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Translational Research for Practice and PopulationsNursing Practice Change Task 1 Melanie Troxell, BA, RN-BC Western Governors University November 4, 2018 Page 1
Translational Research for Practice and PopulationsCurrent Nursing Practice A current nursing practice within many acute care medical facilities that really needs to change is that urine is often allowed to lie, static, in the catheter tubing, including the common presence of a “dependent loop” in the tubing of a patient urinary catheter. While the policy of most hospitals, accordance with CDC recommendations (CDC, 2017, p. 13) demands that, among other precautions, the drainage tubing of a catheter be placed at a continuously downward angle, above the level of the floor, but below the level of the patient’s bladder, it is frequently still the case that foley tubing looped or curved in ways that allow urine to remain static, a form of flow obstruction, in the tube for indeterminate lengths of time. This author recently visited a 180 bed acute care hospital in the Southeastern United States during a period of a one day shift. With permission from the charge nurses, she conducted an inquiry into the nineteen patients with current, temporary, indwelling urinary catheters in eight ICU and medical-surgical units. One patient was counted out for the purposes of the following percentages because it was a chronic urinary catheter, placed outside of the facility under discussion.* Only six of the eighteen catheters, 33%, were positioned safely, according to hospital policy, with the tube free of dependent loops and at an ever downward angle away from the patients’ bodies. The remaining twelve catheters, 66%, were on a spectrum of misplacement, with dependent loops in most, and some with the catheter higher than the level of the bladder. * Interestingly, it was about 14 inches shorter than the ones under consideration and was in the correct position. On further research, it was likely a Brandi catheter, sold by McKesson Medical Surgical, which is a 48” long, one piece tube. (Urinary Drain Bag, n.d.) Page 2
Translational Research for Practice and PopulationsWhy Change? Anytime change is contemplated, the pros and cons, the cost for remaining and the cost for change, must be evaluated. In Guideline for Prevention of Catheter-Associated Urinary Tract Infections (CAUTI), The Centers for Disease Control and Prevention (CDC) recommends that “Proper Techniques for Urinary Catheter Maintenance” include that maintaining a downward flow of urine, ever away from the bladder, is a premiere concern when seeking to prevent urinary system infections in all patients. (CDC, 2017, p. 13) But just because something is recommended doesn’t always meant that it’s better or necessary. What is the cost of not doing everything possible to prevent CAUTIs? There is a heavy cost for patients. Anything that puts the life, health or safety of our patients at risk should be avoided as much as possible. It is believed that hospital acquired infections (HAI) cost healthcare institutions $45,000,000,000 and cause