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@#Objective To explore the independent risk factors for postoperative retention of urinary catheters in the ward of lung tumor patients due to urinary retention under the concept of enhanced recovery after surgery (ERAS). Methods Seventy-five patients with lung tumors who had urinary catheters left in the postoperative ward between June 2019 and August 2019 were selected as a case group, and 75 patients with lung tumors who did not have urinary catheters in the perioperative period as a control group. Independent risk factors for indwelling urinary catheters in the postoperative ward were screened by univariate and multiple-variate logistic stepwise regression analysis. Results There were 45 males and 30 females in the case group with an average age of 55.33±10.78 years, 28 males and 47 females in the control group with an average age of 57.12±10.06 years. Univariate analysis showed that gender, operative time>2 h, intraoperative fluid volume≥1 200 mL, and fluid volume within 6 h of returning to the ward after surgery>1 200 mL were associated with the occurrence of indwelling urinary catheters in patients with lung tumors in postoperative wards (P<0.05). Multiple-variate logistic regression showed that male (OR=2.311, 95%CI 1.173-4.552, P=0.015), infusion volume within 6 h of returning to the ward after surgery>1 200 mL (OR=2.491, 95%CI 1.149-5.401, P=0.021) and intraoperative infusion volume≥1 200 mL (OR=2.105, 95%CI 1.022-4.340, P=0.044) were independent risk factors for postoperative retention of urinary catheters in patients with lung tumors. Conclusion The occurrence of indwelling urinary catheter in lung tumor patients under the ERAS concept is the result of a combination of factors, and patients who are male, have infusion volume>1 200 mL within 6 h of returning to the ward after surgery, and have intraoperative infusion volume≥1 200 mL are the high-risk group for postoperative ward indwelling urinary catheter, and health care personnel should strengthen the assessment and observation, provide targeted health education, appropriately control the perioperative fluid volume, and take other measures to reduce the occurrence of indwelling urinary catheters due to urinary retention postoperatively in ward.
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Introduction: Catheter associated urinary tract infections (CAUTI) is the most common health care associated infection (HAI), accounting for 40% of all HAIs in particularly in patients admitted to intensive care units (ICU) due to their more frequent necessity of urinary catheterization and longer duration of catheter use. Knowledge about Microbiological profile and antimicrobial sensitivity pattern of CAUTI is essential to implement the infection control system in a proper manner.Aims and objectives: To study the rate and microbiological profile of catheter associated urinary tract infections and in patients admitted in Intensive Care Units.Materials and methods: A one-year prospective study was conducted in which urine samples were collected from patients admitted in Medical ICUs on indwelling urinary catheter for >48 hours and processed in Microbiology Department according to standard procedures. CA-UTI rate was calculated and their microbiological profile and various resistance patterns were studied as per CLSI guidelines.Results: Out of 1406 enrolled patients, 64 patients developed CAUTI. Overall CAUTI rate was 4.06/1000 catheter days. Most common isolate in CAUTI cases was Klebsiella spp. (32.3%), followed by Escherichia coli (24.6%). Gram negative isolates showed higher sensitivity to aminoglycosides, imipenam and nitrofurantoin as compared to cephalosporins The Enterococcus spp. were 100% sensitive to linezolid and 71.4% sensitive to both vancomycin and teicoplanin.Conclusion: CAUTI rate in our ICUs was high compared to the benchmarks. Antibiotic sensitivity pattern of the pathogens involved was also low. This study provides the data of predisposing risk factors and its causative microbial flora for CAUTI in our tertiary care.
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@#Objective To investigate the occurrence of indwelling urinary catheter in patients receiving thoracoscopic lobectomy and relevant risk factors. Methods We retrospectively reviewed the clinical data of the 737 patients who received thoracoscopic lobectomy in our hospital and analyzed the risk factors of indwelling urinary catheter during postoperative hospitalization using univariate analysis and multiple-variate logistic regression analysis between December 2018 and May 2019. There were 253 males and 484 females at median age of 57 (50, 64) years. Results A percentage of 14.4% (106/737) of the patients adopted postoperative indwelling urinary catheter. Univariate regression analysis showed that gender and postoperative bedridden time were risk factors for indwelling urinary catheter in the patients after thoracoscopic lobectomy (P<0.05). Multiple-variate logistic regression analysis showed that male gender (OR=2.018, 95% CI 1.316-3.096, P<0.001) and postoperative bedridden time >18 hours (OR=2.298, 95%CI 1.502-3.516, P<0.001) were the independent risk factors for indwelling urinary catheter. Conclusion Male gender and those with longer postoperative bedridden time are high-risk population to indwell urinary catheter. Positive measures should be taken to reduce the chance of indwelling urinary catheter.
