Madigan Elizabeth, Neff Donna Felber
Sarah Cole Hirsh Institute for Best Nursing Practices, Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA.
Online J Issues Nurs. 2003;8(3):7.
The complications and management of long-term indwelling catheters used for urinary retention and incontinence were reviewed. Research evidence from 1992 - 2002 was located through searches of CINAHL (38 articles), and Medline (89 articles). Fifty studies were critiqued for this review. The most common complications of long-term indwelling catheters are bacteriuria, encrustation, and blockage. Less common is the prevalence of bacteremia and renal disease. Risk factors for bacteriuria include female gender, older age, and long-term indwelling catheter use. Urinary white blood cells are the best indicator of urinary tract infection. For drainable catheter systems used by community dwelling adults, daily bag cleaning with a diluted bleach solution (1:10) is effective in reducing bacterial counts to negligible numbers. Application of topical antibiotic cream to the meatus around the catheter does not reduce bacteriuria. Silicone catheters and larger lumen size catheters are more resistant to encrustation than other catheter types and smaller lumen size catheters. Acidifying the urine without removing the urease-producing bacteria does not reduce encrustation. Removal of catheter blockage is preventive for renal disease. Because of the complications of long-term indwelling catheter usage, periodic assessment and voiding trials should be used to determine the continued need for a catheter. Evidence-based recommendations for managing indwelling urinary catheters include screening for risk factors and evaluating urinary white blood cell count for infection, and assessment of the continued need for a catheter. Interventions include consideration of closed versus open drainage systems, type of catheter, and size of catheter lumen.
对用于尿潴留和尿失禁的长期留置导管的并发症及管理进行了综述。通过检索护理及健康领域数据库（CINAHL，38篇文章）和医学文献数据库（Medline，89篇文章）获取了1992年至2002年的研究证据。对50项研究进行了本次综述的批判性评价。长期留置导管最常见的并发症是菌尿、结痂和堵塞。菌血症和肾脏疾病的发生率较低。菌尿的危险因素包括女性、老年以及长期使用留置导管。尿白细胞是尿路感染的最佳指标。对于社区居住成年人使用的可引流导管系统，用稀释的漂白剂溶液（1:10）每日清洗集尿袋可有效将细菌数量减少到可忽略不计的水平。在导管周围尿道口涂抹局部抗生素乳膏并不能减少菌尿。硅胶导管和较大管径的导管比其他类型导管和较小管径的导管更不易结痂。在不清除产脲酶细菌的情况下酸化尿液并不能减少结痂。清除导管堵塞可预防肾脏疾病。由于长期使用留置导管存在并发症，应定期进行评估和排尿试验以确定是否仍需要留置导管。关于管理留置导尿管的循证建议包括筛查危险因素、评估尿白细胞计数以检测感染，以及评估是否仍需要留置导管。干预措施包括考虑采用封闭引流系统还是开放引流系统、导管类型以及导管管径大小。
