Meet the Expert - Diane K. Newman

Diane Kaschak Newman, DNP, FAAN, BCB-PMD
Co-Director, Penn Center for Continence and Pelvic Health Director, Clinical Trials
Division of Urology, University of Pennsylvania Medical Center

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A gray area: the time frame for changing out urinary catheters

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I have been in discussions with CAUTI Challenge users
Another area of gray for me surrounds removal of a urinary catheter / re-insertion of a new catheter before a urine culture is obtained. As you know, APIC guidelines state cultures from "recently inserted" catheters yield reliable results...suggest changing out urinary catheters, but does not give guidance as to a time frame. You mention in your pp that catheters should be changed if in longer than 10 days. Univ of CO Denver requires a urinary catheter be changed before culture if it has been in > 72 hrs.

I appreciate your guidance and expertise in helping me develop an accurate Computer Based Training (CBT) module for Memorial Health System's staff.
I am glad you have found the information on the CAUTI center on UroToday helpful.  It gets lots of traffic and many inquiries, similar to yours.

There is no information or evidence-based recommendations on when a catheter should be removed/changed in a hospital patient.  If a urinary tract infection is suspected and a urine C&S is to be obtained, it is strongly suggested that a new catheter and collection system be placed and the urine C&S obtained from the new system.  But the evidence on this is very little.  Look at this one reference:

Raz, R. (2000). Chronic indwelling catheter replacement before antimicrobial therapy for symptomatic urinary tract infection, Urol. 164:1254-58.

If it’s not possible or may cause the patient harm or burden to change the system then it is recommended that staff obtain the urine sample from the established system by clamping tubing distal to the collection port for short time to allow urine to accumulate, disinfect port with alcohol or chloroprep and allow to dry and use sampling port to draw samples.

As most experts believe that the course of treatment will be improved if the catheter and collection system is changed prior to or along with starting antibiotics, we will always change the system before starting antibiotics on a pt who has a CAUTI.

I hope this is helpful.

Diane

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Diane K. Newman, DNP, FAAN, BCB-PMD, is Research Investigator Senior at the Perelman School of Medicine, University of Pennsylvania. She is Co-Director of the Penn Center for Continence and Pelvic Health, Division of Urology, University of Pennsylvania Medical Center, in Philadelphia. 
Dr. Newman received a Doctor of Nursing Practice program from Thomas Jefferson University, a Bachelor of Science degree in nursing from LaSalle University, and a Master of Science degree in nursing from the University of Pennsylvania, all in Philadelphia. She is certified as an adult nurse practitioner by the American Nurses Credentialing Center and is a Fellow of the American Academy of Nursing.
Dr. Newman is the Principal Investigator, University of Pennsylvania, Translating Unique Learning for Incontinence Prevention: The TULIP Project, R01NR012011, National Institute of Nursing Research, National Institutes of Health. Dr. Newman has served as co-principal investigator on research studies on the treatment and management of urinary incontinence, overactive bladder, interstitial cystitis, prostate cancer and erectile dysfunction. She was a member of the planning committee of the State-of-the-Science Conference on Prevention of Fecal and Urinary Incontinence in Adults, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Office of Medical Applications of Research (OMAR) of the National Institutes of Health (NIH) and presented at the December 2007 meeting. She was the Chairperson of the 2nd, 3rd, 4th and 5th Committee on Continence Promotion, Education & Primary Prevention for the International Consultation on Incontinence. She was the Chair of the International Continence Society (ICS) Continence Promotion Committee (2003-2009).
Dr. Newman was a member of the panel of experts of the Center for Medicare and Medicaid Service’s Scope and Severity of Nursing Care Deficiencies in long term care on “Guidance to Surveyors on Incontinence and Catheters-Tag F315.” She was the Co-chair of the 1996 Agency for Healthcare Research and Quality Clinical Practice Guideline on Urinary Incontinence: Acute and Chronic Management. She served as a member of the Gastroenterology and Urology Devices Panel of the FDA. In 2002, the National Association for Continence (NAFC) presented her with the Continence Care Champion Award.
Dr. Newman is an internationally known speaker on the topic of urinary incontinence and the use of devices and products for the management of incontinence. She has been invited to speak in Hong Kong, Dubai, Singapore, Manila, Sapporo, Yokohama, Florence, Monaco, Edinburgh, Monte Carlo, Halifax, Montreal and Bournemouth.
She holds editorial positions on several journals, including the International Urogynecology Journal, Neurourology and Urodynamics and Ostomy/Wound Management. A prolific writer, Dr. Newman has written and presented more than 100 scientific papers, chapters, and articles on the assessment, treatment, and management of incontinence with an emphasis on the nurse’s role. She is the author of the books The Urinary Incontinence Sourcebook and Managing and Treating Urinary Incontinence. She is the recipient of the American Journal of Nursing 2002 Gerontologic Nursing Book Award for the 1st Edition of Managing and Treating Urinary Incontinence. She is the co-author with Dr. Alan Wein of Overcoming Overactive Bladder, the 2nd edition of Managing and Treating Urinary Incontinence and co-author of Fast Facts: Bladder Disorders.
She has extensive experience in informing consumers about pelvic floor disorders and with continence promotion. Her “Incontinence Center” (www.seekwellness.com) is a resource website for the lay public. Her AJN article on “Stress Urinary Incontinence in Women” was cited by the New York Times Personal Health Column, September 2003. She was interviewed in the August 2007 issue of Oprah Winfrey’s O magazine and the January 2009 issue ofLadies Home Journal. Dr. Newman’s clinical practice was featured in the June 5, 2008 issue of USA Today. She was been appointed to WebMD’s Moderated Health Exchange on Incontinence and OAB(http://exchanges.webmd.com/incontinence-and-oab-exchange).
New Initiatives UroToday is pleased to announce a new initiative with Diane K. Newman to create content for the readers of UroToday with a focus on the urinary incontinent (UI), overactive bladder (OAB) and painful bladder syndrome (PBS) patients.
World Continence Week The Continence Promotion Committee (CPC) was formed following a workshop at International Continence Society (ICS) meeting in Rome in 1995, where it was agreed that the ICS should act as a facilitator for various international continence organisations to meet and address relevant issues to do with continence promotion, awareness and prevention. The principle aims were:
To look at opportunities for networking across various countries;
To increase awareness amongst ICS members of continence related issues;
To facilitate development of continence organisations
To facilitate interchange of information about continence awareness and promotion;
To identify opportunities for continence prevention strategies.
The CPC became an official committee of the new Board of the ICS in 1998, and has the important role of providing input into the important areas of continence awareness, promotion and prevention.
Annual workshops have been held each year at the ICS meetings.
Diane Newman authored: 
Managing and Treating Urinary Incontinence, Second Edition (Coming soon!)
The Urinary Incontinence Sourcebook
Managing and Treating Urinary Incontinence
Diane Newman co-authored with Alan Wein, MD:
Overcoming Overactive Bladder
Awards Received American Journal of Nursing 2002 Gerontologic Nursing Book Award for Managing and Treating Urinary Incontinence

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