What Can You Do for Bladder Spasms With Catheter?
Urinary Catheter Management
Am Fam Medico. 2000 January 15;61(two):369-376.
Article Sections
- Abstract
- Clinical Indications for Catheter Utilise
- Catheter Choices
- Routine Management
- Management of Complications
- References
The utilize of urinary catheters should be avoided whenever possible. Clean intermittent catheterization, when practical, is preferable to long-term catheterization. Suprapubic catheters offer some advantages, and condom catheters may exist appropriate for some men. While clean handling of catheters is important, routine perineal cleaning and catheter irrigation or changing are ineffective in eliminating bacteriuria. Bacteriuria is inevitable in patients requiring long-term catheterization, but but symptomatic infections should be treated. Infections are ordinarily polymicrobial, and seriously ill patients require therapy with two antibiotics. Patients with spinal cord injuries and those using catheters for more x years are at greater risk of float cancer and renal complications; periodic renal scans, urine cytology and cystoscopy may be indicated in these patients.
For centuries, the urethral catheter organisation consisted of a tube inserted through the urethra into the bladder and drained into an open container. The airtight catheter organization today.1
Urinary catheterization can cause many wellness problems. Alternatives to catheterization should be used whenever possible. Studies accept shown that universal bacteriuria occurs within 4 days when open up catheters are used versus approximately 30 days with closed systems.ane Complications of long-term catheterization include chronic renal inflammation, chronic pyelonephritis, nephrolithiasis, cystolithiasis, symptomatic urinary tract infection with pyelonephritis, bacteremia, sepsis and death.1–4
Clinical Indications for Catheter Apply
- Abstract
- Clinical Indications for Catheter Use
- Catheter Choices
- Routine Management
- Management of Complications
- References
Accepted indications for urinary catheterization are listed in Table 1.4–7 An initial episode of acute urinary memory should exist treated with an indwelling catheter to allow the bladder to regain its tone, with catheter removal and a voiding trial after 10 to 14 days.8 While catheters are often used in older patients, chronic indwelling catheterization is not a substitute for good nursing intendance in the management of incontinence. Because a unmarried in-and-out catheterization may cause bacteriuria in as many equally twenty percentage of older people,4 catheterization is not recommended as a manner of obtaining urine specimens for diagnostic testing in patients who could provide a voided specimen.v In women undergoing total vaginal hysterectomy, even brusk-term use of urinary catheters has been associated with longer hospital stays, and added price and discomfort; it too discouraged early ambulation.9
Tabular array 1.
Indications for Use of Urinary Catheters
| Long-term catheterization |
| Bladder outlet obstruction not correctable medically or surgically |
| Intractable skin breakdown caused or exacerbated by incontinence |
| Some patients with neurogenic float and retention |
| Palliative care for terminally sick or severely impaired incontinent patients for whom bed and clothing changes are uncomfortable |
| Preference of a patient who has non responded to specific incontinence treatments |
| Short-term catheterization |
| Urologic surgery |
| Surgery on face-to-face structures |
| Critically ill patients requiring accurate mensurate of urinary output |
| Acute urinary retentivity |
Intermittent catheterization may be preferable to chronic indwelling catheterization in sure patients with bladder-emptying dysfunction.5 Information technology has get the standard of intendance in patients with spinal cord injuries.10 Following surgical repair of a hip fracture, elderly patients regained satisfactory voiding more apace (5.1 days versus 9.4 days) on a programme of intermittent catheterization every half-dozen to 8 hours compared with the use of indwelling catheters.xi Women undergoing full intestinal hysterectomy who had in-and-out catheterization at the fourth dimension of surgery had a lower rate of bacteriuria than women with indwelling catheters.12 While at that place has been reluctance to use clean intermittent catheterization in the nursing home,13 some higher-functioning nursing home patients may be candidates for cocky-administered make clean intermittent catheterization using the procedure described in Table 2.14
TABLE 2.
