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For guidance on the management of catheter associated urinary tract infection (CA-UTI) see the infections chapter.
Indications
Cautions
Short term
Duration: Up to 28 days
Catheter: PTFE coated latex (Bard)
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
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 should only be used if:
Formulary choice solutions:
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.
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 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)