Intensive Care Unit, Hospital Universitari General de Catalunya, Barcelona, Spain.
Nursing Department, Medicine and Health Sciences Faculty, Universitat Internacional de Catalunya, Barcelona, Spain.
Nurs Crit Care. 2024 Nov;29(6):1788-1798. doi: 10.1111/nicc.13111. Epub 2024 Jul 2.
Clinical practice guidelines for the prevention of catheter associated urinary tract infection (CAUTI) recommend urinary catheter securement in critical patients although there is scant research on its effectiveness.
To analyse whether securement of an indwelling urinary catheter (IUC) reduces the risk of CAUTI and meatal pressure injury among intensive care unit (ICU) patients and assess medical adhesive-related skin injury (MARSI) associated with the securement device.
Open randomized controlled trial involving patients admitted to two ICUs in Spain. In the intervention group (n = 169 patients), the IUC was secured to the thigh using an in-house device piloted as part of this trial. Controls (n = 181) received standard care, including non-securement of the IUC. Barrier film spray was applied to the securement site with the aim of preventing MARSI. The definitions of the main outcomes were: CAUTI was diagnosed according to the criteria of the European Centre for Disease Prevention and Control, meatal pressure injury was categorized into four grades and MARSI was classified as either erythema or skin tears. Bivariate analysis and multivariate logistic regression were performed. Log-rank and Cox regressions were used to compare risk over time to CAUTI and meatal pressure injury in the two groups.
Data from 350 patients were analysed, 169 (48.29%) from IG and 181 (51.71%) from CG. In the multiple logistic regression analysis, IUC securement was an independent protective factor against both CAUTI (RR = 0.2, 95% CI [0.05, 0.67]) and meatal pressure injury (RR = 0.31, 95% CI [0.15, 0.58]). The incidence of MARSI was 7.1%.
Effective IUC securement significantly reduces the risk of CAUTI and meatal pressure injury among ICU patients. The in-house device piloted in the present trial is simple for nurses to use, and the incidence of MARSI was low. These results underline the benefits of IUC securement.
Indwelling urinary catheter (IUC) securement reduces the risk of urinary tract infection. IUC securement helps prevent meatal pressure injury. IUC securement with in-house devices is safe and effective.
预防导管相关尿路感染（CAUTI）的临床实践指南建议在重症患者中固定导尿管，但关于其有效性的研究甚少。
分析留置导尿管（IUC）固定是否会降低重症监护病房（ICU）患者发生 CAUTI 和尿道口压力性损伤的风险，并评估固定装置相关的医用胶粘剂相关皮肤损伤（MARSI）。
这是一项在西班牙两个 ICU 进行的开放性随机对照试验，纳入了患者。在干预组（n=169 例）中，使用作为该试验一部分的内部设备将 IUC 固定到大腿上。对照组（n=181 例）接受标准护理，包括不固定 IUC。在固定部位喷洒屏障膜喷雾，以预防 MARSI。主要结局的定义如下：CAUTI 根据欧洲疾病预防控制中心的标准诊断，尿道口压力性损伤分为四级，MARSI 分为红斑或皮肤撕裂。进行了双变量分析和多变量逻辑回归分析。使用对数秩和 Cox 回归比较两组患者在不同时间点 CAUTI 和尿道口压力性损伤的风险。
对 350 例患者的数据进行了分析，169 例（48.29%）来自干预组，181 例（51.71%）来自对照组。在多变量逻辑回归分析中，IUC 固定是 CAUTI（RR=0.2，95%CI [0.05，0.67]）和尿道口压力性损伤（RR=0.31，95%CI [0.15，0.58]）的独立保护因素。MARSI 的发生率为 7.1%。
有效的 IUC 固定可显著降低 ICU 患者发生 CAUTI 和尿道口压力性损伤的风险。本试验中使用的内部设备易于护士操作，且 MARSI 的发生率较低。这些结果强调了 IUC 固定的益处。
留置导尿管（IUC）固定可降低尿路感染风险。IUC 固定有助于预防尿道口压力性损伤。使用内部设备固定 IUC 安全且有效。
