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Johns Hopkins DNP student seeks best practices for use of catheters in children

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Children in the pediatric ICU sometimes can’t tell nurses how their bodies are reacting to treatment or medications, either because they cannot speak, are in and out of consciousness or are afraid.

Instead, nurses rely on clear, accurate measurements, with urine output as one key to understanding what’s going on inside the patient’s body. This often has meant using a urinary catheter.

Maybe too often, Judy Ascenzi, RN, MSN, a DNP student at the Johns Hopkins University School of Nursing in Baltimore, said in a news release.

Ascenzi is part of a team of Johns Hopkins nurse and physician leaders looking at best practices for when a catheter is the right call for a seriously ill child, how long one can or should be used and how to prevent it from leading to a potentially deadly urinary tract infection. Ascenzi said in the release she became fascinated with the catheter-infection link during her work studying intubation and bloodstream-infection links in critically ill children. In the pediatric ICU, she said in the release, she was surprised to see that “there were so many kids with urinary catheters.”

The team, which includes the School of Nursing DNP Director Mary Terhaar, RN, DNSc, CNS; faculty member JoAnne Silbert-Flagg, CPNP, DNP; and Marlene Miller, MD, MSc, of Johns Hopkins Children’s Center, determined the answer was to bundle accepted best practices, such as hand-washing and extra-careful handling of catheters, lines and specimen bags, according to the release.

“The care a nurse provides in the ICU is complex,” Ascenzi said in the release. “We’re multitasking. It is easy to forget the simple things because we become so focused on the high-tech things.”

One simple thing, she said in the release, is considering diapers instead of catheterization.

“We’re asking nurses to be a little creative — working to get people to realize that there are other avenues to measure urine output that do not rely on a catheter,” Ascenzi said in the release.

For instance, there is a scale that measures the weight of a dry diaper versus one that is wet, down to the cubic centimeter. It can be as accurate a gauge as a catheter bag, she said in the release.

“Diapering is routine in less sick patients,” Ascenzi said in the release, “but getting people to accept that it is OK in really sick kids has been the challenge.”

So far, the team’s efforts show promise.

“I haven’t gotten all of the data analyzed yet, but I can tell you anecdotally that we’ve had improvement,” she said in the release. “And we are seeing buy-in.”

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