in the preliminary stage of hemorrhagic stroke or embolic stroke, patients are prone to detrusor underactivity caused by “cerebral shock” and 21-47% patients will suffer from acute urinary retention. Therefore, intermittent catheterization or placement of catheter is required, but both methods will increase the risk of urinary tract infection (Corcos,＆Schick, 2008; Kim, Chun, Han, Yi, & Kim, 2012).Urinary tract infection will prolong stay of patients for about three days, and death rate will be increased by 3 times, and the workload of nursing personnel and medical costs will be increased (Hooton et al., 2010). Urinary tract infection is a common complication of stroke patients, mainly due to the placement of catheter. More than 70% CAUTI can be prevented through appropriate management. How to reduce the use of catheter is an extremely important subject (Galiczewski, &Shurpin, 2017; Burnett et al., 2010; Kim et al., 2012). Bladder ultrasound scanner is an effective and accurate method to monitor residual urine (saint et al., 2013; Conway, & Larson, 2012). According to Rodrigo-Gil et.al (2012), acute stroke unit may apply a portable bladder ultrasound scanner to track residual urine, so as to eliminate the needs for the placement of catheter.
Methods:
Through cross-group collaboration, neurology catheter nursing protocol and portable bladder ultrasound protocol are developed. Applicable timing is as follows: (1) when a patient does not micturate for more than 4 hours, in confirming residual urine, a bladder ultrasound scanner may be used to reduce the use of intermittent catheterization; (2) after catheter is removed, when a patient does not micturate for 4 hours since micturition or the removal of catheter, a bladder ultrasound scanner may be used for confirming residual urine. When residual urine is less than 100ml, residual urine shall be tracked once a day within 48 hours; when residual urine is 100-200ml, residual urine shall be tracked every 4 hours; when residual urine is 200-299ml, residual urine shall be tracked every 2 hours; when residual urine is >300ml, one intermittent catheterization shall be implemented.
Results:
Due to the application of portable bladder ultrasound protocol, the number of person-days of use of catheter in acute stroke ward from February 1, 2017 to December 31, 2017 is reduced from 7,647 person-days to 6,135 person-days, and the usage rate of catheter is reduced from 18.9% to 15.6%, and the catheter related urinary tract infection rate reduced from 3.8 ‰ to 1.7‰. Additional benefit is that the comfort of patients in receiving portable bladder ultrasound scanner is 9.6, while the comfort in intermittent catheterization is only 1.1.
Conclusion:
The first step in preventing urinary tract infection is to reduce the use of catheter. portable Bladder ultrasound protocol is further improved by virtue of repeated revisions and discussion through cross-group collaboration. We believe that bladder ultrasound protocol will be able to effectively reduce the urinary tract infection rate and provide patients with a better medical care quality.