Steps in Performing Make clean Intermittent Self-Catheterization
| ane. Wash hands and catheter with soapy water. |
| 2. Rinse hands and catheter with tap water. |
| 3. Self-catheterize (without gloves). |
| 4. After use, wash reusable catheter with soapy water, rinse and store in ventilated container until dry out. |
| five. Place in plastic zipper purse or other clean container. |
In patients who require long-term intermittent catheterization, no difference in colonization or infection rates has been found between those using sterile single-use catheters and those using make clean intermittent catheterization.fourteen Bacteriuria occurs in most patients in 2 to three weeks.10 Regular, frequent meatal cleansing offers no reward in preventing bacteriuria or urinary tract infections in patients performing or using clean intermittent catheterization.15
Catheter Choices
- Abstract
- Clinical Indications for Catheter Use
- Catheter Choices
- Routine Management
- Management of Complications
- References
EXTERNAL CATHETERS
Utilise of a condom catheter should be considered in incontinent men without urinary retention who have severe functional disabilities.16 In this setting, rubber catheters are more comfortable and have a lower incidence of bacteriuria than indwelling catheters.1 Peel breakdown is common, whereas urethral diverticuli and penile ischemia occur only occasionally.vi To minimize sleep disruption and limit bacteriuria and other complications, condom catheters tin be used just at night.16 External catheters have besides been adult for female patients,17 just their safety and effectiveness have not been adamant in nursing home patients.7
URETHRAL VS. SUPRAPUBIC CATHETERS
Suprapubic catheters are recommended by some physicians for short-term apply when a catheter is needed for gynecologic, urologic and other surgeries.1 Theoretically, there are fewer microbes on the abdominal wall than on the perineum, creating less risk for infection. Some other advantage is easier catheter changes. Suprapubic catheters tin can as well exist clamped to test for acceptable voiding. Some patients might also adopt a suprapubic catheter to raise cocky-image and sexual functioning. Other patients prefer its comfort and convenience.1 Disadvantages of suprapubic catheters include the risk of cellulitis, leakage, hematoma at the puncture site, prolapse through the urethra1 and the psychologic bulwark of insertion through the abdominal wall.
LATEX VS. SILASTIC CATHETERS
Silastic catheters have been recommended for brusque-term catheterization later surgery. Compared with latex catheters, silastic catheters have a decreased incidence of urethritis and, maybe, urethral stricture.18 Yet, use in animal models for longer than vi weeks showed no deviation in inflammatory response between latex and silastic catheters.18 Because of its lower cost and similar long-term outcomes, latex is the catheter of selection for long-term catheterization. The cost differential becomes less meaning in patients who exercise not require frequent catheter changes.6 Silastic catheters should be used in latex-allergic patients.
Catheters impregnated with various substances have not proved to be beneficial in patients with long-term catheterization. Silver-impregnated catheters, antibody-coated catheters and electrified catheters may diminish bacteriuria for a few days but are plush and have no role in long-term catheterization.4,19–21 In one study, silver-impregnated catheters were associated with more frequent bacteriuria and an increased take a chance of staphylococcal bacteriuria.21
Routine Direction
- Abstract
- Clinical Indications for Catheter Utilise
- Catheter Choices
- Routine Direction
- Management of Complications
- References
CATHETER SIZE
Authorities recommend choosing "the narrowest, softest tube that will serve the purpose."22 Rarely is a catheter larger than 18 F required, and 14 or 16 F normally suffices.22,23 A size 12 F catheter was found to be successful in catheterizing men with astute urinary retentivity.24 In most patients, it is best to minimize bladder irritation by using a catheter with a five mL balloon inflated with 5 to ten mL of fluid.22
MINIMIZING INFECTION
Once the decision has been fabricated to apply an indwelling urinary catheter, efforts should exist made to minimize problems. The catheter should be inserted using sterile technique (Table iii).v Once inserted, the catheter should be anchored to foreclose urethral traction. In men, the penis should lie over the lower belly with the catheter taped to the abdomen. In women the catheter should exist secured to the anteromedial thigh.6
Tabular array iii.
