Paper Keywords Nursing catheter indwelling complications
Indwelling catheterization is a method of retaining catheter in bladder to drain urine after catheterization, which is widely used in anesthesia, postoperative and critically ill patients. It is a common invasive nursing operation in clinic. If complications of indwelling catheterization occur, it will directly affect the prognosis of patients. The prevention and nursing of complications of indwelling catheterization are summarized as follows.
1 catheter-associated urinary tract infection
1. 1 Catheter-associated urinary tract infection is a common nosocomial infection. It is reported that urinary tract infection accounts for 20.8%-3 1.7% of nosocomial infections in China, among which catheter-related urinary tract infection accounts for 37.3%-56.0%. Among the people with indwelling catheter, 2%-4% patients developed bacteremia and septicemia, and the mortality rate was as high as 13%-30%. The main risk factors leading to catheter-related urinary tract infection are: ① long-term indwelling catheterization and operational injury. ② Bacterial colonization of urethral orifice, ⑦ Poor connection between catheter and urine collection bag.
1.2 The female urethra is shorter, and the incidence of catheter-related urinary tract infection is higher than that of male, so shortening the hospitalization time and indwelling catheter time can effectively prevent catheter-related urinary tract infection. Because it is more difficult for male patients to introduce urine than female patients, and the intubation angle is not well grasped, it will stimulate and scratch the urethral mucosa and destroy its natural defense barrier. It provides conditions for the invasion of bacteria. It is suggested that the operator choose a catheter with appropriate thickness, be familiar with the anatomical characteristics of men and avoid rough operation. For urethral stricture or prostatic hypertrophy caused by various reasons, it is best to ask a specialist to guide the operation.
The clinical practice of 1.3 proves that the long-term use of antibiotics is limited by bacterial resistance and adverse drug reactions, so the main link of prevention is to prevent bacteria from colonization at the urethral orifice, and 0.5% iodophor has a good bactericidal effect on common vulvar pollution bacteria. Because anal excrement, bedding or underwear pollute the urethral orifice and surrounding mucosa at any time, in addition to cleaning and disinfecting the vulva twice a day, disinfection dressings are continuously placed at the external urethral orifice. Keeping the urinary tract system airtight can effectively reduce the occurrence of catheter-related urinary tract infection.
2 Bladder dysfunction
2. 1 The clinical manifestations of bladder dysfunction are urinary incontinence, frequent urination, dysuria and even urinary retention after removal of urinary catheter. Bladder has dual functions of urine storage and urination. When some diseases or operations require indwelling catheter, open drainage and intermittent urination are often used in clinic. These two ways are different from normal urination. Smooth drainage and urination make the urination activity that should be interrupted become a continuous process corresponding to the urine produced by the kidney. The urine storage function of the bladder is useless, the micturition reflex is interrupted, and the bladder is emptied, so that it gradually adapts to the urine flow. Inert state ",after extubation, active urination consciousness cannot be established in time. However, regular intermittent urination can not properly grasp the filling speed and interval of bladder, and urine flows out with the pressure difference, so it is difficult for patients to feel urination and can not fully train bladder function.
2.2 When urinating, the patient should be reminded to urinate consciously, resulting in a sense of urination or emptying, so that the urination mode is similar to normal urination, and the urine storage and urination function of the bladder can continue to play a role. When the bladder is full, the catheter is removed, so that the urination process is smooth and the urine volume is not affected, which can effectively protect the bladder function. In order to prevent urinary retention after extubation and promote spontaneous urination, sterilized Kaiser Lu was injected directly into the bladder through the catheter before extubation, which could make the detrusor in the bladder contract, cause micturition reflex, promote micturition and reduce the edema of urethral dilator.
2.3 Early bladder function training for coma and paraplegia patients is of great significance to improve their quality of life. According to the bladder filling condition, urinate every 2 hours 1 time, and change it to 3-4 hours after 3 days, and continue until the catheter is removed. Press the bladder before urination every time, establish the patient's micturition reflex by pressing the urine, maintain the normal tension of bladder muscles and avoid the formation of contracture bladder.
