Running head: PICOT AND LITERATURE SEARCH 1 PICOT and Statement Literature Search Student’s Name: Yeni Hernandez Date: 7/22/2018 Course: NRS-433V PICOT and Statement Literature Search Nursing Practice Problem Doctors use urinary catheters to empty urine from patients who have impaired urinary system. Such patients might suffer from kidney failure due to pressure exerted on their kidneys, this is dangerous and can permanently damage their kidneys. The Urinary catheters, however, may cause potential complications on the patients. Research carried on BMC Urology shows that most patients end up suffering from urinary tract infections (UTI) after the use of indwelling urinary catheters. Other complications such as kidney damage, injury to the urethra, bladder stones, and blood in the urine, septicemia and allergic reactions may arise from the usage of the urinary catheter (Feneley, Hopley, & Wells., 2015). Picot Statement Prognosis/Prediction: For pediatric patients 65 years and older (P), how does the use of catheters for much longer time (I) compared to the use of indwelling catheters for shorter time(C) influence the risk of Catheter-associated urinary infections(O) during the first ten weeks of indwelling catheter usage(T)? Most patients who are placed in indwelling catheters for more than the expected time have had the risk of developing urinary tract infections, allergic reactions and others experience challenges in their kidneys. What are some of the practical methods used to ensure that catheter-related diseases are reduced? This study aims to make sure that indwelling urethral catheters (IDC) are carried out in a manner that minimizes risks to infection and trauma (Conway & Larson, 2011). 1st study Feneley, R. C., Hopley, I. B., & Wells, P. N. (2015). Urinary catheters: history, current status, adverse events and research agenda. Journal of Medical Engineering & Technology, 39(8), 459-470. doi:10.3109/03091902.2015.1085600 I chose this study because the there is a qualitative analysis of the article and the scale of the burden of urinary incontinence. Statistical data collected from the year 2006 to 2007 recorded millions of people in England with consistent problems, and in the year 2011, the number of patients had increased than the previous year. Studies show urinary infections have wider effects on the older generation, and those over 85 years of age suffered most, followed by those with over 65 years of age. Challenges emerge while an attempt is made to care for the old people and patients affected. One study reveals that US nursing homes that received 420 admissions had 39% of patients experiencing a daytime urinary inconsistency most of them aged 65 years and above (Feneley, Hopley, & Wells., 2015).Clinicians often choose Catheterization as the last option due to high chances of urinary tract infections. In 2002, US had incidences of advance events of catheter induced_ infections occurring and causing deat.

1. Running head: PICOT AND LITERATURE SEARCH
1
PICOT and Statement Literature Search
Student’s Name: Yeni Hernandez
Date: 7/22/2018
Course: NRS-433V
PICOT and Statement Literature Search
Nursing Practice Problem
Doctors use urinary catheters to empty urine from patients who
have impaired urinary system. Such patients might suffer from
kidney failure due to pressure exerted on their kidneys, this is
dangerous and can permanently damage their kidneys. The
Urinary catheters, however, may cause potential complications
on the patients. Research carried on BMC Urology shows that
most patients end up suffering from urinary tract infections
(UTI) after the use of indwelling urinary catheters. Other
complications such as kidney damage, injury to the urethra,
bladder stones, and blood in the urine, septicemia and allergic

2. reactions may arise from the usage of the urinary catheter
(Feneley, Hopley, & Wells., 2015).
Picot Statement
Prognosis/Prediction: For pediatric patients 65 years and older
(P), how does the use of catheters for much longer time (I)
compared to the use of indwelling catheters for shorter time(C)
influence the risk of Catheter-associated urinary infections(O)
during the first ten weeks of indwelling catheter usage(T)?
Most patients who are placed in indwelling catheters for more
than the expected time have had the risk of developing urinary
tract infections, allergic reactions and others experience
challenges in their kidneys.
What are some of the practical methods used to ensure that
catheter-related diseases are reduced?
This study aims to make sure that indwelling urethral catheters
(IDC) are carried out in a manner that minimizes risks to
infection and trauma (Conway & Larson, 2011).
1st study
Feneley, R. C., Hopley, I. B., & Wells, P. N. (2015). Urinary
catheters: history, current status, adverse events and research
agenda. Journal of Medical Engineering & Technology, 39(8),
459-470. doi:10.3109/03091902.2015.1085600
I chose this study because the there is a qualitative analysis of
the article and the scale of the burden of urinary incontinence.
Statistical data collected from the year 2006 to 2007 recorded
millions of people in England with consistent problems, and in
the year 2011, the number of patients had increased than the
previous year. Studies show urinary infections have wider
effects on the older generation, and those over 85 years of age
suffered most, followed by those with over 65 years of age.
Challenges emerge while an attempt is made to care for the old
people and patients affected.
One study reveals that US nursing homes that received 420
admissions had 39% of patients experiencing a daytime urinary
inconsistency most of them aged 65 years and above (Feneley,
Hopley, & Wells., 2015).Clinicians often choose Catheterization

