Bladder and Bowel Training

the unique after is the insertion of a hollow tube into the bladder

for the removal of urine.

That means that when a CAFTA is inside a bladder,

the bladder does not fill

as the U. N is constantly drained away.

Catheters can be used for a variety of reasons,

but a resident should never be characterised

or continue to have a capita for nursing convenience.

So really things like incontinence. It should be a last resort.

So indications for catheter use then.

So clinical indications might include things

like addressing acute or chronic urinary retention

in order to empty the bladder.

For example, you see this before pelvic surgery might attempt to the bladder.

It might be to accurately measure urine output in acutely ill people

and to irrigate the bladder, for example, following surgery,

particularly prostate surgery,

to bypass an obstruction.

So, for example, in older gentleman, they may have an enlarged prostate,

or there may be a refill structure.

In some cases, we'll be looking at managing acute or chronic

urinary retention,

and we'll come back to that because

that's quite significant for nursing home environment.

Other reasons for a catheter might be

to administrate drugs directly into the bladder,

particularly site toxic drugs that are treating bladder cancer may see

people in the community that have had a catheter inserted.

For this reason why they continue to have treatment,

it might be to carry out blood of function test

It may in some cases, like I said, relieving continent or maintain skin integrity.

That would be when all other management techniques have been exhausted.

However,

it's worth considering that nurses working in a nursing home are much more

likely to encounter a resident with a long term capita in situ.

These people often have dementia or neurological problems,

or even there at the end of the life.

So it's going to be quite unrealistic and in

some ways inappropriate to attempt alternatives to capitalisation,

to manage things that urinate, um, incontinence.

So it is a case of weighing the risks versus the benefits.

If you look at nice guidelines for the management in primary and community care,

it still reminds us that we should emphasise

the importance of alternatives to capitalisation where possible

things like regular toilet ng use of incontinence, aids, um,

and considering other cont inspiration as a priority and as

alternative to capitalisation as much as possible and where possible.

So we know catheters are used for a wide range of reasons them.

We also know that they are associated with a large number of complications. Also

capital associated urinary tract infections.

Or you can see there. We've abbreviated that to see a UTI,

probably the most common type of complication.

But we could also consider things like tissue

damage and by bypassing blockages in crustacean.

Also, being complications of a cafe to

so clinical indicators for CAFTA is

associated.

Urine tract infection may include things like anorexia, tachycardia,

abdominal pain and changes in the urine characteristics.

You can see some of those on the screen, such as the aroma and the appearance

in order.

People just remember signs and symptoms may

be far less specific and include confusion,

disorientation and even falls.

About 60% of individuals using a catheter are going to be

at least chronically colonised

in older people with a long term capita in something like a long stay care facility,

such as a care home.

Um,

if you've got a resident with a long term capita

and you suspect an infection,

the recommendation is to consider removing or changing

the capita before starting any antibiotic treatment.

If it's been in place for more than seven days,

it has been in place for less than seven days.

They're not recommended that you change it again, however,

if it has been in place for more than seven

days because you know it's going to be significantly colonised,

it would be ideal to change it before starting antibiotics.

It's not possible,

then we do not want to delay starting antibiotics for that

reason because of the risk of sepsis and pilot nephritis.

What we know is the longer a catheter is in place,

the more likely bacteria is going to be found in the year.

Rym.

Um, so we're looking to try and avoid this as much as possible.

Using any form of CAFTA is going to have associated risks.

And with the continued risk of urine infections

and associated life threatening complications such shutout sexes.

It is a great important that risk assessment is carried out.

So the cafe to interferes with that natural flushing action.

That urine has to eliminate bacteria from from a healthy bladder,

so bacteria will appear in the urine within sort

of 48 hours of that catheter being inserted.

So by day two there's gonna be some bacteria floating around,

increasing that risk of developing an infection.

And the longer that that catheter remains in situ,

the higher the risk of that chance

of developing a CAFTA is going to be.

So where does the bacteria that causes these capture infections come from?

How is it acquired

in most incidences? It originates from the residents Yuri four metres.

So either the rectum or the vagina, um somewhere on their body for themselves.

Another area on the skin might transfer the bacteria so such as the pressure also

or if they've gotten infected or even a colonised wound.

Other ways that the bacteria gets there is from us,

via the hands of healthcare staff at the catheter in surgeon.

And when we're manipulating or changing or doing things to the cafe to again,

it's us touching it.

That's going to increase that risk

that bacteria then can migrate upwards to

reach the bladder from the drainage system

along the inside of the draining tubing or via

the kind of the periphery full space between the outer wall of the catheter

and the bladder.

Other ways that bacteria can gain access.

So from the drainage system, when it's open to empty the drainage bag

or to take specimens or any other sort of

procedures we might be carrying out, such as a bladder washout,

even the drainage systems of cells.

Although they're fitted with vowels that try to prevent this backflow of urine,

the not actually 100% effective,

there will be a certain amount of urine that back flows into the bladder.

So how do we manage these infections?

It starts by looking

at the causes of those capital associated infections.

When we consider that 70% of these infections are preventable,

it was actually much we can do there to reduce the chances of an infection.

So as nurses, we are

probably the most responsible person

within our teams for managing capital care.

And we need to be closely involved in

sort of ensuring best practise.

That might include implementing things like care, bundles and checklists,

but also around education for residents, for family members, for care staff,

um, even colleagues

of a nursing colleagues.

And this will include things like cleaning

the hands before and after handling captures

or even the tubing the draining bags and wearing personal protective clothing. So

to avoid that, cross contaminations feels like gloves

and aprons.

Also adopting an aseptic technique when empty and drainage bags

to obtain specimens or to deal with leakage or disconnection

and changing the drainage bag when it becomes discoloured,

develops and events of odour

contains sediments or becomes damaged.

However, there is no evidence that supports regular changing of the bag, reduces

the risk of infections or offers any other advantage

only when it's necessary to do so.

Irrigation is not overly useful.

And then just consider that very full bags are going to be uncomfortable.

They're going to pull in the drag. And so again, we want to avoid

any sort of CAFTA bags. That might be,

I felt

also gives a nice little home for the bacteria

to multiply

the track back upwards towards the bladder.

Yeah,

probably the most effective way to reduce catheter

infections is to really ask yourself that

important question of whether the capita is necessary

and really weighing up those advantages versus disadvantages.

You could consider alternatives to indwelling capita,

so things like intermittent self capitalisation,

um

sheaths or external drainage systems that men can use.

We'll talk about sheets as we go through.

Super pubic captors may be an option. He requires a long term capitalisation.

The risk of infection is substantially lower than with fury for capita.

Statistically,

there is a high proportion of people

out there who are cafeterias completely unnecessarily,

so it's always important to continually review that indication for the capita.

Yeah,

so if there are presence of clinical symptoms,

then antibiotics are used

to to treat or to manage your infection.

Other things to consider is that certain

silver impregnated catheters can have some reduced,

uh,

effects on

capitalisation infections or they

It's

important to know that these differences were

significant for silver alloy coated capitals,

but not for silver oxide coated capita.

And so it is important to look at the type of material

because not all silver catheters are going to have a significant effect

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