Great Catheter Care: Preventing Infections

Good catheter care is the biggest factor in preventing catheter-associated urinary tract infections.  Here are some tips for great catheter care.

• Wash your hands.  It sounds simple, but this is the single most important step in preventing infections.  Wash your hands BEFORE and AFTER putting on gloves.
• Use catheters sparingly—only when necessary.
• Use the smallest catheter that will do the job.
• When inserting the catheter, lay out a sterile field and maintain it.  If a person is obese or has contractures you may need two people to insert the catheter while maintaining a sterile field.
• Lubricate the tip of the catheter to prevent damage to the urethra during insertion.
• Use good lighting.  If you accidentally insert the catheter in the vagina, leave it there as a marker until you have placed a second, sterile catheter.
• Keep the system (catheter, tubing and bag) closed if possible.  The system should never be opened simply for convenience.
• Keep the drainage bag below the level of the bladder (but not lying on the floor).  Use clean technique when emptying the bag.
• Secure the catheter to prevent bleeding, trauma, tissue damage or bladder spasms that can be triggered by the catheter or balloon.  Tape can be hard on the skin; use a commercial device when possible.
• Keep the perineum clean.  Treat the catheter area like any other part of the body, washing as you would any other body part.
• If the resident is also incontinent of stool, check frequently to prevent stool from contaminating the catheter.
• Keep residents with catheters away from residents with infections.

Suspected infection:

If you suspect a urinary tract infection, remove the catheter and replace it with a new one.  Get a urine sample for culture and sensitivity from the new catheter.  Antibiotics should only be used for infections that are symptomatic.

Leakage

If catheter leakage occurs, check that the balloon is inflated and that the catheter is in the right place.  Make sure the balloon is inflated completely.  It is never acceptable to use a 30 cc balloon partially inflated.  Before changing to a larger catheter, keep in mind that constipation and fecal impaction may also contribute to leakage.  Larger catheters with larger balloons can damage the neck of the bladder.

YOU are the key to good catheter care that can prevent infections and discomfort, and save time and money.

Music Can Mean Less Pain

Focusing on music can distract people who have significant anxiety about pain enough that they feel the pain less acutely, according to a recent study done at the University of Utah Pain Research Center.  The study found that pain was reduced as the demands of focusing on the task rose.

Researchers had 153 volunteers concentrate on following a melody so they could identify the tones that stood out.  During the session small pain shocks were administered through fingertip electrodes.  The authors explained that the effects of the music resulted from competition with the participants’ pain pathways.

Interestingly, those who had registered the most anxiety about pain became more absorbed in the task and were more likely to experience reduced perception of pain.  The study authors suggested that, “Clinicians should consider patients’ personality characteristics when recommending behavioral interventions like music listening for pain relief.”

Pathways has volunteers that can provide music sessions to our hospice patients as part of our Integrative Therapies program of care for body and soul.

The results were published in the December, 2011 issue of the Journal of Pain.

Meds That Cause ER Visits

Four Culprits

Just four drugs and drug classes cause two thirds of the 100,000 annual emergency room visits for drug reactions in the elderly, according to recent research.  At the top of the list is warfarin (also known as Coumadin); it alone accounted for one third of the visits.  The other categories are insulins, oral hypoglycemic agents and oral antiplatelet medications.

With antiplatelet or blood thinning drugs, bleeding was the main problem. For insulin and other diabetes medications, about two-thirds of cases involved changes in mental status such as confusion, loss of consciousness or seizures.

Some of the common denominators in these drugs are that: they are commonly prescribed; there is a fine line between the therapeutic dose and a dangerous one; and they can all be difficult to use.  The researchers made note that none of the medications that were culprits were drugs that were labeled “high risk” for older adults, although some over-the-counter drugs like Benedryl are.

“Of the thousands of medications available to older patients, a small group of blood thinners and diabetes medications caused a high proportion of emergency hospitalizations for adverse drug events among elderly Americans,” said lead study author Dr. Daniel Budnitz of the Centers for Disease Control and Prevention (CDC). 

“We weren’t so surprised at the particular drugs that were involved,” Budnitz said. “But we were surprised how many of the emergency hospitalizations were due to such a relatively small number of these drugs.”

It is estimated that hospitalizations for accidental overdoses and adverse side effects are likely to increase as Americans live longer and the senior population grows.  Currently 40% of people older than 65 take five to nine medications; 18% take 10 or more.

Researchers at CDC published the study in the Nov. 24, 2011 New England Journal of Medicine.

Feeding Tubes: Pluses & Minuses

Feeding tubes can provide nutrition to people who have difficulty swallowing or are unable to eat for medical reasons—maybe someone with a head-and-neck cancer.  It’s most beneficial for residents whose illness can be reversed. 

A feeding tube can be inserted through the nose into the stomach (NG-tubes), or through the abdominal wall into the stomach.  NG tubes can usually only be used for a short time to prevent ulcerations in the nasal tract.  If a feeding tube will be used for weeks or months, it is likely that a PEG tube (percutaneous endoscopic gastrostomy) will need to be inserted surgically through the abdominal wall into the stomach.

Supplementary Nutrition

Sometimes a person with a feeding tube can keep eating. Here, the feeding tube is providing additional nutrition because of poor intake by the resident. Most feeding tubes are inserted because the resident has trouble swallowing and can’t eat without the risk of aspirating food into the lungs.

Risks of Aspiration

Aspiration pneumonia is caused by food or fluid entering the lungs instead of the stomach.  It is common in people with advanced dementia.  There is no evidence that tube feedings prevent aspiration pneumonia because even if tube fed, people always produce saliva which they may aspirate. Tube feeding doesn’t correct the swallowing problem and residents are still at risk of aspiration pneumonia.
 
Quality of Life

Tube feedings should be considered very carefully.  They can cause discomfort, may require physical restraints, and increase the risk of infection.  When considering tube feedings, it is good to remember that terminally ill residents rarely experience hunger or thirst.  Of those who do, small amount of food and fluids, mouth care or ice chips can give relief.  An actively dying person can no longer absorb nutrients, so tube feeding in the final stages of many progressive diseases may not help to prolong life.

Of course it is the resident’s right to accept or refuse a feeding tube.  From an ethical standpoint, removing the tube is the same as not starting tube feedings.  But for the person discontinuing the tube, it may feel like a much more active role in the resident’s eventual death.

Alternatives

In making a decision regarding the use of feeding tube, it may be helpful to get a swallowing evaluation by a specialist. Discontinuing medications may reduce eating difficulties.  Some drugs, such as sedatives, tranquilizers and anti-cholinergics, can cause difficulty swallowing.

Interventions such as adjusting medications, using assistive devices, changing the type of foods, proper feeding techniques, and dental care may prevent having to use a feeding tube.

In an ideal world, people would consider their choices when not in a crisis, and state their preferences about feeding tubes in advance directives.