The Practice Of Urinary Catheter Procedure - Reflective Essay

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Reflective Essay On The Practice Of Urinary Catheter Procedure

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Introduction

This is a reflective essay and the focus of the essay will be on the Urinary Catheter system. From my experience in my respective field, I witnessed that the technology made near to nothing contribution towards the existing flawed catheter system. This flawed and outdated system is risking the well-being of the patients as well as it takes too much time and effort from the healthcare professionals and as it is evident that the work is already overwhelmed for us, advancement within Urinary catheters is highly needed.

Legends suggest that Urinary catheters have been in use for more than 3500 years, and it is helping people to drain their bladder, in case the people are failing to empty it by themselves. People suffering from bladder disease or some remote diseases, always require an indwelling catheter, and a Foley catheter is the inevitable choice for near about 80 years, some advancements have been made. Still, the issues in regards to using these old urinary catheter technologies are at large, such as the health implications. These old ways can be the potential cause behind various diseases, such as; Chronic and recurrent infections due to bacterial colonization, septicaemia and bladder stone, small to big damages to the bladder, kidneys, and urethra. It is becoming a big concern globally, as using a catheter is not a medical choice, instead, it is necessary and it works for its purpose but the negative impact it can cause to a human individual is making it a potential risk for the patients. As I mentioned it came as a surprise that despite these cons, the technology never really made any progressive steps to mitigate these issues. Also, the process of handling the catheter is not easy or simple. As a medical professional it is not a piece of complaint against the complexity of using the existing catheters, most of the tasks, even the basic one related to the medical profession hold a level of complexity. Although for years every other sector is developing its process, products, service, tools, and techniques with the help of incessant technological enhancement, still, shockingly, the technology has never made any progress with Catheter (Al-Qahtani et al. 2019). That is why there must be an urgent requirement for a new indwelling catheter system. The new system needs to be more advance so it would be easy to insert and the process would not be painful or require less time or effort from the medical professional. Also, the catheter system requires to be advanced enough so that it would not influence any other disease as well as it can mimic the natural bladder physiology, by simply filling at low pressure along with completely emptying the bladder without any damage. According to Stephenson, 2017 there has been no proper advancement within the system. That is why I believe this can be the ideal subject for my reflective essay.

The key points for the discussion would be the complete lack of progressive advancement within the use of the catheter, and the essay will also discuss the context regarding its impact on the clinical practices, relevant research, and theory policies. Also, the essay will analyse the ideal managing process of the catheter and the guidelines regarding it, specifically, it will explore the area of blocked catheters, as this affected my practice and is a big concern from my professional community perspective. Also as this is a reflective essay, I will use a reflective model to facilitate the context along with my previous practice experiences, and the essay will suggest changes within the practice that can enhance the service towards the patient.

Body

1. Blocked catheter

Blocked Catheters is becoming a big concern regarding the service, so far now the catheter system mostly depends on the experience of the professional who is inserting it, and in public hospitals or within any other healthcare facilities, it would be wrong to expect experienced professionals are putting or removing every patent's Urinary catheter, so in my experience leakage around the catheter area become common and it can cause discomfort and also can harm the hygiene of the place. The leakage is mainly caused by catheter blockage. Also, the blockage can affect the patient by causing pain and discomfort around the kidney area due to urinary retention within the bladder. Also, this can lead to kidney infection, even for long time catheter users, the block can lead to kidney stones. As it is mentioned before that catheter is not only used for the patients suffering from kidney or bladder problems, it is used for many patients who are unable to release the urine, so Catheter is used for all kinds of patients, and thus the complications related to the catheter can impact these patients too (Woodward and Rew, 2020). In the case of the injured patient, they often lose consciousness or lose control over the specific body part, and the blocked catheter can lead to fatal consequences, such as; for spinal cord injured patient Autonomic dysreflexia is a very common yet serious medical emergency, in this case, the blocked catheter can act as a stimulus and can trigger hypertension by creating excessive "Systematic nervous responses" and thus it can cause convulsions, stroke, cardiac arrest, even death (Cowan, 2015).