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Objective To systematically assess the efficacy and safety of non-indwelling urinary catheter during perioperative period of cesarean section.Methods The databases including Medline(PubMed),EMbase,Cochrane Library,CNKI and WanFang Data were retrieved by computer.The randomized controlled trials (RCTs) on the efficacy and safety of non-indwelling urinary catheter during perioperative period of cesarean section were comprehensively collected.Two reviewers independently screened literatures,extracted the data and assessed the quality.The Meta-analysis was conducted by using RevMan 5.3 software.Results A total of 5 RCTs involving 1 090 patients were included.The meta-analysis results showed that compared with the indwelling urinary catheter group,although the non-indwelling urinary catheter group increased the incidence rate of urinary retention[RR=11.67,95%CI(2.22,61.24),P<0.01],but significantly decreased the incidence rate of urinary tract infection(UTI) [RR=0.10,95%CI(0.04,0.26),P< 0.01] and incidence rate of initial urination discomfort [RR=0.17,95%CI (0.04,0.74),P=0.02],significantly shortened the initial time of off-bed activities [SMD=-3.68 ,95%CI(-5.25,-2.12),P<0.01]and hospitalization time [SMD=-1.03,95%CI(-1.67,-0.38),P<0.01].There were no significant differences in the operation time[SMD=-0.13,95%CI(-0.32,0.07),P=0.20] and incidence rate of postpartum hemorrhage (PPH)[RR=1.50,95%CI (0.43,5.26),P=0.53],The incidence rates of bladder injury in the two groups were similar.Conclusion According to the evidence of current clinical researches,selecting non-indwelling urinary catheter in elective cesarean section is effective and safe,prompting that indwelling urinary catheter during the perioperative period of cesarean section is selective rather than routine indwelling.
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Objective To summarize the meticulous nursing experience of indwelling urinary catheter between the children with hypospadias during perioperative. Methods 317 cases of indwelling urethral only in the silicone Foley tube, and without other urinary diversion with hypospadias were retrospectively analyzed, summarized the fine points of nursing, including preoperative children with comprehensive risk assessment, standardized preoperative skin preparation and postoperative protective constraint, effective properly fixed catheter keep the urine drainage unobstructed, close observation of urine drainage characteristics, maintain urine collection system tightness, maintain perineal skin clean and improved extubation nursing method, and do a good job after extubation nursing. Results 266 cases were cured with a cure rate of 83.9%(266/317);the incidence of urine leakage in 42 cases, the incidence rate was 13.2%(42/317); 7 cases of urethral stenosis, the incidence rate was 2.2%(7/317); 2 cases of urethral closing, the incidence was 0.6% (2/317), none of the patients had accidental extubation. Conclusions The meticulous nursing has a better effect in hypospadias patients during the perioperative period and it can reduce the incidence of postoperative complications;shorten the time of hospitalization and alleviate the suffering of children;improve the quality of nursing service, which is worthy of clinical application.
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Objective To explore the control effect of proactive monitoring on senile stroke women with Escherichia coli infection caused by indwelling catheter.Methods From October 2011 to September 2012 elderly female stroke patients with indwelling urinary catheter were chosen in the department of neurology and were given proactive monitoring,which included the following:management of antibiotics has been humanized,urinary catheter care used first-cleaning and then disinfection method,pathogen monitoring professionals directly went to the bacteria room for obtaining information.The monitoring results were compared with those last year.Results The urinary Escherichia coli infection in monitoring popu-lations declined sharply,Escherichia coli infection rate reduced from 20.5％ to 3.6％.The urinary infection rate in hospitalized patients reduced from 10.8％ to 5.7％ respectively.The preventive application of an-tibacterial drugs greatly reduced from 70.0％ to 24.7％.The nursing staff all mastered the nursing method of the catheter.Conclusions To give proactive monitoring to senile stroke women with indwelling urinary catheter can control Escherichia coli and other bacteria induced urinary infection due to indwelling catheter significantly,demonstrate a deterrent effect on unreasonable application of antibiotics,which can be recommended to control other indwelling catheter induced urinary hospital infection.