Indwelling urinary catheters

For guidance on the management of catheter associated urinary tract infection (CA-UTI) see the infections chapter.

Indications and cautions

Indications

  • Acute / chronic urinary retention
  • Severe incontinence where treatment or other management methods have failed

Cautions

  • Confused patients who may pull catheter out
  • Frail patients where their general well-being would be compromised by catheter related infection
  • A clear care plan should be developed at the onset and all catheter information should be documented (Core Care Plans are available from Debbie Yarde, Senior Specialist Nurse)

Catheter choice

Short term

Duration: Up to 28 days

Catheter: PTFE coated latex (Bard or Rusch)

Size: 12-14 Ch-women,12-16 Ch-men (balloon size should always be 10mL)

Length: All catheters come in 2 lengths: 'Female' for women, 'Standard' for men

Long term

Duration: Up to 12 weeks

Catheter: Hydrogel-coated latex (Bard or Rusch)

Size: 12-14 Ch-women, 12-16 Ch-men (balloon size should always be 10mL)

Length: 'Female' and 'Standard' as above

Long term

Duration: Up to 12 weeks

Catheter: Silicone (Bard or Rusch)

Size: 12-14 Ch-women, 12-16 Ch-men (balloon size should always be 10mL)

Length: 'Female' and 'Standard' as above

Notes

  1. For patients with latex allergy where there is no alternative to catheterisation, 100% silicone catheter should be used.
  2. Silicone catheters do have a very slightly larger lumen, so may aid drainage when there are encrustation problems. However, silicone catheters are stiffer and thus less comfortable than the hydro-gel coated catheter. Silicone catheters are not suitable for supra pubic catheterisation because they can cause problems on changing due to the balloon being surrounded by a cuff on deflation but should always be used if the patient has a latex allergy.
  3. A 10mL balloon should always be used. Additional water should never be added, nor should the balloon be partially deflated.

Blocked catheters

Assessment should take place for obvious causes such as constipation and mechanical causes e.g. kinked tubing or poorly positioned bag. If unresolved catheter maintenance solutions can be used on an individual patient basis. There is no evidence based research to show the optimum duration of treatment with catheter maintenance solutions. However expert opinion is that the smallest number of solutions should be used to maintain patency of the catheter for a reasonable length of time.

If a patient is still blocking change the catheter more frequently, blocking 6 weekly change 4 weekly, blocking weekly change every 5 days. If a patient has a suprapubic catheter you can increase the size gradually up as far as 22 CH.

Administration should be constantly evaluated. For further advice please contact the Bladder and Bowel Care Service (North Devon: 01769 575182, East Devon 01392 208465)

Catheter Maintenance Solutions

Catheter maintenance solutions should only be used if:

  • Catheters are blocking more than once a month
  • Where sediment is visibly present in catheter tubing
  • Increased fluid intake has proved ineffective
  • Where frequent catheter changes are painful/traumatic to patient
  • Constipation if present has been resolved with no benefit to catheter problem

Formulary choice solutions:

  • Uro-Tainer® Twin Suby G
  • Optiflo® G

Directions for use:

Use no more than three times a week and leave a break of a day. Work out individual regime using 20-30mL of solution depending on severity of case.

The mucosa of the bladder acts as a defence against urinary tract infection. Saline and chlorhexidine may reduce the bladder's natural resistance to infection through an increased shedding of urothelial cells.

Anticholinergics

Blockage or by-passing may be caused by bladder spasm. If this is thought to be the case an anticholinergic should be considered (see section 7.4 Drugs for genito-urinary disorders).

Asymptomatic bacteriuria

Patients with indwelling urinary catheters invariably have abnormalities on dipstick testing including nitrate, leucocyte esterase, blood and protein. Bacteria are present in most patients.

Asymptomatic catheterised patients with cloudy or crystalline urine, debris in urine, discomfort or bypassing of the catheter do not require treatment for infection.

Investigation for the presence of infection is inappropriate unless the patient has clear symptoms of systemic infection such as fever, new onset of confusion etc.

When a sample for culture is indicated, need to include specimen collection details.

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.

(advice based on Effective Practice Committee recommendation January 2007)

 

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