Audit on method of male urethral catheterization and its management in a tertiary care centre, of south india

Author: 
Vivek Harihar., Ratkal chandrashekar., Mohan Kumar and Girish.H

Aim and Objective; To evaluate the standard and safe catheterization method among the both male and female nurses , house surgeons and residents of R.L.J.Hospital.
Materials and Methods; Both male and female nurses , house surgeons and residents of  R.L.J.Hospital  are made to record their technique of male catheterization, in a standard proforma prepared for this study , which will be then compared with the standard and safe catheterization technique and results obtained will be analysed in terms of percentage.
Results ; Study includes a total number of 250 participants out of  which 100 participants were  house surgeons (HS), 100 participants were trained nurses (N) and 50 were Post graduate residents (PG).
Out of 250 participants, 227 participants has the practice of using sterile gloves. 57,78 and 12 participants does not know to choose appropriate catheter type and size for a given particular case  in HS, N and PG group respectively. 28,51 and  9 participants from HS, N and PG group respectively does not know the standard and safe method of catheterization. 42,67 and 26 participants from HS, N and PG group respectively does not know post catheterization management like securing the catheter, catheter care, how often to change catheter in a chronic bed ridden patients and also unaware about the complications of catheterization.
Discussion;
Authors suggest following panacea to raise the standard of male urethral catheterization.

  1. Nurses: In the study 75% of the nurses were unable to choose the appropriate size for a given particular patient for which they have to be educated regarding various urethral catheters with their sizes. 37% of nurses are unaware of the urethral catheterisation but it is the nurses who undertake the majority of catheterisations in primary care and hence they should be educated about the indications and as well as the contra-indications of the procedure.
  2. House-surgeons:Though House-surgeons will be the first line of contact to the patients in most of medical college hospitals and tertiary care centres, they should be thought to handle difficult catheterisation procedure like in case of prostatomegaly and pelvic injuries to choose the appropriate size and type of catheter for a given particular patients. Since majority of House-surgeons (88%) were aware about the anatomy of the male urethra in our study the more emphasis should be given to the practical aspects.
  3. Post-graduate residents: A clinical post graduate should always be aware of the indications, contraindication and complication associated with the catheterisation. In case of catheterisation failure or acute urinary retention secondary to stricture, BXO and etc, post graduates should be able to perform supra pubic cystostomy. It must be recommended that surgical post graduates should have a compulsory urology posting during their Master degree course.

Conclusion ; This study is particularly notable as it emphasizes on safe and standard method of male catheterization among health care assistants, which is most common procedure to be performed in day to day medical practice.

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