CDC Guidelines for Prevention of Catheter-Associated UTI
| Category I. Strongly recommended |
| Catheterize only when necessary. |
| Educate personnel in correct techniques of catheter insertion and care. |
| Emphasize handwashing. |
| Insert catheter using aseptic technique and sterile equipment. |
| Secure catheter properly. |
| Maintain closed sterile drainage. |
| Obtain urine specimens aseptically. |
| Maintain unobstructed urine period. |
| Category II. Moderately recommended |
| Periodically re-educate personnel in catheter intendance. |
| Apply smallest suitable catheter bore. |
| Avoid irrigation unless needed to prevent or save obstacle. |
| Refrain from daily meatal care. |
| Exercise not change catheters at arbitrary intervals. |
Every attempt should be made to keep the drainage system closed. Whatsoever break in the catheter-to-drove unit may invite earlier infection. Infection in the catheterized patient is suggested by signs or symptoms of pyelonephritis6,25 (fever greater than 38.3°C [100.9°F] for more than ane twenty-four hour period, mental status changes, hypotension), unusually cloudy urine, more frequent blockage, and new or increased detrusor spasms.
Fugitive cross-contamination is most of import in controlling nosocomial epidemics of catheter-related infections.ten Caretakers should wash hands before and after any manipulation of a patient's catheter or collection unit of measurement. If possible, devices used for emptying collection bags should be make clean and patient-specific.
Catheters should not be changed routinely. Some physicians abet monitoring patients for fourth dimension-to-obstruction of urinary catheter, with the catheter changed but before the patient would be expected to obstruct.26 With this approach, some patients required catheter changes weekly, and others did not demand them for several weeks. Such a policy volition atomic number 82 to fewer catheter changes than scheduled changes and will issue in less trauma to the urinary system and fewer symptomatic infections.6 An obstructed catheter with cessation of urine flow for 4 to 8 hours should plainly be changed. Some physicians recommend a catheter change when an episode of symptomatic urinary infection occurs.25
Several procedures that have been used to decrease the run a risk of infection are of no do good. For case, meatal disinfectants and antibacterial urethral lubricants are ineffective.half-dozen Cleansing with soap and water during bathing suffices to remove accumulated debris.half dozen Prophylactic bladder irrigations using antibiotics, hydrogen peroxide or povidone-iodine are not helpful.27–29 The end outcome is colonization or infection with more resistant organisms.
Some physicians recommend diluted acetic acrid irrigations in patients with frequent catheter obstructions who take had no response to increased fluid intake or acidification of urine.7 Pharmaceuticals, including systemic antibiotics, methenamine (Hiprex) and acidifying agents have also non proved to be beneficial in minimizing bacteriuria or infection. Agents added to drove bags take too not proved effective.6 Table 35 provides the guidelines from the Centers for Disease Control and Prevention for preventing catheter-associated infections.
Management of Complications
- Abstract
- Clinical Indications for Catheter Use
- Catheter Choices
- Routine Direction
- Management of Complications
- References
OBSTRUCTION
The material that obstructs urinary catheters consists of bacteria, glycocalyx, protein and precipitated crystals.ane Patients who tend to develop blocked catheters excrete more calcium, protein and mucin, and have a higher urine pH level than patients with infrequent blockage.26 Proteus mirabilis bacteriuria may also exist associated with catheter obstruction. Its potent urease splits ammonia, causing element of group i urine, which in turn precipitates crystals of struvite and apatite in the catheter lumen.6,10 Methenamine preparations may be benign in reducing episodes of obstacle.30 Irrigation may prevent repeated obstructions that are not responsive to increased fluid intake and urine acidification.seven,31 However, obstructed catheters must exist removed.
LEAKAGE
Bladder spasms are not uncommon in patients with long-term catheterization. The strength generated by spasms commonly overwhelms the drainage capacity of the catheter, creating leakage around the catheter. This type of leakage should not be corrected by using a larger bore catheter. Infection or catheter obstruction, if nowadays, should be treated. Antispasmodics, such as oxybutynin (Ditropan) and flavoxate (Urispas), tin be effective in alleviating spasm due to detrusor instability (Tabular array 4).
Table 4.
