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FOCUS ON TWOC
i
I
ndwelling urinary catheters are
one of the most commonly used
clinically invasive devices in the
UK (Loveday et al, 2014; Feneley et
al, 2015). There are at least 90,000
people living in community settings
in England currently using long-
term urinary catheters (Gage et al,
2016). It has long been recognised
that the length of time a catheter
is in place can increase the risk
of developing an infection and a
significant number of patients with
long-term catheters develop sepsis,
which can lead to death (Chenoweth
and Saint, 2013; Loveday et al, 2014).
Feneley et al (2015) estimated
that about 2,100 deaths a year
are directly caused by the use of
indwelling catheters. Given that
the cost of treating catheter-related
urinary tract infections (CAUTIs)
is estimated to be about £2,000 an
episode (Yates, 2016), and the total
Best practice for trial without catheter
Information Centre, 2013). It is
probable that a fair proportion of
these were linked to indwelling
catheters when considered with
the statistical data on how often
these devices are used (Feneley et
al, 2015). The impact of catheter
complications is felt by the patient
who suffers the often significant
issues relating to infection and
the need for antibiotics (Chapple
et al, 2016). Nursing and care
services both in the community and
emergency departments experience
an increased demand on their
services, a reduction in capacity and
ability to respond to the holistic
needs of patients with indwelling
catheters, which results in an
increased economic burden on the
NHS and social care sector (Tay et al,
2016; Ansell and Harari, 2017).
Indwelling catheterisation should
only be considered when all other
options have been discounted (Geng
Sharon Holroyd, lead CNS continence,
Calderdale and Huddersfield Foundation Trust;
chairperson,Yorkshire ACA
IN BRIEF
Unnecessary continuation of indwelling catheterisation heightens
the risk of catheter-associated urinary tract infection (UTI)
or sepsis.
Timely removal of an indwelling catheter is essential to prevent
unnecessary infections.
Trial without catheter (TWOC) is used to assess patients’ bladder
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empty their bladder unaided.
KEY WORDS:
Trial without catheter
(TWOC)
Patient assessment
Catheter-associated
urinary tract infection
HOUDINI
cost of using indwelling catheters in
the NHS is estimated to be between
£1–2.5 billion a year, appropriate
management and early removal of
these devices must be a priority.
There are many clinical situations
where an indwelling urinary catheter
is indicated for bladder drainage
(see
pp. 28–34
). Ensuring that best
practice guidelines are followed and
that catheters which are no longer
necessary are removed promptly may
be a way of reducing infection rates
and unnecessary deaths (Magers,
2013; Chenoweth et al, 2014). This
article will explore optimum timing
for trial without catheter (TWOC)
and current evidence advising on
how to safely and effectively
manage TWOC.
Hospital episodic data (HES,
2011–12 data) for one year alone
recorded more than 280,000
episodes of urinary tract infection
(UTI) in acute care in England and
Wales (Health and Social Care
UROLOGY AND CONTINENCE CARE TODAY
2018,Vol 1, No 1
35
‘Ensuring that best practice
guidelines are followed and
that catheters which are no
longer necessary are removed
promptly may be a way of
reducing infection rates and
unnecessary deaths...’
i
TWOC...
Trial without catheterisation
(TWOC) is the term used to
describe the removal of a catheter
for a trial period to see if the patient
is able to pass urine safely and
spontaneously without the need
for recatheterisation.
Sharon Holroyd