supposed to keep a closed drainage system. When I take showers and when I am put to bed the leg bag is detached and the beg bag is attached to my catheter. When the connection is broken it is done only with the use of sterile gloves. Are there additional sterilization procedures that should be followed?

    They change my Foley once a month on the first of the month regardless of how it looks. I do not have blood clots but when the Foley is changed there are dried blood scabs. I was told this is normal because of the irritation caused by changing the Foley. Can you verify that? Also should my Foley be changed when it appears dirty not on an arbitrary date which would also affect flushing issues? With the SCI's that you have worked with, on average how often were their catheters changed?
    Marie
    Unbroken by the grace of God

  10. #10
    Quadmarie, the citation above from the CDC is the current recommendation. It is not "outdated" and the references are quite current. It is used as a standard for hospitals and nursing homes around the country. I am puzzled by the lack of knowledge of this standard by the health care professionals at your institution. We have known that routine irrigation of catheters increases the risks for UTIs since the early 1980s.

    If you need more supporting articles, here are a few abstracts:

    Ostomy Wound Manage. 2003 Dec;49(12):34-45.
    Indwelling catheter management: from habit-based to evidence-based practice.

    Smith, JM.
    Medical Services and Support Department, C.R. Bard Inc., Covington, GA, USA. joannsmithrn@aol.com

    Indwelling urinary catheters are used in the care of more than five million patients per year. Prevalence rates range from 4% in home care to 25% in acute care. Catheter-associated urinary tract infections account for more than 40% of all nosocomial infections and can be associated with significant complications. Clinical practices in catheter management vary widely and frequently are not evidence-based. Effective nursing measures include: identifying patients who no longer need indwelling catheters, discussing appropriate catheter alternatives, and providing patient and caregiver education. Many catheter-associated problems can be avoided by selecting a closed catheter system with a small size catheter (14 to 18 French with a 5-cc balloon), following manufacturer's recommendations for inflation/deflation, maintaining a closed system, securing the catheter, and properly positioning the drainage bag. Practices such as routine catheter irrigation should be avoided. Current recommendations related to the management of encrustation and blockage also are discussed. Providing evidence-based catheter management strategies may reduce the rate of catheter-associated urinary tract infection, catheter encrustation, and leakage as well as the discomfort and costs associated with these complications.
    Drugs Aging. 2005;22(8):627-39.Related Articles, Links

    Catheter-related urinary tract infection.

    Nicolle, LE
    Departments of Internal Medicine and Medical Microbiology, University of Manitoba, Health Sciences Centre, Winnipeg, Manitoba, Canada.

    Indwelling urinary catheters are used frequently in older populations. For either short- or long-term catheters, the infection rate is about 5% per day. Escherichia coli remains the most common infecting organism, but a wide variety of other organisms may be isolated, including yeast species. Bacteria tend to show increased resistance because of the repeated antimicrobial courses. Urinary tract infection (UTI) usually follows formation of biofilm on both the internal and external catheter surface. The biofilm protects organisms from both antimicrobials and the host immune response. Morbidity from UTI with short-term catheter use is limited if appropriate catheter care is practised. In patients with long-term catheters, fever from a urinary source is common with a frequency varying from 1 per 100 to 1 per 1000 catheter days. Long-term care facility residents with chronic indwelling catheters have a much greater risk for bacteraemia and other urinary complications than residents without catheters.Asymptomatic catheter-acquired UTI should not be treated with antimicrobials. Antimicrobial treatment does not decrease symptomatic episodes but will lead to emergence of more resistant organisms. For treatment of symptomatic infection, many antimicrobials are effective. Wherever possible, antimicrobial selection should be delayed until culture results are available. Whether to administer initial treatment by an oral or parenteral route is determined by clinical presentation. If empirical therapy is required, antimicrobial selection is based on variables such as route of administration, anticipated infecting organism and susceptibility, and patient tolerance. Renal function, concomitant medications, local formulary and cost may also be considered in selection of the antimicrobial agent. The duration of therapy is usually 10-14 days, but patients who respond promptly and in whom the catheter must remain in situ may be treated with a shorter 7-day course to reduce antimicrobial pressure. Relevant clinical trials are necessary to define optimal antimicrobial regimens for the management of catheter-acquired UTI.Prevention of catheter-acquired UTI and its complications is a major goal. With short-term catheters, avoiding their use or limiting the duration of use to as short a time as possible are the most effective prevention strategies. Maintaining a closed drainage system and adhering to appropriate catheter care techniques will also limit infection and complications. As the duration of catheterisation is the principal determinant of infection with long-term indwelling catheters, it is not clear that any interventions can decrease the prevalence of bacteriuria in this setting. Catheter flushing or daily perineal care do not prevent infection and may, in fact, increase the risk of infection. Complications of infection may be prevented by giving antibacterials for bacteriuria immediately prior to any invasive urological procedure, and by avoiding catheter blockage, twisting or trauma. The major focus of future advances in prevention of catheter-acquired UTI is the development of biomaterials resistant to biofilm formation. There is substantial current research addressing this issue, but current catheter materials all remain susceptible to biofilm formation.
    (KLD)

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