2. Literature review

According to Holroyd and Sharon, 2019, Indwelling "urinary catheters" are still being used, despite the impact they can have on a patient's body or even though they are so complex to manage that they can lead to Catheter blockage and the consequences can be horrific, even death (Tenke et al. 2018). This particular study focuses on the impact of using these outdated catheter systems within UK health care facilities. "Healthcare acquired infections (HCAIs)" is one of the biggest concerns for the NHS and UK government, as it is reported that due to HCAIs 5,000 people died in the year 2019, and more specifically 20% of those deaths are associated with Urinary tract and all of them are preventable (Shum et al. 2017). The whole study is focused on how the catheter system is completely outdated and still, the nursing community goes through guidelines and training to use those outdated techniques, which have so many negative impacts. So the study suggested that how it is high time for the health industry to be associated with technological advancement and innovation to introduce new and progressive techniques or tools or systems to replace the outdated existing urinary catheter system.

As stated by Feneley et al. 2015, there is no advancement in the urinary catheter system in the last eighty years. On the other hand, the health industry implemented technology as part of their innovative development process and now so many new tools and techniques are introduced in case of diagnosis and treatment (Holá et al. 2020). The study focuses on the inevitable use of typical Foley catheters within most of the healthcare facilities in the UK, despite the potential negative impacts are very lucid in front of the medical community. So the study mostly analyses the effects and suggested the use of modern catheters, which are made of silicone elastomer along with hydrophilic coating, in this way at least the insert and removal procedure of the catheter would be less painful and will also be less complex, as these catheters can provide slippery surface thus reduces the friction.

3. Adverse impacts and suggested solutions

As is mentioned before, this is an important discussion and requires immediate consideration and attention from the leading health care facilities and the Government (Wilson and Gaido, 2018). This essay is going to discuss the adverse effects from the use of existing catheter system can propagate within the human body and also the discussion will be specific to the issues or impacts caused by blocked catheters also the discussion will include my suggestions based on my experience to mitigate the issues.

The existing catheter system does not have any valve installed in it, so it causes continuous drainage thus suppressing the normal process. The valve will help in nearly mimicking the urination process and thus will help in the inhibition of the build-up of bacterial colonies within the bladder or kidney via periodic flushing (Nasrabadi et al. 2021). As it is evident that my suggestions will be to install a valve, it is shocking that such minimal advancement has been ignored over the years, and also as the technology advances, I believe catheters should be designed to conduct tidal drainage. As it can reduce the infection risk rate from over 70% to 15%.

Another inexcusable aspect is the use of Antibiotic resistance. A few decades back when it became evident that the Catheter can be a potential carrier for bacteria, the use of antibiotics started for resisting the reaction from bacteria within the urinary tract, but over the years it has been witnessed that the preferred antibiotics do not affect bacteria like E.coli, so my suggestion would be to use better antibiotics which can eliminate the frequent bacteria from the list provided by the WHO.

Blocked catheter often causes cease the flow of urine resulting in infected urine and later that got mixed up with uninfected urine but due to blockage it gets mixed up and stayed in the bladder thus causing the chronic infection in the bladder. 

In recent time from my practice experience, I have seen the most frequent consequences are bladder stones for long tern catheter users (Kranz et al. 2020). Due to the blockage often the bladder got infected from “Proteus mirabilis” and it causes the struvite crystals and which can be the nuclei for bladder stone formation and that can have a wide range of health consequences (sciencedirect.com, 2019).

4. Reflective Cycle

As it is a reflective essay, I am going to describe my experience which is a pivotal reason behind this discussion through Gibbs reflective cycle

In the description part, I am going to discuss a specific incident. The first time I realised the concerns related to the urinary catheter system, during my practice as a medical professional, the patient is unconscious due to surgery regarding a severe accident. Some days later I realised that the urine is leaking, I asked my junior to change the catheter, but she failed to do that smoothly, and also caused the patient pain and took an awful lot of time to finish the job. Although a few days later I detected some infection and further tests showed infection within the urinary tract.