Anticholinergics For Treatment of Bladder Spasm
| Medication | Dosage | Comments |
|---|---|---|
| Oxybutynin (Ditropan) | two.5 to 5 mg four times daily | May have central anticholinergic effects |
| Flavoxate (Urispas) | 100 to 200 mg four times daily | May take central anticholinergic effects |
| Dicyclomine (Bentyl) | 10 to 20 mg four times daily | Unapproved for float spasticity |
| Hyoscyamine sulfate (Cystospaz) | 0.125 to 0.5 mg four times daily | May have primal anticholinergic effects |
| Tolterodine (Detrol) | 1 to 2 mg twice daily | Better tolerated just may be less effective |
COLONIZATION VS. INFECTION
Virtually every patient with chronic catheterization is colonized with bacteriuria within six weeks. Bacteriuria also occurs within a few months in the majority of patients using clean intermittent catheterization. Asymptomatic bacteriuria does not crave treatment.32 Antibiotic prophylaxis simply promotes emergence of antibody-resistant microbes.32,33 Slight pyrexia is non uncommon in patients with chronic indwelling urinary catheters and often lasts but a day. An isolated incident should non prompt initiation of antibody therapy.1 In the noncatheterized population, no bear witness has been shown of a causal relationship between asymptomatic bacteriuria and mortality.4
Asymptomatic bacteriuria occurs oftentimes subsequently the removal of a short-term–use indwelling catheter.34 It is currently not clear what the proper treatment should be. Some physicians recommend handling of asymptomatic bacteriuria, but information technology may exist more reasonable to treat merely symptomatic episodes. If treatment is chosen, a single dose of trimethoprim-sulfamethoxazole (Bactrim, Septra) is constructive in asymptomatic younger women and those with lower urinary tract symptoms. Duration of antibiotic treatment should probably exist at to the lowest degree 10 days in women 65 years and older.34 While no studies have addressed this issue in men, it seems reasonable to use this approach in men with short-term catheterization. Just symptomatic infection should be treated in patients undergoing long-term catheterization.10 Periodic urine cultures in chronically catheterized patients are not warranted. The bacterial flora changes over time, and serial cultures offer no benefit in determining correct antibiotic choice for future acute infection episodes.33
When a patient undergoing long-term catheterization develops fever, a source of infection should exist sought. When urinary infection is suspected, civilisation should exist obtained to guide therapy. Some physicians recommend inserting a new catheter and collecting a fresh urine sample for civilisation, to more accurately make up one's mind the source of float infection,four,25 although no data support this practice. Blood cultures may exist helpful if bacteremia is suspected. Infections are usually polymicrobial and may include bacteria such equally Pseudomonas, Proteus, Providencia, Enterobacteriaceae, Morganella and Enterococci.4,10
The usual duration of therapy is v to 14 days or longer.four When multidrug-resistant pathogens are non probable and the patient is non critically ill, trimethoprim-sulfamethoxazole or a second-generation cephalosporin volition generally suffice.4,25 Seriously ill or septic patients require a two-drug combination of ampicillin plus a tertiary-generation cephalosporin such as ceftriaxone (Rocephin), aztreonam (Azactam), an aminoglycoside or a quinolone.4,25 A urinary Gram stain may guide empiric therapy while culture results are pending; i organism per oil field is approximately xc percentage sensitive in indicating 105 bacteria per mL on urine culture.25 Enterococcus is more than often isolated from men.4 Handling recommendations for catheter-associated urinary tract infections are summarized in Table 5.4–7,25
TABLE 5.
Handling Recommendations for Catheter-Associated UTI
| Catheterization menstruation | Infection | Handling | |||
|---|---|---|---|---|---|
| Short-term | Single organism | TMP-SMZ (Bactrim, Septra) | |||
| or | |||||
| Quinolone | |||||
| or | |||||
| Nitrofurantoin (Furadantin, Macrobid) | |||||
| Long-term | Usually polymicrobial | Noncritical disease: | |||
| TMP-SMZ | |||||
| or | |||||
| Second-generation cephalosporin (e.one thousand., Cefuroxime) | |||||
| Disquisitional disease: | |||||
| Ampicillin plus ane of the following: | |||||
| Ceftriaxone (Rocephin), cefprozil (Cefzil) or ceftazidime (Fortaz) | |||||
| or | |||||
| Aztreonam (Azactam) | |||||
| or | |||||
| Aminoglycoside or quinolone | |||||
Complications of urinary tract infections may occur. Increasing renal dysfunction and recalcitrant or recurring bacteremia should prompt a search for urinary stones or other causes of obstruction.1 Men may develop urethritis, urethral fistula, epididymitis, scrotal abscess, prostatitis and prostatic abscess.ane,4
SPECIAL CIRCUMSTANCES
Renal calculi are common in patients with spinal string injury and touch at least viii percentage of patients.vi Renal failure is the cause of death in 20 to 68 percent of these patients. Thirty-nine percent of those who died from renal failure had urolithiasis at autopsy compared with 18 per centum of those who died from not-renal causes.6 Secondary prevention measures include almanac urinary tract evaluation with creatinine clearance and a renal sonogram with urologic evaluation every three years, or more often if indicated.35
Periodic surveillance for urolithiasis and removal of stones is recommended to maintain renal function.35 Patients who have had an indwelling catheter for longer than 10 years have an increased chance of float cancer. In these people, annual cytology or cystoscopy is recommended every bit a secondary prevention strategy.6 Even so, none of these strategies has been systematically evaluated in a clinical trial.
