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The placement of an indwelling urinary catheter (IUC) is a commonly performed clinical procedure which may become challenging for the clinician and painful for the patient. In response to urologic complications attributed to repeated failed IUC insertion attempts by nurses, a difficult urinary catheter (DUC) team program was launched in October 2012. The purpose of the doctoral project was to conduct a quality improvement evaluation of the effectiveness of the DUC team program using retrospective data from May 1, 2013 through May 31, 2017. Benner's novice to expert model was chosen as the theoretical framework to guide the additional training, critical thinking, problem-solving, and skill acquisition necessary for team member inclusion. The practice-focused question for the project answered whether DUC team nurses, through advanced training and demonstrated procedural competence, have been effective with DUC insertions. Sources of evidence included primary and secondary articles in peer-reviewed journals, as well as clinical evidence collected from internal sources. During the project time-line, 463 DUC team consultations were recorded with an insertion success rate of 89.6%. Based on the DUC team concept, additional didactic content and simulation training may be developed for other cognitive and skill-based clinical procedures. The implications for positive social change include improved patient safety and comfort, as well as cost savings for the organization and overall healthcare system.

The interaction between the mapping/ablation catheter and left atrial (LA) myocardium potentially affects the LA electrical and mechanical properties and impacts on ablation efficacy. Using catheters able to provide real-time contact force (CF) measurement, it has become possible to explore these relationships in vivo. In 60 persistent atrial fibrillation (AF) patients, ablation CF was higher in the right than left wide area circumferential (WACA) lines and where steerable transseptal sheaths were used. Differences were also apparent in the burden of WACA segment reconnection but did not just reflect differences in ablation CFs, suggesting factors other than CF contribute to ablation efficacy. Relationships between ablation force time integral (FTI), impedance drop and electrogram attenuation were assessed in 15 persistent AF patients. FTI significantly correlated with electrogram attenuation and impedance drop from ablation. The relationship was stronger for the former but in both cases plateaued at 500g.s, suggesting no ablation efficacy gains beyond this. Factors further affecting CF and ablation efficacy, the latter judged by impedance drop, were assessed in 30 patients. The variability of the CF waveform and catheter locational stability were both affected by factors including atrial rhythm and catheter delivery mode. Greater CF variability, catheter drift and perpendicular catheter contact were associated with reduced ablation efficacy. The relationship between CF and the electrogram was assessed in 30 patients. The size of the electrogram complexes was affected by CF increases but only where initial CF was <10g. This was also the case for electrogram fractionation measurements. Increasing CF was associated with an increasing incidence of atrial ~ 3 ~ ectopics during sinus rhythm. Spectral parameters (dominant frequency and organisation index) were unaffected by CF. Various factors affect the contact between the catheter and LA myocardium. In turn, catheter contact significantly affects the electrogram during LA mapping and the efficacy of clinical radiofrequency ablation.

Atrial Fibrillation (AF) is a debilitating heart rhythm disorder affecting over 2.7 million people in the US and over 30 million people worldwide annually. It has a high correlation with causing a stroke and several other risk factors, resulting in increased mortality and morbidity rate. Currently, the non-pharmocological therapy followed to control AF is catheter ablation, in which the tissue surrounding the pulmonary veins (PVs) is cauterized (called the PV isolation - PVI procedure) aims to block the ectopic triggers originating from the PVs from entering the atrium. However, the success rate of PVI with or without other anatomy-based lesions is only 50%-60%. A major reason for the suboptimal success rate is the failure to eliminate patientspecific non-PV sources present in the left atrium (LA), namely reentry source (a.k.a. rotor source) and focal source (a.k.a. point source). It has been shown from several animal and human studies that locating and ablating these sources significantly improves the long-term success rate of the ablation procedure. However, current technologies to locate these sources posses limitations with resolution, additional/special hardware requirements, etc. In this dissertation, the goal is to develop an efficient algorithm to locate AF reentry and focal sources using electrograms recorded from a conventionally used high-resolution multi-pole diagnostic catheter. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2019. / FAU Electronic Theses and Dissertations Collection

