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PICO Project

Yolande Tumot, Tamara Calixte, Amy G, Kenia D. Roa

Miami Dade College

NUR 3069: Advanced Health Assessment

Roxana Orta DNP, AGNP-C, PMHNP-BC, APRN

June 8, 2023

Introduction

Urinary tract infections (UTIs) are a common healthcare-associated infection, particularly in patients with a weak bladder. Patients with weak bladder function often require urinary catheterization to manage urine drainage. However, the use of indwelling urinary catheters has been associated with an increased risk of UTIs. The purpose of this project is to investigate or research the effectiveness of indwelling catheters when compared to straight catheters to allow drainage and prevent urinary tract infections. This issue is what has inspired our PICO question, for patients with a weak bladder and urinary tract infections, does the use of an indwelling urinary catheter compared to a straight catheter allow urine drainage and decrease the risk of urinary tract infections?

A urinary tract infection can affect the kidneys, bladder, ureters and or the urethra. This infection is usually caused by a bacterium but can also be caused by a virus or fungus. Lower urinary tract infections are the most common which involves the bladder and the urethra and is more common in women. Some of the early symptoms may include burning when urinating (dysuria), smelly urine, frequent urination, and pelvic pressure. Once the infection gets worse or advances the symptoms become severe and it affects the kidneys; some symptoms include high fever, nausea and vomiting, flank pain, chills, septic shock which can become detrimental.

People that have a weak bladder, also known as urinary incontinence, have problems being able to urinate. This issue can manifest in different ways like occasional leakage, complete loss of bladder control, or the need to urinate frequently and urgently. The problem itself can be caused by different factors such as pregnancy, childbirth, and menopause in women. While in men it can indicate prostate problems. However, older adults are also affected due to weakened muscles or nerve damage.

Indwelling urinary catheters are commonly used in clinical practice to ensure continuous urine drainage in patients with weak bladders. However, these catheters can serve as a potential route for bacteria to enter the urinary tract, leading to UTIs. Another method used is straight catheterization also known as intermittent catheterization.

The choice between using an indwelling urinary catheter or a straight catheter is a critical decision for healthcare providers caring for patients with weak bladders and UTIs. It is essential to consider not only the effective drainage of urine but also the prevention of UTIs, which can lead to significant morbidity, hospital stay and healthcare costs.

Currently, there is a need to examine the available evidence regarding the use of indwelling urinary catheters compared to straight catheters in terms of their impact on urine drainage and the risk of UTIs in patients with weak bladders. Understanding the effectiveness of these interventions can guide healthcare providers in making evidence-based decisions to optimize patient care and minimize the risk of complications.

By addressing this gap in knowledge through a comprehensive review of the literature, healthcare professionals can enhance their understanding of the benefits and limitations associated with using indwelling urinary catheters and straight catheters, thus improving clinical practice and patient outcomes.

In the United States, it is estimated that UTIs account for approximately 8.1 million visits to healthcare providers each year, making it one of the most common infections. Women tend to be more susceptible to UTIs than men, primarily due to anatomical differences that make it easier for bacteria to enter the urinary tract in females. From personal experience working in an emergency room, Urinary tract infections (UTIs) can have a significant impact on the elderly population. Due to various age-related changes in the urinary system and overall health, older adults are more susceptible to developing UTIs and may experience more severe symptoms, complications and even death.

The primary goal is to determine whether the use of an indwelling urinary catheter or a straight catheter is more effective in terms of urine drainage and decreasing the risk of urinary tract infections (UTIs). Population: Patients with weak bladder and urinary tract infections. This refers to individuals who experience difficulties in controlling their bladder function and have been diagnosed with urinary tract infections. Intervention: The use of an indwelling urinary catheter. An indwelling catheter is a flexible tube inserted into the bladder through the urethra to drain urine continuously. It remains in place for an extended period. Comparison: A straight catheter is inserted Straight catheters are inserted into the bladder through the urethra, urine flows out of the catheter funnel. The catheter is carefully taken out and discarded after the bladder is empty. Outcome: The two primary outcomes of interest are urine drainage and the risk of urinary tract infections. The study aims to assess whether one intervention, indwelling urinary catheter or straight catheter is superior to the other in terms of facilitating effective urine drainage and reducing the likelihood of UTIs.

Background

Urinary tract infections are common in hospitals and is common among patients with urinary catheterization. There are many different reasons patients why patients need to use a urinary catheter. Indwelling catheters are used for a period of time to drain the bladder of urine. Straight catheterization known as intermittent catheterization is also used to drain the bladder and is removed after a one-time use, both interventions contribute to urinary tract infections. The goal of the study is to determine which intervention, a straight catheter or an indwelling urinary catheter, is more effective at facilitating efficient urine drainage and lowering the risk of UTIs.

Search Methods

For the purpose of this project, we focused on whether an indwelling urinary catheter is superior to a straight catheter in facilitating effective urine drainage and reducing the likelihood of UTI. I began my search on PubMed by entering key words urinary tract infection, indwelling catheterization, and intermittent catheterization. We found a systematic review of randomized controlled trials that evaluated UTI’s, and the risks of different methods used which include indwelling catheterization, intermittent catheterization and suprapubic catherization. We did not include suprapubic in our proposal even though it is mentioned in the review. There were 24-232 participants in the studies. Inclusion criteria included randomized clinical trial, suprapubic catheterization compared with indwelling catheterization or indwelling catheterization vs intermittent catheterization. Individuals undergoing benign or malignant gynecologic surgery, either electively or as an emergency. Review articles, editorial, comments, meeting abstracts, and studies on unrelated topics were all excluded.

Literature Review of the proposed change

In their review they combined information from 15 RCTs to arrive at the most trustworthy result, although, two trials compared indwelling with intermittent catheterization.] which was our focus. The GRADE approach was used to evaluate the quality of the data. In comparison to indwelling urinary catheterization, intermittent catheterization was related with a decrease in symptomatic UTI. (Li et al., 2018). According to this review more high-quality randomized trials are needed to determine which method of drainage system is best for patients who had gynecologic surgeries. According to the 2015 urological infection guidelines from the European Association of Urology, intermittent urethral catheterization is associated with a lower incidence of bacteriuria than indwelling urethral catheterization. However, they were unable to offer any suggestions for symptomatic UTI (Li et al., 2018).

Discussion

References

Centers for Disease Control and Prevention. (2021, October 6). Urinary tract infection. Centers for Disease Control and Prevention. https://www.cdc.gov/antibiotic-use/uti.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fantibiotic-use%2Fcommunity%2Ffor-patients%2Fcommon-illnesses%2Futi.htmlTop of Form

Li, M., Yao, L., Han, C. et al .  The incidence of urinary tract infection of different routes of catheterization following gynecologic surgery: a systematic review and meta-analysis of randomized controlled trials.  Int Urogynecol J  30, 523–535 (2019). https://doi.org/10.1007/s00192-018-3791-3

Mayo Foundation for Medical Education and Research. (2022, September 14). Urinary tract infection (UTI). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/symptoms-causes/syc-20353447

Mayo Foundation for Medical Education and Research. (2022a, May 3). Overactive bladder. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/overactive-bladder/symptoms-causes/syc-20355715