Factors Of Urinary Leakage And Catheterization In Critically Ill Elderly Female Patients With Indwelling Catheterization

Objective:1.Investigate the influencing factors of urinary leakage in critically ill elderly women undergoing indwelling catheterization.2.Construct a structural equation model mediated by urinary leakage in patients with indwelling catheterization in severely ill elderly women.3.Use ultrasound to evaluate the change of balloon volume in the urinary catheter of indwelling catheters in severely ill elderly women at different times.Methods1.A retrospective analysis method was used to collect and investigate the data collection and investigation of critically ill elderly women who were hospitalized in the intensive care unit of a tertiary hospital in Yangzhou City,Jiangsu Province from January 2021 to December 2021.Collect the patient’s medical records(including the patie nt’s course of illness,medical orders,etc.),nursing records,laboratory tests and other relevant information.The input data was described by Excel,SPSS26.0 was used for statistical analysis,the counting data were described by frequency and percentage,the normality test was performed on the measurement data,and the mean and standard deviation were used to describe the normal distribution,and vice versa,the median and quartile spacing were used,and univariate regression was used to analyze the influence of each factor on the patient’s urinary leakage;the meaningful factors were then multivariate analysis to determine the independent influencing factors.2.The convenience sampling method was used to collect data from patients who met the inclusion and exclusion criteria with patients with indwelling catheterization in severely ill elderly women hospitalized in ICU,NICU and EICU in a tertiary hospital in Yangzhou City,Jiangsu Province from February 2022 to October 2022.In additi on to the results of the first component,the use of ultrasound assessment of intensive care was added to data not collected by retrospective analysis:urethal balloon size;and the addition of RASS as a sedative factor to meet the AMOS model conditions.SPSS26.0 and AMOS 24.0 were used for statistical analysis to analyze the correlation between global factors,technical factors,sedative factors,disease factors,urinary leakage,and urinary catheter-associated urinary tract infection(CAUTI).AMOS 24.0 was used to construct a structural equation model with urine leakage as the mediating effect,the maximum likelihood method was used for parameter estimation,the model structure was adjusted according to the modification index,model results and professional knowledge,and the confidence interval(CI)of the Bootstrap Bias-corrected Method modified 5000 times was used to test the mediation effect.3 Based on the second part of the data,SPSS 26.0 was used for statistical analysis,the metric data corresponding to the normal distribution were expressed as mean and standard deviation,and one-way ANOVA was used for the between-group comparison to analyze the changes of the balloon at different times and determine the best observation time.Results1.The results of retrospective cross-sectional surveys showed that the incidence of urinary leakage in 230 severely ill elderly women with indwelling catheterization was 39.13%.Univariate analysis showed that urinary leakage in patients with indwelling catheterization in severely ill elderly women had a statistically significant difference in menopausal years,BMI,disease type,urinary catheter model,sedation time,white blood cells,red blood,cellsbacteria,and epithelial cells(P<0.05).Among them,trauma was used as a comparison condition in disease types,and the effects of cardiov ascular and cerebrovascular diseases,infectious diseases,digestive diseases and urinary system diseases on urine leakage were statistically different(P<0.05),and the effects of urinary catheter No.18 catheters No.14 and No.16 on urine leakage were statistically significant(P<0.05).2.The modified model fitting results are good:χ~2=56.240,df=51,NC value=1.103,GFI=0.961,AGFI=0.940,RMSEA=0.022,NFI=0.937,RFI=0.919,IFI-0.994,TLI=0.992，CFI=0.994.Technical factors had a negative effect(total effect-0.341);disease factors had the highest positive effect on urinary duct leakage paths(total effect 0.246);followed by overall factors(total effect 0.177);sedative factors had the least effect(total effect 0.1700);catheter leakage had a positive effect on CAUTI(effect size 0.276).Next,the Bia-Corrected Bootstrap method was used to test the significance of the mediation effect,and 5000 sampling times were performed,and the results s howed that 95%CI of the path did not contain 0,indicating that the mediation effect was significantly effective.3.Studies of changes in balloon size have found that balloons gradually decrease with increasing time,and balloon changes are significant on days 5 and 7,so the best observation time should be used on days 4 and 6 for patients with short-term indwe lling urinary catheters,and should be monitored on a 7-day cycle for patients with long-term indwelling.Conclusion1.The incidence of urinary leakage in patients with indwelling catheterization in severely ill elderly women is high,and menopausal years,BMI,sedation time,disease type,urinary catheter model,white blood cells,red blood cells,bacteria and epithelial cells are the influencing factors of urine leakage in patients with indwelling cathe terization in severely ill elderly women.Nursing staff should pay more attention to the patient’s urinary leakage and prevent it as early as possible to reduce the incidence of urine leakage.2.In the face of CAUTI,technical factors can lead to the occurrence of CAUTI through urine leakage,disease factors can positively affect CAUTI with the strongest effect through urine leakage,and sedative factors can affect the occurrence of CAUTI with positive effect through urine leakage.In order to avoid and reduce the occurrence of urine leakage and CAUTI,medical staff should select a suitable urinary catheter model,observe the change of balloon size in time,pay more attention to patients with cardiovascular and cerebrovascular diseases,infected patients,digestive tractdiseases and urinary system diseases,and strictly control and reduce the sedation time,so as to reduce the occurrence of complications related to indwelling urinary catheters.3.The use of intensive care ultrasound as an auxiliary observation tool can make up for the shortcomings of balloon size assessment tools,and balloon size gradually shrinks with time,so regular evaluation and catheter replacement is an important means to prevent urinary leakage and other complications of indwelling catheters,for patients with short-term indwelling catheters,day4 and day6 should be the best and most important observation time,for patients with long-term indwelling catheters should be monitored in a 7-day cycle to prevent related complications.