In the feelings part, I am going to discuss the sets of feelings I am going through in that situation. As a medical professional, I was feeling guilty for letting the infection grow that much, the junior who is also involved with the patient is also feeling similar things (Guirguis et al. 2020). Although I was satisfied with my sangfroid reaction, as to how I treated the infection adequately. Also, I was skeptical about the traditional managing process of the catheter, as I was confirmed to follow all the guidelines and installed the catheter in the right manner.

In the Evaluation section, I will discuss the pro and cons of the experience. As it is hard to find any pro to these kinds of situations, but still after the infection was detected, I carried out an evaluation process and I realised that I installed the catheter first time in the right manner and I used the exact catheter the respective facility asked me to use, also when the leak was detected I supervised the catheter installation by my Junior and she also followed the guidelines and conducted the process how she learned from her training years (Shenot et al. 2020). The only con was that we missed out on the investigation after we spotted the leakage.

The next step is analysis, which is the most important one considering the experience. I analysed the incident thoroughly and realised that the process is itself is flawed, as I am a little more experienced than my junior, so It is a little less complex and time-consuming for me, also the blockage was created for the poor outdated mechanism of the existing catheters and the leakage and infection were caused by the blocked catheter.

In the conclusion, it is fair to state that the policies or training, or guidelines are learned and followed by the nurses, but that would not help unless the catheters get improved. Also, further investigation and observation tell me that these kinds of incidents are very frequent.

In the action plan part, I am going to state my frustration and shocking experience of learning the background about the use and management of urinary catheters. I learned that in 80 years there are no recognisable changes or improvements that take place in the catheter system (Terlecki and Wilson, 2020). So the leading medical or health care organisations should improve the catheter system with the help of technology and some basic improvements are needed ASAP, like installing Valve, or using smooth silicone elastomer along with hydrophilic coating for catheter production, also using modern Foley catheters, which retained with the help of wings and will open up after inserting within the bladder through the "Suprapubic tract”. This shows less trapping and also reduces the chances of blockage thus pseudopolyps and also easy to install and remove (koreamed.org, 2019).

Conclusion

For concluding the essay it should be mentioned that this critical reflection will have great importance in my Career to provide more appropriate patient-centered care. The practice of proper urinary catheter care in my view is highly beneficial and important. As I studied I found that there is a great susceptibility for an individual to develop a bacterial infection due to improper post catheter care. In some instances, this infection can have a great effect and cause internal bleeding of the urinary wall (Duta et al. 2020). So I found that the researchers, as well as medical experts, say providing a huge focus in developing a sanitization technique that will restrict the growth of bacterial and other pathogenic colonies on the catheter. I found that till now the antibacterial property of metals like silver is harnessed for the production of new catheter tips which will restrict the growth of the bacterial colony on it. I found that due to the presence of free electrons and other ions at the surface of the metal such as silver the bacterial colonies fail to replicate due to the redox reaction. Along with this, proper sanitation is also followed to restrict the presence of bacterial colonies on the tip of the catheter. I found that in order to fulfill this goal the alcohol-based sanitizer is being implemented. Alcohol-based sanitizers not only help in the process of killing the bacterial colonies but also have a great role in making the surface resistant to any contamination. In some regions specialty in Australia, the tips which are used for catheters are autoclave before the use. As I studied I found that this process is highly beneficial as most of the time the pollen in other bacterial colonies can produce a covering that can restrict the sterilization property of the sanitizer.

I found that not only the proper stabilization technique but the process of implementation also plays a great role in the purpose of providing proper care to the patient when administered with a Catheter. I found that in some rural provinces of the United Kingdom the community nurses are used to administer the catheter technique to the patient. In some cases, it causes some unfortunate events where the urinary walls of the patient get heavily in your due to the improper implementation technique. This can be avoided quite easily with the help of government agencies such as the NHS. As I found that they have the authority as well as the resources to help the hospitals to have at least some medical personalities who have enough training and experience to administer the catheterization technique to the patient. Other than this new research is going on as I found that it will include the usage of less harmful materials for the preparation of catheter tips which will further restrict the growth of bacterial colonies.