3. Surface crystallization of catheter
The crystal on the surface of indwelling catheter is easy to cause urinary tract infection, and it is easy to damage urethral mucosa when extubation. Drinking more water and urinating more can effectively achieve the purpose of mechanical "internal irrigation" and prevent urinary tract infection and catheter surface crystallization.
4. The role is not suitable for patients
4. 1 Some patients not only need to keep a catheter during hospitalization, but also leave the hospital with a catheter. If the patient's role is not well adapted (role strengthening or role missing, etc.). ), and the indwelling catheter can not be managed correctly, which will affect the rehabilitation and quality of life of patients.
4.2 Through planned health education, patients and their families can understand the purpose and significance of indwelling catheterization, master relevant nursing methods and precautions, mobilize patients' subjective initiative in the process of realizing self-health, let patients adapt to the role change as soon as possible, and improve their quality of life.
5 nursing
Strengthen nurses' sense of responsibility, understand the seriousness of adverse consequences caused by improper operation, and be skilled in operation technology. Psychological care should be done before catheterization; If conditions permit, please don't empty your bladder before catheterization. According to the patient's body shape and age, we can know whether there are urethral malformations, prostatic hyperplasia and hypertrophy. Before intubation, we should routinely check whether the catheter balloon is filled with liquid and pumped back, whether there is leakage or damage, and whether the catheter is unobstructed, so as to avoid urethral mucosal damage caused by balloon rupture due to quality problems.
In general, before catheterization, apply 0.5% iodophor as lubricant on the outer wall of catheter, and inject 2 ~ 5ml from urethral orifice. Its surfactant can form a film with urinary catheter on the surface of urethral mucosa, which plays a lubricating role. If there is prostatic hyperplasia and hypertrophy, 5% lidocaine can be injected into the urethral orifice, or lidocaine gel can be used instead of lubricant to smear the catheter, which can obviously alleviate the pain of patients when intubating, and the success rate of one-time intubation is high.
Nurses should master the operation rules of catheterization and strictly adopt aseptic technique. Intubation should be gentle and slow, communicate with patients more, avoid twitching back and forth, change direction slightly when encountering resistance, touch the front end of catheter with your finger at perineum, and gently pressurize it to guide it into the posterior urethra. If a local anesthetic or lubricant syringe is inserted into the rear end of the catheter, it is easy to succeed. It is advisable to insert the catheter into the bladder 5 ~ 10 cm, mostly 5cm, after seeing the urine flowing out, so as to fill the bladder, so as to avoid the filled bladder being embedded in the urethra and causing urethral injury.
During intubation, patients should be told to avoid excessive traction when turning over and not to increase abdominal pressure excessively when defecating; The urine in the urine collection bag should not be too full; Note that the urine collection bag cannot be higher than the bladder; You can't extubate yourself, so as not to cause urethral mucosal injury, bleeding and secondary urinary tract infection. For people who are delirious, fidgety and impatient, you should exercise appropriate restraint and let patients and their families actively cooperate to avoid complications.
After successfully indwelling the catheter, carefully record the color, quantity and characteristics of the derived urine and the amount of liquid injected into the balloon for reference when extubating; During the indwelling catheter, keep the drainage unobstructed, prevent the catheter from being squeezed, keep the closed drainage, do a good job in the basic nursing of patients, and keep the skin clean and dry, especially the sheets clean and dry without slag; Scrub the urethral orifice with 0.5% iodophor twice a day, change the urine collection bag 1 time every day, and change the catheter 1 time every two weeks. Drink as much water as possible every day, about 2000ral, and take sodium bicarbonate tablets orally to increase urine volume to alkalize urine and prevent urine scale adhesion. If necessary, do bladder irrigation once a day. Nurses should often patrol the ward, observe the drainage and the fixation of the catheter, and record the urine volume, smell, color and characteristics in detail to help encourage patients to do more massage in the bladder area and promote the recovery of bladder muscle strength. According to the condition, intermittent micturition should be performed every 2 ~ 3 hours two days before extubation, so as to train and improve the bladder contraction function and extubate the tube as soon as possible, so as to make the patient recover as soon as possible.