One concern for medical professionals and women experiencing cesarean deliveries is the use of indwelling urinary catheters, which is associated with a delay in first void time, slower ambulation time, increased discomfort, longer hospital stays, and an increased risk for urinary tract infections. The purpose of this project was to determine if a practice change regarding the use of urinary catheters among pregnant women decreases the number of women receiving a catheter prior to having a cesarean section in a small community hospital. The knowledge to action and Rosswurm and Larabee's models were used to guide this project, which was comprised of 2 phases. Phase 1 included a team of 10 experts that created the needs assessment that would establish hemodynamic stability using a 4-point scale. The items for inclusion in the needs assessment included primary cesarean, repeat cesarean, no urinary tract infection present, no fetal distress present, no systemic disorders present, no hypertensive disorders present, and no contraindications for anesthesia. Phase 2 was the implementation and evaluation of the needs assessment and new practice guidelines. Statistical analysis was performed using the Mann Whitney U test. There was 98% compliance (p < 0.001.) with the use of the assessment in women undergoing a cesarean delivery and a 64% reduction in the length of time an indwelling catheter was left in place. However, there was no significant change in the number of women receiving a catheter prior to cesarean delivery after a needs assessment was performed (p = 0.805). This project has potential implications that would support social change by reducing the use of indwelling catheters among hemodynamically stable women undergoing cesarean deliveries.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Estudo de desenvolvimento que objetivou validar procedimentos operacionais padrÃo (POPâs) para o cuidado com o cateter totalmente implantado; atravÃs do nÃvel de concordÃncia dos juÃzes quanto à adequaÃÃo dos conteÃdos dos POPs referentes à punÃÃo, heparinizaÃÃo e curativo do cateter e obter a opiniÃo dos enfermeiros quanto à objetividade e clareza dos instrumentos. A abordagem metodolÃgica de validaÃÃo adotada foi a de Hoskins (1989) em duas de suas trÃs etapas, a validaÃÃo de conceito e a de conteÃdo. O primeiro passo da teoria foi concluÃdo em experiÃncia acadÃmica anterior, latu senso. A validaÃÃo de conteÃdo aconteceu em duas fases. Previamente, os POPâs foram submetidos à apreciaÃÃo por nove expertos, mediante um instrumento organizado como ferramenta de mediÃÃo na forma de escala tipo Likert, com quatro nÃveis de suporte. A primeira parte deste instrumento conteve informaÃÃes sobre os avaliadores a fim de caracterizÃ-los quanto à sua atuaÃÃo cientifica; a segunda abrangeu os itens a serem avaliados do POP de acordo com suas subdivisÃes (resultado esperado, recursos necessÃrios, atividades, cuidados especiais e aÃÃes de nÃo-conformidade). No final de cada item avaliativo, os participantes puderam justificar suas respostas e dar sugestÃes. A segunda fase da validaÃÃo de conteÃdo deu-se pela anÃlise de sete especialistas (validaÃÃo aparente) quanto à clareza e objetividade dos instrumentos. Para este fim, foi montada uma estaÃÃo prÃtica com boneco adaptado com cateter totalmente implantado para a punÃÃo, heparinizaÃÃo e curativo. Esta pesquisa foi aprovada pelo Comità de Ãtica em Pesquisa do Hospital UniversitÃrio Walter CantÃdio. Os dados foram tabulados e analisados de acordo com a escala proposta por Fehring (1987), em que à realizada a mÃdia ponderal dos escores, considerando-se o percentual de concordÃncia de 80%. Os resultados evidenciaram, nos itens e na maioria dos subitens, Ãndice de concordÃncia dos expertos superior ao percentual estipulado. Os subitens que obtiveram escore abaixo de 80% (0,66 a 0,77) receberam sugestÃes quanto à abrangÃncia, aspectos-chave, sequÃncia dos itens e precisÃo. Cada sugestÃo do experto ou especialista foi analisada e modificada de acordo com as evidÃncias cientificas. A eleiÃÃo da ferramenta âProcedimento Operacional PadrÃoâ possibilitou que fossem contempladas as diversas dimensÃes da prÃtica do enfermeiro no cuidado com o cateter totalmente implantado e a visualizaÃÃo da necessidade da construÃÃo de novos POPâs. Os instrumentos validados neste estudo oferecem subsÃdios para direcionar os enfermeiros e estudantes de Enfermagem na assistÃncia aos pacientes portadores de cateter totalmente implantado, criando perspectivas de discussÃes e pesquisas futuras

