Master of Science
Ethelyn E. Exley
Research has documented numerous risks and complications in the use of indwelling urethral catheters.1 In spite of this, indwelling catheters are still widely used for the management of incontinence.2
During the past four decades, studies have shown that incontinence can be managed or resolved in many patients by using intermittent catheterization. Early investigators used elaborate sterile technique and included only patients with neurogenic bladder as a result of spinal cord injury.3 Later studies showed favorable results in patients with incontinence of non-traumatic etiology--even in patients previously dependent on an indwelling urethral catheter.4 The early literature on sterile technique occasionally mentioned teaching self-catheterization to those patients capable of learning the aseptic procedure, but this was apparently uncommon.
In l972,Lapides introduced the use of clean technique intermittent self catheterization for the treatment of a diversity of bladder dysfunctions. The results were equivalent bacteriologically to those with sterile technique and the simplicity of the procedure made it convenient and acceptable to many patients.6
During three years experience as a staff nurse in a visiting nurse association, the investigator worked with numerous patients who used indwelling urethral catheters on a permanent or semi-permanent basis and to whom nursing visits were made solely for the purpose of changing the catheter. Frequently, the catheter had been placed for incontinence without urodynamic evaluation. In many cases, the individuals caring for the patient in the home were responsible and competent.
The investigator read about Lapides' research as part of graduate education and was impressed with positive results obtained even when the patient had lengthy previous dependency on an indwelling catheter.7 The investigator questioned whether there were patients with indwelling catheters living at home for whom this alternative had been overlooked and whether some of the competent caretakers could be taught the procedure in cases where the patient was not a candidate for self-catheterization.
Numerous benefits would result if a patient were freed of an indwelling urethral catheter by using intermittent catheterization: the costs of sterile equipment, personnel and transportation involved in catheter changes would be eliminated; the nurses' time would be freed for other responsibilities; medical complications and their inherent costs would be averted; and freedom from tubing and bag would permit greater mobility for the patient and simpler handling by the family.
An investigation was planned to examine the relationship between bacteria in the urine and the use of clean technique intermittent catheterization when used following removal of an indwelling catheter. Previous research demonstrated that, in the absence of symptoms, microscopic visualization of bacteria in fresh, centrifuged urine sediment was highly predictive of growth on culture of 100,000 or more colonies per milliliter (ml.).8 Robins et al. suggested that the reliability of microscopy for predicting positive culture results was further enhanced by visualizing leukocytes as well as bacteria.9 Since the procedure of microscopic examination is inexpensive and can easily be learned by nurses, this test could be useful in monitoring bacteriuria in asymptomatic patients using clean technique intermittent catheterization.
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