Catheter-associated urinary tract infections (CAUTIs) contribute to increased patient length of stay and health care costs. The literature has shown that one plausible cause of CAUTIs is improper Foley catheter insertion techniques among nurses. The purpose of this project was to answer the project-focused question that asked if there was a difference in nurses' practice skills following an educational intervention involving aseptic Foley insertion. Benner's novice-to-expert theory was the conceptual model for the study. Nurses from a college nursing program were asked to demonstrate Foley catheter insertion on a simulation model, and their technique was evaluated using a standardized checklist. Following the simulation demonstration, an educational intervention was conducted with ample opportunity for the nurses (n = 16) to practice catheter insertion. Following the practice opportunity, the nurses completed a 2nd return demonstration. Percentages of correct skills from the preintervention observation were compared with percentages of correct skills from the postintervention observation to determine the effectiveness of the education intervention in enhancing Foley catheter skills in an acute care setting. Results of a paired t test revealed a significant increase (p < .01) in performance scores on the demonstrations after the intervention and catheter insertion techniques were taught. Hospitals and nursing education programs could implement simulation interventions to improve nurses' Foley catheter insertion skills. This study has the potential to contribute to social change by providing evidence that simulation training can lead to improved competence and confidence with nursing skills.

<p><strong>Introduction</strong> Every tenth patient in Sweden is affected by nosocomial infections. Among these, urinary tract infection (UTI) is the most frequently occurring within the hospital environment. Nosocomial infections lead to increasing costs for care, more suffering among the patients, increasing use of antibiotics, and longer treatment spells. The Academic hospital have engaged all wards in the so called VRISS-project (“nosocomial infections must be stopped”) in order to reduce the number of nosocomial infections.</p><p><strong>Aim</strong> In connection to the VRISS-project new routines for removal of uretrahl catheters are introduced at ward 70E2 at the Academic hospital. The new routines imply that the catheter should be removed during the first post-op day. According to the old routines the catheter was to be removed no later than on the third post-op day. The authors of this study choose to investigate whether the new routines for uretrahl catheter removal have any effect on the occurrence of nosocomial UTI’s.</p><p><strong>Methods </strong>The study is a restrospective record study with quantitative, descriptive design. 411 journals from 2007 (188) and 2009 (223) have been reviewed. All patients that underwent knee or hip operations during January, February, March, and April 2007 and 2009 are included in the sample.</p><p><strong>Results</strong> The study shows that the new routines at ward 70E2 had some, but not full, influence on the share of patients with nosocomial UTI. Among women under 71 years of age and men older than 70 years, the number of days with uretrahl catheter and the share of patients with nosocomial UTI have decreased. However, among the younger men (<71 years) and the older women (>70 years) no effects of the new routines are detected.</p><p><strong>Conclusion</strong> To summarize it can be concluded that the routines for how to use uretrahl catheters at ward 70E2 work fairly well. However, the results also show that the number of days with uretrahl catheter and the share of patients with nosocomial UTI among risk patients, above all among the older women, are the same in spite of the new routines for removal of uretrahl catheters. Thus, strategies for detecting risk patients in an early stage can be improved upon. Such measures can reduce the risk for nosocomial UTI among these patients.</p>