Bakgrund: Kvarvarande katetrar är vanligt förekommande i vården och det finns en mängd olika anledningar till att patienter ordineras dessa. Oftast sker ordinationen i samband med problem eller sjukdomar i urinvägarna. Med kvarvarande katetrar följer även en del komplikationer. Somliga komplikationer uppstår på grund av den teknik som används vid katetersättningen. Syfte: Syftet med denna litteraturstudie är att belysa patientens upplevelse av att leva med en kvarvarande kateter. Metod: En litteraturöversikt har gjorts i denna studie. Tio stycken resultatartiklar söktes fram, nio var kvalitativa och en var kvantitativ och de har sedan analyserats och tolkats för att sedan tematiseras. Artiklarna har hämtats från databaserna CINAHL Complete, PubMed och Psyc Info. Resultat: Resultatet beskrivs i två teman som presenterar skillnaderna mellan negativa upplevelser och positiva upplevelser. Resultatet visar att katetern kunde upplevas som ett hinder i vardagen och ofta upplevde deltagarna smärta, som vid urinvägsinfektion, oro eller obehag vid läckage och blockage. Självbilden och sexualiteten kunde förändras då vissa deltagare inte längre upplevde sig själva som kvinnliga eller manliga. Några deltagare upplevde även en positiv förändring i livet då de menade att katetern bidragit till en ökad frihet och trygghetskänsla. Diskussion: Metodens styrkor och svagheter bearbetas i metoddiskussionen. I resultatdiskussionen diskuteras resultatet med vårdvetenskapligt material och valda delar av Katie Erikssons omvårdnadsteori som belyser lidandet. / Background: Indwelling catheters are common in health care and there are multiple causes why patients get them prescribed. The most common reasons for the prescription is of difficulties and or diseases in the urinary tracts. Indwelling catheters are also an cause of complications like infections, pain or other catheter problems. Aim: The aim of this study was to explore the patient's experience of living with an indwelling catheter. Method: A literature review was conducted. Ten scientific articles were analyzed, interpreted, nine were qualitative and one was quantitative and then categorized into two themes. The articles were found from the databases CINAHL Complete, PubMed and Psyc Info. Results: The result presents two themes which represents the differences between the negative and the positive experiences from the patients. The result described that urinary catheter became an obstacle in the everyday life and were often the reason to urinary tract infection, anxiety, discomfort under leakage or blockage. The patients self-image and sexuality could sometimes change since some of the patients did not experienced themselves as the person they used to be before they got the urinary catheter. Some patients experienced a positive change in their life because they felt that the catheters contributed them with a sense of security and freedom. Discussion: The method's strengths and weaknesses are processed in the discussion. The result discussed articles and selected parts of Katie Eriksson nursing theory that highlights the suffering.

