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Factors associated with the successful removal of indwelling urinary catheters post-operatively in the fragility hip fracture patient

机译:脆性髋部骨折患者术后成功拔除导尿管的相关因素

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摘要

Introduction Patients presenting to hospital with a fragility hip fracture are routinely catheterized in the emergency department. Studies have found that the duration of catheterization is the greatest and most important risk factor for developing a urinary tract infection. Whilst there is a considerable body of evidence around correct techniques for insertion of urinary catheters, there appears to be little evidence as to the timing of their removal. Aim of the study To describe the current practice of indwelling catheter (IDC) removal post operatively in the fragility hip fracture patient and to identify factors associated with the successful removal of IDCs post operatively in the same cohort of patients. Methods This study was a retrospective cohort analysis of patients admitted to a large, tertiary hospital with an established ortho-geriatric model of care. Results Aperient regime was the only factor that appeared to have a significant impact on the successful IDC removal. The patient commenced on the aperient regime was three times more likely to have an unsuccessful IDC removal than the patient on a limited or no aperient regime. Conclusion This study highlights the need for redesigning care that is patient focused, evidence-based, effective and efficient. The argument that a patientu27s bowel is required to be emptied prior to the successful removal of an IDC appears to be false, as in this study it was not identified as a predictor of successful IDC removal. A prospective clinical trial may be the next step forward in developing a clinical guideline for the successful removal of IDCs in the fragility hip fracture patient and/or surgical patient. Nurses have a crucial role to play in contributing to evidence-based practice and are continually challenged to do so.
机译:引言急诊科就诊的患者通常是因脆性髋部骨折而就诊的医院。研究发现,导管插入的持续时间是发生尿路感染的最大,最重要的危险因素。尽管有大量证据表明有正确的导尿管插入技术,但关于拔除时机的证据似乎很少。研究的目的描述脆弱性髋部骨折患者术后留置导管(IDC)的当前做法,并确定与同一组患者术后成功去除IDC有关的因素。方法这项研究是一项回顾性队列分析,分析了一家大型三级医院的患者,这些患者均已建立了正老年医学护理模式。结果开通状态是唯一对成功删除IDC产生重大影响的因素。刚开始接受开放性治疗的患者发生IDC清除失败的可能性是有限或没有接受开放性治疗的患者的三倍。结论本研究强调需要重新设计以患者为中心,循证,有效和高效的护理。关于成功清除IDC前需要排空患者肠道的说法似乎是错误的,因为在本研究中,并未将其识别为成功清除IDC的预测因素。前瞻性临床试验可能是制定临床指南的下一步,该指南将为成功切除脆弱性髋部骨折患者和/或手术患者中的IDC提供参考。护士在促进循证实践中起着至关重要的作用,并且在这样做方面不断受到挑战。

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