Introduction Every tenth patient in Sweden is affected by nosocomial infections. Among these, urinary tract infection (UTI) is the most frequently occurring within the hospital environment. Nosocomial infections lead to increasing costs for care, more suffering among the patients, increasing use of antibiotics, and longer treatment spells. The Academic hospital have engaged all wards in the so called VRISS-project (“nosocomial infections must be stopped”) in order to reduce the number of nosocomial infections. Aim In connection to the VRISS-project new routines for removal of uretrahl catheters are introduced at ward 70E2 at the Academic hospital. The new routines imply that the catheter should be removed during the first post-op day. According to the old routines the catheter was to be removed no later than on the third post-op day. The authors of this study choose to investigate whether the new routines for uretrahl catheter removal have any effect on the occurrence of nosocomial UTI’s. Methods The study is a restrospective record study with quantitative, descriptive design. 411 journals from 2007 (188) and 2009 (223) have been reviewed. All patients that underwent knee or hip operations during January, February, March, and April 2007 and 2009 are included in the sample. Results The study shows that the new routines at ward 70E2 had some, but not full, influence on the share of patients with nosocomial UTI. Among women under 71 years of age and men older than 70 years, the number of days with uretrahl catheter and the share of patients with nosocomial UTI have decreased. However, among the younger men (&lt;71 years) and the older women (&gt;70 years) no effects of the new routines are detected. Conclusion To summarize it can be concluded that the routines for how to use uretrahl catheters at ward 70E2 work fairly well. However, the results also show that the number of days with uretrahl catheter and the share of patients with nosocomial UTI among risk patients, above all among the older women, are the same in spite of the new routines for removal of uretrahl catheters. Thus, strategies for detecting risk patients in an early stage can be improved upon. Such measures can reduce the risk for nosocomial UTI among these patients.

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Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.

Bakgrund: Det finns tre olika former av behandling med urinkateter vilka alla har olika egenskaper och påverkar användaren i olika utsträckning. Urinvägsinfektion är en vanlig komplikation i samband med kateteranvändning och den personliga upplevelsen av behandlingen skiljer sig beroende på vilken typ av urinkateter som används. En ökad förståelse för patienters upplevelser av långvarig behandling med urinkateter kan hjälpa sjuksköterskor att individanpassa information och omvårdnad avseende kateterbehandlingen. Syfte: Att beskriva patienters upplevelser av långvarig kateterbehandling i det dagliga livet. Metod: Denna studie har genomförts som en litteraturöversikt där 11 vetenskapliga artiklar utgör grunden för resultatet. Sökningarna har genomförts i databaserna CINAHL och PubMed. Resultat: I litteraturöversikten framkom ett antal områden vilka påverkade livet för kateteranvändare. Huvudkategorierna som identifierades var: Betydelsen av informationoch kunskap och Påverkan på individen. Vidare fann vi fem underkategorier: Handhavande, komplikationer, sexualitet, kroppsuppfattning och självbild, självständighet och dagliga aktiviteter. Slutsats: Kateteranvändande patienter önskar tydligare information kring kateteranvändande. Ökad kunskap och informationsnivå sågs stärka patienternas självkänsla och möjligheten att leva ett mer självständigt liv. För att säkerställa att patienternas frågor och behov tillgodoses krävs att sjuksköterskorna känner sig trygga och kompetenta i dessa avseenden. / Background: There are three different forms of treatment with urinary catheters, all of which have different characteristics and affect the user to different extents. Urinary tract infection is a common complication associated with catheter use, while the personal experience of thetreatment differs depending on the type of urinary catheter used. An increased understanding of patients’ experiences of long-term treatment with urinary catheters can help nurses to customize information and nursing regarding catheter treatment. Aim: To describe patients’ experience of long-term catheter treatment in daily life. Method: This study has been conducted as a literature review where 11 scientific articles form the basis for the results. The searches were performed in the databases CINAHL and PubMed. Results: The literature review revealed several areas that affected the lives of catheter users. The summary main categories that were identified were: The importance of information and knowledge and Impact on the individual. Furthermore, we found in these main categories six subcategories: Care, complications, sexuality, body image and self-image, independence, and daily activities. Conclusions: Catheter-using patients wants more information regarding catheter use. Increased knowledge was seen to strengthen patients’ self-esteem and the possibility to live a more independent life. To ensure that patients’ questions and needs are met, nurses must feel safe and competent in these regards.