3. as the last option due to high chances of urinary tract infections.
In 2002, US had incidences of advance events of catheter
induced_ infections occurring and causing deaths of about
13089 patients. Infections related to usage of catheter machine
have ever raised a controversial issue regarding the
development of antimicrobial resistance and distress both to the
clinicians and the sufferers.
2nd study
Flores-Mireles, A. L., Walker, J. N., Caparon, M., &
Hultgren, S. J. (2015). Urinary tract infections: epidemiology,
mechanisms of infection and treatment options. Nature Reviews
Microbiology, 13(5), 269-284. doi:10.1038/nrmicro3432
I chose this study because the article gives a qualitative analysis
of the pathogenesis of the urinary infections during
catheterization. There are endogenous sources of
microorganisms causing CAUTI. It originates from
contaminated hands of the healthcare personnel, vaginal
colonization, and meatal, contaminated equipment and rectal.
These pathogens pass either through the extraluminal route,
intraluminal route, through the catheter from the contaminated
collected bag or travel along the outside of the catheter in the
form of a periurethral mucous sheath. Introduction of the sterile
objects has shown a reduction in risk of bacteriuria in a closed
urinary drainage. However, studies have shown that bacteriuria
can occur via breaks in the machines or through the
extraluminal route. Eventually, there is a 10% daily risk of
bacteriuria with catheterization and about 100%risk in a month;
this occurs in a short and long-term duration of catheterization
(Flores-Mireles, Walker, Caparon & Hultgren, 2015). If
clinicians prolonged catheterization then there is a high chance
that the urinary pathogens would form biofilms on the surface
of the catheter. With time, the microorganism begins to colonize
on the surface of the urinary catheter in an immobile state.
Hence it becomes resistible to antimicrobials, and their
eradication becomes impossible without removal of the catheter.
3rd study

4. P., J. (2013). Urinary incontinence and the importance of
catheter fixation. Journal of Community Nursing, 27(5), 24-29.
Retrieved from
http://www.southernhealth.nhs.uk/_resources/assets/inline/full/0
/70589.pdf
I chose this study because the article qualitatively highlights the
process for insertion of the urinary catheter. The guidelines
recommend that a trained and a competent doctor should carry
the process of IDC insertion in urinary catheterization. It is also
imperative that the specialist should conduct the following
Aseptic technique procedures depending on gender patients. For
female patients, a doctor would have to perform hand hygiene,
place a patient in a supine pose with hips flexed and knees bent.
In case of soiling evidence, a clinician should clean the genital
area with water and soap before conducting the primary
procedure. Hand hygiene is necessary at this point after which
the Doctor would open the dressing pack in an aseptic field and
prepare the needed equipment using aseptic technique. To avoid
contamination saline is sterilized and poured onto a tray and
hand wash is done under aseptic environment, a doctor should
also wear sterile gloves apply sterile towel and separate labia
with one hand to expose the urethral opening. Using swabs
apprehended in forceps with another hand a specialist would
clean the labial folds, and the urethral opening then moves the
swab from above urethral opening downwards towards the
rectum (J., 2013).After each urethral fondle, a doctor should
discard swab into a designated waste bag and remove the
catheter wire. Following the procedural guidelines, the doctor
would then lubricate the catheter, insert it into urethral opening
upward at about 30 degrees until urine begins to flow. The
doctor should inflate the balloon slowly in the last procedure
using sterile water and check if the patient feels any pain, if not
then they would deflate the balloon and insert the catheter
further and ensure that urine is flowing before inflating the
balloon again (J., 2013).
4th Study

5. Lee, N. G., Marchalik, D., Lipsky, A., Rushton, H. G.,
Pohl, H. G., & Song, X. (2016). Risk factors for catheter-
associated urinary tract infections in a pediatric institution. The
Journal of Urology, 195(4), 1306-1311.
doi:10.1016/j.juro.2015.03.121
I chose this study because the article qualitatively describes the
effects of using the catheter on patients with urinary
complications. Half of the patients placed in catheterization for
more than seven days have a high chance of contracting
bacteriuria. Health care workers perform an intervention on the
urinary system either to empty the bladder, facilitate the
installation of a solution or medication or to dilate a urethral
stricture through the insertion of the catheter. When performing
clinical care, the inclusion of the catheter on the patients may
lead to catheter-associated urinary tract infection (CAUTI)
depending on the host susceptibility, quality of catheter care
duration, method of catheterization. If the catheter specialist
fails to follow guidelines and leave the catheters for a longer
period, then the infections may arise and traumatized the
urinary tract (Lee, et al., 2016).
5th Study
Meddings, J., Rogers, M. A., Krein, S. L., Fakih, M. G.,
Olmsted, R. N., & Saint, S. (2014). Reducing unnecessary
urinary catheter use and other strategies to prevent catheter-
associated urinary tract infection: an integrative review. BMJ
Quality & Safety, 23(4), 277-289. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3960353/
I chose this study because the guideline gives qualitative
highlights of some of the proper measures that a doctor should
undertake while performing a catheterization. When conducting
insertion of the urinary catheter, a trained doctor should take
special precautions since rapid drainage of urine from the
bladder may cause hemorrhage. A clamp should also be released
after every 20 minutes to allow more drainage of urine. A
clinician is required to use electrolyte after post-obstructive
diuresis IV replacement under the discussion of treating medical

