Short term (up to 7 days)

• Short rigid plastic/PVC

Medium term (up to 28 days)

• Teflon (P.T.F.E) - coated latex

Long term (up to 12 weeks)

• Hydrogel - coated latex
• All Silicone

Teflon-coated catheters are still available for medium-term use for up to 28 days.

Hydrogel coated catheters have been produced to help minimise catheter complications. The soft slippery surface helps reduce trauma on insertion and removal.

Hydrogel-coated catheters may be associated with fewer episodes of urinary bypassing and to be retained in situ longer than Silicone Elastomer coated catheters. Hydrogel-coated catheters are also available pre-filled which ensures that the correct quantity of sterile water is used for inflating the balloon.

For patients with a latex allergy an all silicone or a Hydrogel-coated silicone catheter should be used. This is indicated for suprapubic and urethral use.

All silicone catheters could be an option for continual blockage due to a larger lumen. However the catheter is less pliable.

Silicone also allows the slow diffusion of water from the balloon. This should be remembered when deflating the balloon and may account for 10% of silicone catheters falling out. The balloon may also "cuff" when deflated which can be a problem when inserted supra-pubically. Assuming the catheter is licensed for supra pubic use this should not deter from its use especially when a patient may be allergic to latex.

Silver Coated Catheters

Silver alloy coated catheters such as Bardex IC are claimed to reduce the risk of catheter associated urinary tract infection. There are no randomised controlled trials conducted in primary care settings on which to base this nor are there any trials conducted in patients using catheters on a long-term basis.

Evidence to support use in short-term catheterised patients in hospitals is conflicting. Most of the randomised controlled studies assessing this are of low methodological quality whilst a higher quality study found no significant benefit over standard catheters.

There is insufficient evidence to recommend the routine use of silver coated catheters over standard catheters whilst they remain more expensive.

The key principle here is to use the smallest size of catheter which allows good drainage. Catheters can be prescribed with pre-filled balloons to ensure the correct amount of water is in the balloon. Large catheters and balloons are believed to increase bladder irritability causing spasms and leakage of urine.

Small balloons are recommended for all patients, 10ml balloons for adults and 3-5ml balloons for children. Larger balloon sizes of 30ml for long-term catheterisation must never be used.

Recommended Sizes of Catheter

For urethral use:

• Female length - 12-14ch.
• Standard (male) length - 12-16ch.
• Standard length catheters must always be used for males (National Agency for Patient Safety 2009)
• Female length should be used for females unless the positioning of the catheter bag for easy emptying needs the standard length, i.e when the patient is bedbound or very obese

Supra pubic catheters are always a standard length and should be sized according to the tract, usually 16ch or 18ch for both sexes.

This is initially a surgical procedure whereby an artificial tract is made into the bladder via an abdominal incision. This procedure is carried out in hospital. It is usually done under a general anaesthetic and does carry a significant risk of complications including bowel perforation.

First change of a supra pubic catheter must not take place before 6-8 weeks after insertion and should be done at RD&E or NDDH. If blocked prior to this, the patient must be referred back to the Urology department or as per local policy. It is advised that subsequent changes of the catheter are made at 8-12 weeks according to the patency of the individual patient's catheter.

The use of a lubricant gel is left to the discretion of the individual nurse and the individual assessment of the patient.

The size of the catheter inserted during the initial procedure must be maintained during future catheter changes. This is because the artificially made tract provides a 'snug' fit for the catheter.

The care of the supra pubic catheter after this remains the same as for a urethral catheter.

Over granulation of the site can be treated as per the local tissue viability policy for over granulation. Alternating the side to which the catheter is attached will also reduce over granulation.