Catheter management, problem solving

There are three main categories of complications, which can arise during long-term catheterisation.

  1. Tissue damage and inflammation
  2. Urinary tract infection
  3. Catheter encrustation leading to blockage

Tissue damage

The catheter is a foreign body and therefore initiates an inflammatory response that can range in severity. This can be minimised by careful selection of catheter material and catheterisation technique. The bladder mucosa can easily be sucked into the catheter eyelets (hydrostatic suction). This can be minimised by placing the drainage bag no lower than 30cm below the bladder.

Failure to effectively support the catheter drainage bag can result in traction causing pressure ulceration and erosion of the urethral meatus. Adequate support must be used and whenever possible the bag should be attached to each leg alternately.

Urinary tract infection

  • During catheterisation (extraluminal)
  • Following migration within the catheter lumen from the collection bag (intraluminal)
  • Via the mucus film adherent to the external catheter surface (extraluminal late)

Reducing the Risk of Infection

  • Use closed drainage system
  • Normal daily hygiene to meatal area. The area should be dried well. Alternatively a daily bath or shower would be sufficient
  • Care staff should wash hands and wear clean, non-sterile gloves before emptying or changing catheter leg bags. Hands should be decontaminated after removing gloves
  • A mixed fluid intake of at least 2 litres or 3 pints a day

Complications and problem solving

An individualised plan for catheter management must be made.

For patients with catheters in place consider the following:

If urine does not drain or is draining slowly

  • Check that the catheter or tubing is not kinked and that the cap has been removed
  • Check leg straps are secure around the back of the leg bag
  • Check that the drainage bag is below the level of the bladder
  • Check that there is no tension on the catheter
  • Check that the urine bag is not over full
  • Check to make sure that the patient is not constipated
  • Check urine for infection and treat if appropriate
  • If catheter is still not draining, change it and inspect the removed one for encrustation

If there is bypassing of urine

  • Check as above
  • Explore the possibility of bladder irritation. Signs of this would be bypassing of clear urine preceded by an urge to void. If this is the case consider:
    • Increasing fluid intake to dilute urine.
    • Checking for infection
  • Poor support
  • Replacing the catheter with a smaller size
  • Discussing the possibility of anticholinergic medication with General Practitioner

Encrustration

  • If a catheter is blocked by debris, testing the urine is advised to monitor the alkalinity or acidity
  • Use acid catheter maintenance solution (bladder washout)
  • If severe, check for bladder calculi

Haematuria

  • Any haematuria must be reported to a doctor
  • Small amounts of blood may be caused by trauma or infection
  • Look at preventative measures
  • If severe, establish cause e.g. trauma or possible infection. If symptoms suggest a urinary tract infection, treatment is required as urinary tract infections can lead to septicaemia. Urgent medical help may be required in the case of haematuria, and treatment initiated

The inflation balloon does not deflate when the catheter is being changed

  • Try a different syringe, leave in place for a while
  • Check for constipation and, if present, relieve
  • "Milk" the catheter along its length
  • Seek further advice, hospital attendance by the patient may be required
  • Try inflating up to an extra 1mL of sterile water into balloon
  • Never attempt to burst the balloon and never cut the end of the catheter

 

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