6. team. Based on an ongoing nursing management a doctor should
measure and access urine output after every 1-4 hour, in case of
any variation in the usual amount of urine which is usually 1-
2ml/kg/hr., then a doctor should report the matter to the medical
team (Meddings, et al., 2014).The doctor should adhere to
sterilization throughout the process, and avoid any breaches to
the closed system; this reduces the risk of catheter-associated
infections. The Guidelines on nursing management recommends
that a doctor should position drainage bag to prevent backflow
of urine and change the catheter tube to prevent obstructions of
the disconnected system, contamination, and infections. For
proper hygiene, carers should maintain routine cleanliness by
ensuring they shower patients and clean the IDC insertion site
with warm water and soap. Moreover, the doctor should
consider removing the IDC when it is no longer in need to
lessen the risk of urinary tract infection (UTI).
Proposed Evidence-Based Practice Change
Conway, L. J., & Larson, E. L. (2012). Guidelines to prevent
catheter-associated urinary tract infection: 1980 to 2010. Heart
& Lung: The Journal of Acute and Critical Care, 41(3), 271-
283. doi:10.1016/j.hrtlng.2011.08.001
I chose this study because the Clinicians in this article used
Qualitative analysis of to examine patients in ICU who are
under the care of catherization. Additionally, this study
supports the premise of the paper by providing a solution to the
problem in the PICOT question. The specialist catheterizes only
those in need of catheterization to avoid damages on the urinary
tract system. Also, performers carried the process of
catheterization using aseptic techniques, and they ensured that
sterilization of the equipment was strictly adhered to; also they
used closed and sterile drainage system throughout the
treatment session. The doctors examine the patients under the
care of indwelling catheter at an interval of 4 weeks and ten
weeks. Results revealed that some pediatric patients who were
under the care of indwelling catheters for more than six weeks
were beginning to develop the catheter-associated urinary

7. infection while those placed in catherization for less than four
weeks were still healthier. This is an indication that timing of
catheter change should be a priority throughout the process,
nurses should treat each differently because other patients have
a greater risk of developing Catheter-related diseases. To
minimize the risk of urinary infections and other related
infections doctors should change the indwelling catheters after
two weeks or three weeks depending on different individuals.
The guidelines on this article recommend all persons to be
responsible during the insertion of the catheters and that
clinicians should have to go through a thorough training, the
nurses in this study documented the analysis of catherization as
per the guidelines (Conway & Larson, 2011).Above all the
doctors provided a feedback information regarding the clinical
measures to administrators.
Conclusion
National quality and regulatory initiatives are aligned
together with the guidelines for preventing CAUTI. Prioritizing
the cleanliness and maintaining an aseptic environment is a key
factor that clinicians should worry. Also the clinicians should
ensure that closed urinary drainage system is maintained to
meet a regulatory and a quality requirement in the hospital.
References
Conway, L. J., & Larson, E. L. (2012). Guidelines to prevent
catheter-associated urinary tract infection: 1980 to 2010. Heart
& Lung: The Journal of Acute and Critical Care, 41(3), 271-
283. doi:10.1016/j.hrtlng.2011.08.001
Feneley, R. C., Hopley, I. B., & Wells, P. N. (2015). Urinary
catheters: history, current status, adverse events and research
agenda. Journal of Medical Engineering & Technology, 39(8),
459-470. doi:10.3109/03091902.2015.1085600
Flores-Mireles, A. L., Walker, J. N., Caparon, M., &
Hultgren, S. J. (2015). Urinary tract infections: epidemiology,
mechanisms of infection and treatment options. Nature Reviews
Microbiology, 13(5), 269-284. doi:10.1038/nrmicro3432

8. Lee, N. G., Marchalik, D., Lipsky, A., Rushton, H. G.,
Pohl, H. G., & Song, X. (2016). Risk factors for catheter-
associated urinary tract infections in a pediatric institution. The
Journal of Urology, 195(4), 1306-1311.
doi:10.1016/j.juro.2015.03.121
Meddings, J., Rogers, M. A., Krein, S. L., Fakih, M. G.,
Olmsted, R. N., & Saint, S. (2014). Reducing unnecessary
urinary catheter use and other strategies to prevent catheter-
associated urinary tract infection: an integrative review. BMJ
Quality & Safety, 23(4), 277-289. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3960353/
P, J. (2013). Urinary incontinence and the importance of
catheter fixation. Journal of Community Nursing, 27(5), 24-29.
Retrieved from
http://www.southernhealth.nhs.uk/_resources/assets/inline/full/0
/70589.pdf