References

Journals

Al-Qahtani, M., Safan, A., Jassim, G. and Abadla, S., 2019. Efficacy of anti-microbial catheters in preventing catheter associated urinary tract infections in hospitalized patients: A review on recent updates. Journal of infection and public health12(6), pp.760-766.

Duta, O.C., ?î?u, A.M., Marin, A., Ficai, A., Ficai, D. and Andronescu, E., 2020. Surface modification of poly (vinylchloride) for manufacturing advanced catheters. Current medicinal chemistry27(10), pp.1616-1633.

Guirguis, M., Shobeiri, S.A. and Alshiek, J., 2020. Transvesical Glidewire and Vaginal Foley–Assisted Recurrent Vesicovaginal Fistula Repair: A Case Series. Female Pelvic Medicine & Reconstructive Surgery26(10), pp.e40-e43.

Holá, V., Ruzicka, F. and Horka, M., 2020. Microbial diversity in biofilm infections of the urinary tract with the use of sonication techniques. FEMS Immunology & Medical Microbiology59(3), pp.525-528.

Jeong, S.J. and Oh, S.J., 2019. Recent updates in urinary catheter products for the neurogenic bladder patients with spinal cord injury. Korean journal of neurotrauma15(2), pp.77-87.

Kranz, J., Schmidt, S., Wagenlehner, F. and Schneidewind, L., 2020. Catheter-Associated Urinary Tract Infections in Adult Patients: Preventive Strategies and Treatment Options. Deutsches Ärzteblatt International117(6), p.83.

Nasrabadi, M.Z., Tabibi, H., Salmani, M., Torkashvand, M. and Zarepour, E., 2021. A comprehensive survey on non-invasive wearable bladder volume monitoring systems. Medical & Biological Engineering & Computing, pp.1-30.

Shenot, P.J., Teplitsky, S., Margules, A., Miller, A. and Das, A.K., 2020. Urinary undiversion by conversion of the incontinent ileovesicostomy to augmentation ileocystoplasty in spinal cord injured patients. The Journal of Spinal Cord Medicine, pp.1-8.

Shum, A., Wong, K.S., Sankaran, K. and Goh, M.L., 2017. Securement of the indwelling urinary catheter for adult patients: a best practice implementation. International journal of evidence-based healthcare15(1), pp.3-12.

Tenke, P., Kovacs, B., Johansen, T.E.B., Matsumoto, T., Tambyah, P.A. and Naber, K.G., 2018. European and Asian guidelines on management and prevention of catheter-associated urinary tract infections. International journal of antimicrobial agents31, pp.68-78.

Terlecki, R.P. and Wilson, S.K., 2020. A new paradigm for surgical revision of the artificial urinary sphincter for recurrent stress urinary incontinence: Wilson’s Workshop 11. International Journal of Impotence Research, pp.1-7.

Wilson, M.L. and Gaido, L., 2018. Laboratory diagnosis of urinary tract infections in adult patients. Clinical infectious diseases38(8), pp.1150-1158.

Woodward, S. and Rew, M., 2020. Patients' quality of life and clean intermittent self-catheterization. British journal of nursing12(18), pp.1066-1074.

Online Article

koreamed.org, 2019, Recent updates in urinary catheter products for the neurogenic bladder patients with spinal cord injury, Available at, https://synapse.koreamed.org/articles/1136044 [Accessed on 01.08.2021]

sciencedirect.com, 2019, Efficacy of anti-microbial catheters in preventing catheter associated urinary tract infections in hospitalized patients: A review on recent updates, Available at, https://www.sciencedirect.com/science/article/pii/S1876034119303090 [Accessed on 01.08.2021]

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