Long term foley use

[Vtachy1]

How long have you seen a foley stay in a patient? I know they aren't meant for long term use, but in a dying patient it is there for comfort reasons and skin breakdown issues.

He has had the foley for 5 months and now is on continuous antibiotics. Problem is, now he is having bladder spasms more frequently. We just initiated B&O suppositories yesterday. Tried pyridium, ditropan, and antibiotics.

We may have to take out the foley to make him more comfortable??? Is there anything else I can do besides remove the foley?

[CompleteUnknown]

not a study, but this is from a guide by the tasmanian government infection prevention and control unit.

approaches not considered a routine part of cauti prevention

1. do not routinely use silver-coated or other antibacterial catheters

2. do not screen for asymptomatic bacteruria in catheterized patients

3. do not treat asymptomatic bacteruria in catheterized patients except before invasive urologic procedures

4. do not clean the periurethral area with antiseptics to prevent cauti while the catheter is in place. routine hygiene

(e.g. cleansing of the meatal surface during daily bathing) is appropriate

5. avoid catheter irrigation:

a. do not perform continuous irrigation of the bladder with antimicrobials as a routine infection prevention measure

b. if obstruction is anticipated, closed continuous irrigation may be used to prevent it

c. to relieve obstruction due to clots, mucus, or other causes, an intermittent method of irrigation may be used

6. do not use systemic antimicrobials routinely to prevent cauti in patients requiring either short or long-term

catheterization

7. do not change indwelling catheters or drainage bags at arbitrary fixed intervals*

a. follow manufacturers instructions

8. do not use urinary catheters in patients and nursing home residents for the routine management of incontinence

9. antiseptic or antimicrobial solutions need not be instilled into urinary drainage bags routinely to prevent cauti

10. clamping indwelling catheters prior to removal is unnecessary.

the pamphlet itself refers to some systematic reviews.

http://www.dhhs.tas.gov.au/__data/assets/pdf_file/0008/75716/preventing_catheter_associated_urinary_tract_infection_guide_a3_size_v1.0.pdf

[CapeCodMermaid, RN]

Hey guys a request. Many folks love to use the phrase, studies have shown blah blah blah, please post a link to the study you are referring to.....

Thanks :)

You can go to the CDC website...search 'changing indwelling catheters'. The CAUTI study shows there is no need to change catheters routinely. They should be changed for blockage and the like. The article is interesting, and, no offense to a previous poster, but I'd believe the CDC over the Tasmanian government:smokin:

[nurseprnRN, BSN, RN]

don't dis the tasmanians-- they're almost real ozzies! ::ducking and running::

another thing that i've heard is sometimes done for someone who will be permanently on urinary collection is a sphincterotomy. then there is nothing preventing urine from exiting the bladder, and so an external condom cath is best. nothing invasive, no further sphincter spasm. anybody still seeing this?

[thehipcrip]

Hey guys a request. Many folks love to use the phrase, studies have shown blah blah blah, please post a link to the study you are referring to.....

Thanks :)

Ack! Forgot my link. The NIH funded study that recommended using the 10 percent bleach solution and found that pseudomonas thrived in bags cleaned with vinegar can be found at: http://www.ncbi.nlm.nih.gov/pubmed/8466427

[seemerun]

I don't think I expressed myself correctly. It's not that you NEVER change it. Like a previous poster stated -not at a fixed interval. You change on an as needed basis.

I knew when I posted that I needed to get the references. I should have waited. :-) I will see what I can get from my friend. I do know some of her info was from the CAUTI info also posted.

[CompleteUnknown]

You can go to the CDC website...search 'changing indwelling catheters'. The CAUTI study shows there is no need to change catheters routinely. They should be changed for blockage and the like. The article is interesting, and, no offense to a previous poster, but I'd believe the CDC over the Tasmanian government:smokin:

Lol well none taken, but it's agreeing with you anyway. :)

GrnTea, I'm not in Tasmania, otherwise you may well have to duck and run!

[seemerun]

http://www.medscape.com/viewarticle/587464_6

Also interesting:

if you need to collect a UA it is no longer recommended that you clamp the cath and aspirate from the port. This is an instance where you should change the catheter. The thought process is that if it's an old catheter the bacteria present in the UA collected would represent both whatever may be causing the symptomatic infection as well as the colonized bacteria that is present in all long term foleys. You would not know which bacteria is responsible for s/s of acute infection and appropriate treatment may slowed. If you use a new cath - then the UA will only show the 1 or 2 organism that are likely causing the symptoms.

http://www.medscape.com/viewarticle/587464_3

[Vtachy1]

I had another patient that had his foley for 10 years. I inquired to the wife if he'd ever had bladder spasms in the past. Yes he had. She said that what helped was irrigating with distilled water. I dunno, this would just introduce MORE bacteria???