BACKGROUND: Malignant and paramalignant pleural effusions are important complications of many malignancies. The two main management options debated in the literature are: 1) insertion of an indwelling pleural catheter (IPC) to achieve chronic drainage of the effusion, or 2) hospitalization with tube thoracostomy and subsequent chemical pleurodesis (CP) with talc or doxycycline to prevent fluid reaccumulation. We aimed to describe a large series of patients with malignant pleural effusions managed with an IPC, identify and validate factors identified in the literature as predictors of spontaneous pleurodesis in the IPC group and compare the group managed with IPC to patients managed with CP. METHODS: We designed a retrospective cohort study comparing patients with malignant and paramalignant pleural effusions managed either with CP between March 1, 2003 and February 28, 2006 or IPC insertion between May 1, 2006 and April 1, 2009. The CP group was identified through the prescription of talc or doxycycline and the IPC group from the IPC clinic database. Data were collected from paper and electronic records and from the Government of Ontario. RESULTS: We identified 193 consecutive patients with an ECOG performance status of less than 4 (ECOG less than 4 means that the patient is not completely disabled and confined to bed or chair) having undergone IPC insertion and 168 who were managed with CP. None of the variables we tested were significant predictors of spontaneous pleurodesis in the IPC group. Pleural effusion control rates at 6 months were higher in the IPC group than in the CP group (52.7% vs 34.0%, p<0.01) but the rate of freedom from pleural effusion at 180 days and catheter removal at 90 days was not significantly different (25.8% in the IPC group and 34.0% in the CP group p=0.14). Patients in the IPC group had a significantly longer median survival (148 days measured from the date of catheter insertion vs 133 days in the CP group, log-rank p<0.05). CONCLUSION: We found an intriguing possible survival benefit favouring management of malignant or paramalignant effusions with an IPC. Given possible biases due to the design of this study and uncertain explanatory mechanism, this needs to be confirmed in a randomized controlled trial. Quality of life, an important measure of success for these palliative procedures, should also be measured.

BACKGROUND: Malignant and paramalignant pleural effusions are important complications of many malignancies. The two main management options debated in the literature are: 1) insertion of an indwelling pleural catheter (IPC) to achieve chronic drainage of the effusion, or 2) hospitalization with tube thoracostomy and subsequent chemical pleurodesis (CP) with talc or doxycycline to prevent fluid reaccumulation. We aimed to describe a large series of patients with malignant pleural effusions managed with an IPC, identify and validate factors identified in the literature as predictors of spontaneous pleurodesis in the IPC group and compare the group managed with IPC to patients managed with CP. METHODS: We designed a retrospective cohort study comparing patients with malignant and paramalignant pleural effusions managed either with CP between March 1, 2003 and February 28, 2006 or IPC insertion between May 1, 2006 and April 1, 2009. The CP group was identified through the prescription of talc or doxycycline and the IPC group from the IPC clinic database. Data were collected from paper and electronic records and from the Government of Ontario. RESULTS: We identified 193 consecutive patients with an ECOG performance status of less than 4 (ECOG less than 4 means that the patient is not completely disabled and confined to bed or chair) having undergone IPC insertion and 168 who were managed with CP. None of the variables we tested were significant predictors of spontaneous pleurodesis in the IPC group. Pleural effusion control rates at 6 months were higher in the IPC group than in the CP group (52.7% vs 34.0%, p<0.01) but the rate of freedom from pleural effusion at 180 days and catheter removal at 90 days was not significantly different (25.8% in the IPC group and 34.0% in the CP group p=0.14). Patients in the IPC group had a significantly longer median survival (148 days measured from the date of catheter insertion vs 133 days in the CP group, log-rank p<0.05). CONCLUSION: We found an intriguing possible survival benefit favouring management of malignant or paramalignant effusions with an IPC. Given possible biases due to the design of this study and uncertain explanatory mechanism, this needs to be confirmed in a randomized controlled trial. Quality of life, an important measure of success for these palliative procedures, should also be measured.