To encounter the full article, log in or buy admission.
REFERENCES
bear witness all references
1. Warren JW. Catheter-associated bacteriuria. Clin Geriatr Med. 1992;8:805–xix. ...
2. Warren JW, Muncie HL Jr, Hebel JR, Hall-Craggs Thousand. Long-term urethral catheterization increases chance of chronic pyelonephritis and renal inflammation. J Am Geriatr Soc. 1994;42:1286–90.
three. Kunin CM, Douthitt Southward, Dancing J, Anderson J, Moeschberger M. The clan betwixt the use of urinary catheters and morbidity and mortality among elderly patients in nursing homes. Am J Epidemiol. 1992;135:291–301.
4. Yoshikawa TT, Nicolle LE, Norman DC. Management of complicated urinary tract infection in older patients. J Am Geriatr Soc. 1996;44:1235–41.
5. Wong ES. Guideline for prevention of catheterassociated urinary tract infections. February 1981. Retrieved September 27, 1999, from the World Wide Web: http://aepo-xdv-www.epo.cdc.gov/wonder/prevguid/p0000416/entire.htm
6. Wood DR, Bough BS. Long-term urinary tract catheterization. Med Clin North Am. 1989;73:1441–54.
7. Besdine RW, Rubenstein LZ, Snyder L, eds. Medical intendance of the nursing home resident: what physiciansneed to know. Philadelphia: American Higher of Physicians, 1996.
8. Ferri FF, Fretwell MD. Practical guide to the care of the geriatric patient. St. Louis: Mosby-Yearbook, 1992.
9. Meeks GR. Discussion. In: Summitt RL Jr, Stovall TG, Bran DF. Prospective comparison of indwelling float catheter drainage versus no catheter later vaginal hysterectomy. Am J Obstet Gynecol. 1994;170:1818–21.
ten. Warren JW. Catheter-associated urinary tract infections. Infect Dis Clin North Am. 1997;11:609–22.
eleven. Skelly JM, Guyatt GH, Kalbfleisch R, Singer J, Winter L. Management of urinary retention after surgical repair of hip fracture. Can Med Assoc J. 1992;146:1185–ix.
12. Dobbs SP, Jackson SR, Wilson AM, Maplethorpe RP, Hammond RH. A prospective, randomized trial comparing continuous float drainage with catheterization at abdominal hysterectomy. Br J Urol. 1997;80:554–six.
13. Sadowski A, Duffy L. A survey of clean intermittent catheterization in long-term care. Urol Nurs. 1988;ix(1):xv–7.
14. Moore KN, Kelm M, Sinclair O, Cadrain Yard. Bacteriuria in intermittent catheterization users: the effect of sterile versus clean reused catheters. Rehabil Nurs. 1993;18(3):306–ix.
15. Bakke A, Vollset SE. Take chances factors for bacteriuria and clinical urinary tract infection in patients treated with clean intermittent catheterization. J Urol. 1993;149:527–31.
xvi. Ouslander JG, Greengold B, Chen S. External catheter employ and urinary tract infections among incontinent male nursing home patients. J Am Geriatr Soc. 1987;35:1063–70.
