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I
t has never been the most
glamorous piece of medical
equipment, but a growing older
population, rising rates of obesity
and a higher number of surgical
procedures mean that the demand
for catheters has never been greater.
And, it doesn’t end here; the global
catheter market is expected to rise
8.1% between 2017 and 2023
(Global urinary catheter market
2017–2023, 2017).
Catheters have been used to drain
poorly emptying bladders for 3,500
years (Feneley et al, 2015). Indwelling
catheters are inserted into the bladder
via the urethra, whereas suprapubic
catheters are inserted into the bladder
via the abdomen, just above the pubic
bone. While the design has moved on
somewhat since Egyptian times, the
catheter design that most nurses are
familiar with has remained basically
the same since it was designed by
Frederic Foley in 1929 — a long
flexible plastic tube with an inflatable
Is it time to take a fresh look at
catheter care and could we do better?
balloon that holds the catheter in
place in the bladder.
A catheter should only ever be
used as a last resort after the nurse has
undertaken a thorough assessment
to identify the cause of the patient’s
bladder dysfunction. In most cases,
catheters are employed for short-term
use and can be left
in situ
for anything
from a few minutes to a few days.
However, in 2015, figures showed that
90,000 people required an indwelling
catheter for three months or more (BBC
news, 4 July 2015 —‘Industry“must do
more”to improve urinary catheters’).
For patients with permanent conditions
which can result in the patient having
no bladder control, such as spinal cord
injury or multiple sclerosis, the use
of an intermittent catheter may be a
lifelong measure.
And yet, despite its prevalence
in both hospital care and in the
community, there is still controversy
surrounding catheter use.This mainly
focuses on when catheters should be
used and for how long, how to manage
them
in situ
and how to ensure patients
who are fitted with a catheter are made
comfortable and assisted to retain their
dignity.While many of these issues are
the result of poor clinical assessment,
the lack of innovation in the design of
catheters themselves is also a concern.
TREADING WATER
Unlike drugs, which are often
redesigned and rebranded, or
medical equipment such as scanning
or diagnostic equipment, which is
regularly modernised to increase
patient comfort, the basic design of the
catheter has changed very little in the
past 80 years. In 2015, Mandy Fader,
professor of continence technology at
the University of Southampton, called
on‘industry to wake up and invest
more heavily in new catheter designs
and materials that resist infection’(BBC
news, 4 July 2015 —‘Industry“must do
more”to improve urinary catheters’).
CONTINENCE CARE MATTERS
i
Catheters are internal devices which can cause considerable harm and risk to patient
safety. However, some people require them in the short term following surgery, or
long term due to an inability to empty the bladder.When catheters block, they cause
an emergency situation, impacting on the patient’s wellbeing and nursing resources.
Catheterisation and catheter care is every nurse’s business and is a significant component
of the community nurse’s work, with large numbers of catheterised patients on caseloads.
Hospital nurses can be challenged by this aspect of care and fail to remove catheters in a
timely fashion, or to plan adequately for the discharge of the catheterised patient.
The introduction of catheter passports is a welcome development and should be embraced by hospital and
community nurses alike to improve discharge communication, documentation and outcomes for patients. Used
in conjunction with evidence-based catheter care bundles, they have the potential to significantly improve
practice, and thus contribute to the campaigns to reduce CAUTIs and unplanned admissions, facilitate timely
reviews, and expedite early catheter removal — in short, to improve general catheter management and
outcomes for patients.
Karen Logan OBE,
nurse consultant, Aneurin Health Board
Catheters have been around for thousands of years, but the basic principles have
not changed, so here we ask...
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UROLOGY AND CONTINENCE CARE TODAY
2018,Vol 1, No 1