Indwelling Urinary Catheters and Home Care Management: Part 2
Presented by Lisa A. Gorski
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As many as 11% of home care patients in the US have indwelling urinary catheters, more commonly referred to as Foley catheters. In Part 2 of this course, the fundamentals of catheter care and management are summarized. Unfortunately, complications associated with indwelling urinary catheters are common, and home care nurses must possess a comprehensive body of knowledge to effectively manage such complications. Addressed are catheter-associated urinary tract infection (CAUTI), obstruction, encrustation, and bladder spasms. Because patients with long-term catheters universally have bacteria in their urine, nurses must understand the difference between colonization and infection, the problem of antimicrobial resistance, and the role of the nurse in antimicrobial stewardship. Because causes and preventive interventions for complications often overlap, nurses must apply critical thinking skills when planning actions and interventions. Case examples are used throughout this course to demonstrate the problem-solving approach. Key points for patient education are highlighted. Lastly, the importance of the nurse’s role in supporting patients is emphasized as acceptance and adjustment to living with a catheter take time and impact quality of life for many patients and caregivers.
Meet your instructor
Lisa A. Gorski
Lisa A. Gorski has worked for 40 years as a clinical nurse specialist (CNS) and educator for Wheaton Franciscan Home Health & Hospice, now part of Ascension at Home, in Milwaukee, Wisconsin. As a CNS, she has played a key role in the home infusion therapy program, contributing to clinician education, policy and procedure…
Chapters & learning objectives
1. Catheter Care and Management
Proper ongoing catheter care and management is essential in minimizing the risk of complications and is a vital component of patient and family education. Aspects of care addressed in this chapter include routine perineal care, catheter irrigation, and drainage bag care. The etiology and significance of the uncommon phenomenon of purple urine bag syndrome are also explained.
2. Complications: Urinary Tract Infection
Catheter-associated urinary tract infection (CAUTI) is an ongoing risk for patients with indwelling urinary catheters. It is important for nurses to understand the difference between infection and colonization, the role of biofilm in the development of infection, and the emerging problem of antimicrobial resistance. The role that home care nurses play in antimicrobial stewardship is described in this chapter. Attention to proper urine sampling procedures and catheter replacement in the context of CAUTI is addressed. CAUTI prevention is summarized, along with identification and interventions, including the importance of accurate specimen collection in the event of suspected UTI. Case examples are included in this section, and key patient education points are addressed.
3. Complications: Obstruction/Encrustation and Catheter Leakage
Catheter leakage, catheter blockage due to encrustation, and bladder spasms are common complications faced by patients with indwelling urinary catheters. These complications are explored in the context of case examples and the nurse's critical thinking process to analyze signs/symptoms, causative factors, appropriate interventions, and preventive strategies.
4. Patient/Caregiver Education and Support
Key topics for patient education are summarized in this chapter. Beyond the technical aspects of catheter care, acknowledging the challenges of living with a catheter and understanding the patient’s needs and the impact of the catheter on the patient's lifestyle are essential aspects of home care nursing. The important role that the nurse plays in supporting the patient and caregiver is highlighted.