17. Pieper B, Cleland V. An external urine-collection device for women: a clinical trial. J ET Nurs. 1993;20(2):51–v.
xviii. Nacey JN, Tulloch AG, Ferguson AF. Catheterinduced urethritis: a comparison between latex and silicone catheters in a prospective clinical trial. Br J Urol. 1985;57:325–8.
xix. Shafik A. The electrified catheter. Part in sterilizing urine and decreasing bacteriuria. Earth J Urol. 1993;11(3):183–5.
20. Liedberg H, Lundeberg T, Ekman P. Refinements in the coating of urethral catheters reduce the incidence of catheter-associated bacteriuria. Eur Urol. 1990;17:236–40.
21. Riley DK, Classen DC, Stevens LE, Shush JP. A big randomized clinical trial of a argent-impregnated urinary catheter: lack of efficacy and staphylococcal superinfection. Am J Med. 1995;98:349–56.
22. McGill South. Catheter management: information technology's the size that's important. Nurs Mirror. 1982;154(14):48–9.
23. Pomfret IJ. Catheters: design, selection and management. Br J Nurs. 1996;5(4):245–51.
24. Allardice JT, Standfield NJ, Wyatt AP. Acute urinary retention: which catheter?. Ann R Coll Surg Engl. 1988;seventy(6):366–8.
25. Wood CA, Abrutyn E. Urinary tract infection in older adults. Clin Geriatr Med. 1998;14:267–83.
26. Kunin CM, Chin QF, Chambers S. Indwelling urinary catheters in the elderly. Am J Med. 1987;82:405–11.
27. Warren JW, Platt R, Thomas RJ, Rosner B, Kass EH. Antibiotic irrigation and catheter-associated urinarytract infections. North Engl J Med. 1978;299:570–iii.
28. Schneeberger PM, Vreede RW, Bogdanowicz JF, van Dijk WC. A randomized study on the effect of bladder irrigation with povidoneiodine before removal of an indwelling catheter. J Hosp Infect. 1992;21:223–9.
29. Sweet DE, Goodpasture HC, Holl Thou, Smart S, Alexander H, Hedari A. Evaluation of HiiO2 prophylaxis of bacteriuria in patients with long-term indwelling Foley catheters: a randomized controlled written report. Infect Command. 1985;vi(seven):263–vi.
30. Norberg A, Norberg B, Parkhede U, Gippert H, Lundbeck Grand. Randomized double-bullheaded study of prophylactic methenamine hippurate treatment of patients with indwelling catheters. Eur J Clin Pharmacol. 1980;18:497–500.
31. Ruwaldt M. Irrigation of indwelling urinary catheters. Urology. 1983;21(two):127–9.
32. Warren JW, Anthony WC, Hoopes JM, Muncie HL Jr. Cephalexin for susceptible bacteriuria in afebrile, long-term catheterized patients. JAMA. 1982;248:454–8.
33. Breitenbucher RB. Bacterial changes in the urine samples of patients with long-term indwelling catheters. Arch Intern Med. 1984;144:1585–viii.
34. Harding GK, Nicolle LE, Ronald AR, Preiksaitis JK, Frontwards KR, Depression DE, et al. How long should catheter-acquired urinary tract infection in women exist treated? A randomized controlled study. Ann Intern Med. 1991;114:713–8.
35. Binard JE. Care and handling of spinal cord injury patients. J Am Paraplegia Soc. 1992;15:235–49.
Members of various medical faculties develop manufactures for "Practical Therapeutics." This article is ane in a serial coordinated by the Department of Family and Community at the Academy of Missouri–Columbia Schoolhouse of Medicine, Columbia, Mo. Guest editor of the series is Robert 50. Blake, Jr., Thou.D.
Copyright © 2000 by the American Academy of Family unit Physicians.
This content is endemic past the AAFP. A person viewing information technology online may make one printout of the cloth and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether at present known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.
Almost Contempo ISSUE
February 2022
Access the latest issue of American Family Physician
Read the Upshot
Email Alerts
Don't miss a single result. Sign upwards for the free AFP electronic mail tabular array of contents.
Sign Up Now
Source: https://www.aafp.org/afp/2000/0115/p369.html
0 Response to "What Can You Do for Bladder Spasms With Catheter?"
Post a Comment