Catheter Infections: A Pressing Issue for Oncology Nurses

Catheters are widely used in the healthcare world, and it’s no different in the cancer space. However, these medical devices used daily by oncology nurses can be a major source of infection in patients, according to recent research conducted at the University of Michigan School of Nursing.

The researchers claimed that devices such as catheters are the cause of a quarter of the infections in hospitals, and issues typically arise from poor communication between physician and nurses. However, the healthcare field has not improved in this area as much as providers would like, explained Milisa Manojlovich, PhD, RN, CCRN, a professor at the University of Michigan School of Nursing, and author on the study.

“What we know is that infections caused by catheters account for 25% of all healthcare-associated infections,” Manojlovich said in an interview with Oncology Nursing News. “This can be really serious, and sometimes fatal, especially for oncology patients who are often immune-compromised.”

Catheters in Cancer Care

Intravenous catheters and ports are commonly used in oncology to administer agents ranging from chemotherapy to antiemetics. Urinary catheters are also frequently used for patients who have trouble going to the bathroom.

Though most people probably don’t think twice about them, they are a key part of many patients’ cancer care.

“The challenge with oncology is that sometimes patients need both kinds of catheters. So, then it becomes a question about having a conversation regarding how long the patient actually needs them.”

Communication Barriers Lead to Infections

Leaving a catheter in for too long — or using one unnecessarily – can both lead to a large number of catheter-related infections, according to the research.

In order to determine how long a patient should have a catheter — or if it is appropriate to consider other options – care teams need to have clear lines of communication. However, this is not always the case.

Manojlovich and her team interviewed nurses, physician assistants, nurse practitioners, and physicians about issues they were having monitoring and communicating with their teams about patients’ indwelling catheters. They found that poor team communication resulted in the delay of removing catheters in patients who no longer needed them.

Aspects contributing to communication barriers included:

• Poor relationships between doctors and nurses
• Hierarchical differences/misalignments of workflows that prevented nurses from being present during daily rounds
• Catheters being hidden under blankets, so physicians may not immediately know if a patient is using one
• Provider distraction, when they are about to change a catheter or have a conversation about a catheter and then get pulled away for another task

“So, you’ve got social complexity because of these differences in hierarchy and social relationships. You’ve also got what we call cognitive complexity, and that relates to the electronical medical record (EMR), as well as things like getting interrupted,” Manojlovich said, noting that EMRs are often complex to navigate, and if a provider does not know exactly where to go, he or she may completely miss a note about a catheter.

Improvements for Safer Catheter Use

Looking ahead, Manojlovich is hopeful that this issue improves. For that to happen, it is crucial that nurses understand the risks that are associated with catheters. For example, the more ports a vascular catheter has, the more likely it is to have complications.

Additionally, healthcare providers should only use catheters when absolutely necessary, and take them out as soon as possible.

“For both types of catheters, the risk increases with every day the catheter is in use,” Manojlovich said, though she understands how convenient catheter use can be, especially for busy oncology nurses who are treating multiple patients a day. “Make sure that if you are using catheters, that you really do need it. It’s not just for your convenience or, in some cases, patient and family convenience.”

Nurses should consider other options, such as condom catheters for men, or other external catheters for urine, or administering drugs orally instead of intravenously.

“I think the bottom line is that we should try to reduce the use of these catheters, even though they’re so convenient,” Manojlovich said. “I know myself. I’ve been a nurse for 30 years, and believe me, nothing is harder than having to admit that it’s time for that catheter to come out. But I know that if I leave it in, that the risk for my patients is just too high.”