Many patients with end-stage renal disease come to rely on catheters as their only means of hemodialysis when other options are no longer viable. These patients have a very poor quality of life due to their chronic illness as well as many long-term complications related to the use of tunneled catheters. Many prior attempts have been made to understand these catheter-related problems. Yet, they continue to be a major cause of morbidity and mortality in chronic catheter-reliant patients. We hope to examine the rate as well as long term time course of these complications such that in future, we may decrease their occurrence. We predict that over time, chronic catheter use decreases the mean indwell time for each catheterization and increases the incidence of complications. To study this, we conducted a retrospective study looking at all patients who had three or more tunneled catheter exchanges between July 2003 and July 2008. We collected information from Yale IDX database on the patients age and gender, the type of catheter used, the indwell time of the catheter, the vessel used as access, the indication for catheter removal, whether the procedure was performed by a medical doctor (M.D.) or physicians assistant (P.A.) and whether it was a de novo insertion or over-the-wire exchange. We collected a total of 764 data points on 191 patients (89 males and 102 females). They ranged from 8 to 87 years old with a median age of 56 years. Infection was the number one indication for catheter removal at 37%. The rate of infection was 3.34 per 1,000 catheter days. There was no difference in the rate of complications by the side of vessel accessed nor by type of catheter. However, right-sided catheters had a longer indwell time of 117 + 159 days compared to left-sided catheters, 87 + 124 days (p =0.008). There was no significant difference in the indwell duration of first catheter in comparison to all subsequent placements. There was also no difference in complications whether the catheter was exchanged over the wire or placed de novo. Nor were complication rates different among M.D. versus P.A. conducted procedures. We conclude that our rates of infection are similar to other institutions and the vessels located on the right-side of the neck are preferable to left-sided vessels to increase catheter longevity. Future research is needed to better assess how rates and incidences of complications change with long standing catheter-reliance.

No description available.

BACKGROUND: Malignant and paramalignant pleural effusions are important complications of many malignancies. The two main management options debated in the literature are: 1) insertion of an indwelling pleural catheter (IPC) to achieve chronic drainage of the effusion, or 2) hospitalization with tube thoracostomy and subsequent chemical pleurodesis (CP) with talc or doxycycline to prevent fluid reaccumulation. We aimed to describe a large series of patients with malignant pleural effusions managed with an IPC, identify and validate factors identified in the literature as predictors of spontaneous pleurodesis in the IPC group and compare the group managed with IPC to patients managed with CP. METHODS: We designed a retrospective cohort study comparing patients with malignant and paramalignant pleural effusions managed either with CP between March 1, 2003 and February 28, 2006 or IPC insertion between May 1, 2006 and April 1, 2009. The CP group was identified through the prescription of talc or doxycycline and the IPC group from the IPC clinic database. Data were collected from paper and electronic records and from the Government of Ontario. RESULTS: We identified 193 consecutive patients with an ECOG performance status of less than 4 (ECOG less than 4 means that the patient is not completely disabled and confined to bed or chair) having undergone IPC insertion and 168 who were managed with CP. None of the variables we tested were significant predictors of spontaneous pleurodesis in the IPC group. Pleural effusion control rates at 6 months were higher in the IPC group than in the CP group (52.7% vs 34.0%, p<0.01) but the rate of freedom from pleural effusion at 180 days and catheter removal at 90 days was not significantly different (25.8% in the IPC group and 34.0% in the CP group p=0.14). Patients in the IPC group had a significantly longer median survival (148 days measured from the date of catheter insertion vs 133 days in the CP group, log-rank p<0.05). CONCLUSION: We found an intriguing possible survival benefit favouring management of malignant or paramalignant effusions with an IPC. Given possible biases due to the design of this study and uncertain explanatory mechanism, this needs to be confirmed in a randomized controlled trial. Quality of life, an important measure of success for these palliative procedures, should also be measured.

Diss. (sammanfattning) Linköping : Univ., 2001. / Härtill 7 uppsatser.

Background: The urinary catheter was designed by Foley in 1937.  There are diverse types of urinary catheters. Complications are common to patients living with indwelling urinary catheters. Nurses have the responsibility to provide information about the catheter to patients. Aim: To describe patients’ experiences of living with an indwelling urinary catheter. Method: A literature review of qualitative study was carried out. 10 articles were analysed. Friberg’s analysis model was used to analyse data. Results: Patients had different perceptions about living with indwelling urinary catheters. Some needed to adjust to having indwelling urinary catheters as part of their life. Others experienced catheter related problems such as pain, leakage and discomfort. Patients expressed need for support from family and healthcare professionals. Conclusion: Patients felt that they had received inadequate information from healthcare professionals and needed information about having an indwelling urinary catheter.