Urology Care Today

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FOCUS ON INDWELLING CATHETERISATION i
28 UROLOGY AND CONTINENCE CARE TODAY 2018,Vol 1, No 1
Clinical indications for the use
of indwelling urinary catheters
have been identified by the
Royal College of Nursing (RCN, 2012)
and also the European Association of
Urology Nurses (EAUN) (Geng et al,
2012) (Table 1). There are significant
risks associated with the introduction
of a foreign body into the bladder
(Table 2 ), not least infection, with
statistics demonstrating that the
longer a urinary catheter is in place,
the more likely an infection is to
develop (Loveday et al, 2014). It is
widely acknowledged, therefore, that
indwelling urinary catheters should
only be used as a last resort and
when all other options have been
considered, tried and failed (National
Institute for Health and Care
Excellence [NICE], 2014; Davey, 2015;
Yates, 2016; Simpson, 2017).
An indwelling urinary catheter can
be inserted through the urethra or
via the suprapubic (abdominal) route
using a self-retaining balloon catheter,
which can be used over a short-term
(less than 28 days) or long-term (up to
12 weeks) period (RCN, 2012).
Best practice in the use of
indwelling catheterisation
Latex catheters
Latex catheters are the most common
type of catheter available. They are
made from natural rubber and have
been traditionally popular due to
their flexibility. However, the high
surface friction associated with latex
can increase the risk of catheter
encrustation, particularly around
the catheter tip, which can increase
pain and discomfort for the patient
(Feneley et al, 2015;Yates, 2016).
Sensitivity and allergy to latex is
common and the initial assessment
of each patient needs to consider
the risks associated with the use of
latex materials (Health and Safety
Executive [HSE], 2011; NICE, 2017).
Silicone catheters
Silicone catheters have a wider
internal lumen due to the
composition, i.e. thinner walls
Sharon Holroyd, lead CNS continence,
Calderdale and Huddersfield Foundation Trust;
chairperson,Yorkshire ACA
IN BRIEF
Over one million indwelling urinary catheters are inserted every
year in the UK; this equates to between 12 and 24% of hospital
patients having an indwelling catheter at some point during their
inpatient stay (Feneley et al, 2015).
The use of indwelling urinary catheters in the care sector can be
higher (Royal College of Physicians, 2004; Loveday et al, 2015).
Nurses should be familiar with best practice and understand
the advantages and disadvantages of using indwelling urinary
catheters in the urethral and suprapubic sites.
KEY WORDS:
Indwelling catheterisation
Catheter choice
Catheter-associated
urinary tract infection
(CAUTI)
Encrustation
Sharon Holroyd
Inserting a new, or changing an
existing urinary catheter should only
be undertaken following a thorough
individual assessment (Feneley
et al, 2015; Yates, 2016). This must
include a risk assessment of any
contraindications before insertion
(RCN, 2012), such as an inability
to care for it, no carer support,
or cognitive impairment where
there is a high risk of deliberate
self-expulsion/removal, and also
consideration of the type of drainage
system used to ensure safe and
effective drainage of the bladder
(Leaver, 2017). The clinical
indication for the use of the catheter
should be clearly identified and
documented in the patient notes and
reviewed every time the catheter is
changed to ensure it is still the best
option for managing the individual’s
bladder drainage.
CHOOSING THE
CORRECT CATHETER
There are many different types
of indwelling urinary catheters
available. The nurse should consider
the use of latex, silicone, coated
or composite materials, and pay
attention to any patient history
of sensitivity or allergy (Elvy and
Colville, 2009).
i Practice point
Indwelling urinary catheters are
also commonly referred to as
Foley catheters, named after the
American urologist Frederick
Foley, who popularised their use in
the 1930s.