48 / 52
COST AND COMPLICATIONS OF CATHETERISATION
›
form the care plan for patients
and their catheters, and should be
used to document catheter care
and management. Risk assessment
should be carried out before all
catheterisations, especially in the
community, to ensure the
patient’s safety.
URINARY CATHETER
COMPLICATIONS
According to NHS England (2015),
regular audits by the Healthcare
Quality Improvement Partnership
(HQIP), the latest being in 2010,
show that despite the amount of
guidance available, the quality of
continence care remains variable
across the country and poorer
overall for the elderly. In the author’s
clinical experience, many continence
problems can be cured and certainly
managed better.
Bladder spasms
Bladder spasms feel like abdominal
cramps and are usually caused by
the bladder trying to squeeze out
the balloon that holds the urinary
catheter in place. If spasms are
causing distress, patients can be
prescribed medication to help relax
the bladder muscles (Davey, 2015).
Leakage/bypassing
Leakage around the urinary catheter
is called ‘by-passing’. It is sometimes
caused by bladder spasms, or it can
happen when opening the bowel. It
can also occur if the urinary catheter
is blocked and stops draining.
In the author’s experience, any
incidence of urinary catheter by-
passing has cost implications, as
the catheter has to be changed to
a different one, involving the cost
of staff to perform this procedure.
The following measures may help to
prevent bypassing of urine around
the catheter:
48
UROLOGY AND CONTINENCE CARE TODAY
2018,Vol 1, No 1
›
Use a small Charrière (Ch) size
(diameter size) (10–12 Ch in
women, 12–14 Ch in men)
›
Anticholinergic medication may
help reduce bladder spasm
›
Consider using an all-silicone
catheter which has a wider lumen
and larger eyes to allow optimum
drainage, rather than a hydrogel-
coated latex catheter
›
Check for UTI
›
Avoid restrictive clothing
›
Check for constipation
›
Consider the position of the
catheter and troubleshoot to find
out cause of leakage
›
Secure the fixing device.
Temporarily raise the urine bag
above the level of the bladder
to reduce suction and avoid
occlusion of the drainage eyes by
bladder mucosa.
Blockage
Blockage can cause a great deal of
pain and needs urgent attention.
Patients are advised to check that
their drainage bag is below the level
of their bladder, that the urinary
catheter and tubing is not kinked or
twisted, and that there are no clots
or debris in the urinary catheter.
However, if the urinary catheter fails
to unblock and no urine is draining,
patients are advised to contact their
district nurse or GP immediately,
as this could indicate acute
urinary retention.
Expulsion
Urinary catheters can sometimes fall
out. If this occurs, patients should
contact their district or specialist
urology nurse immediately so that it
can be replaced. If this continues to
happen, patients may be referred to
the urologist for further advice and
reassessment of the type of catheter
in use.
Infection
Infection will present as blood or
debris in the urine (cloudy urine).
The longer a urinary catheter has
been in the bladder, the more likely
this is to occur. Blood and debris
can sometimes block the urinary
catheter and when this occurs,
patients are advised to contact their
district nurse, GP or continence
specialist nurse.
Urinary tract infection can also
be detected when patients develop
symptoms such as pyrexia (high
temperature), discomfort, pain in
the urethra, or increased confusion
in those with dementia, etc. If this
happens, patients can contact their
district nurse or GP who will decide
whether they need antibiotics
and may send a urine sample for
laboratory testing to find out the
cause of the blood in the urine, such
as renal problems, bladder cancer, etc.
However, it is important to
remember that there will always
be some bacteria in the urine if a
patient has had a urinary catheter for
more than a few days, so this does
not necessarily mean that the patient
has an infection and needs to take
antibiotics (British Association of
Urological Surgeons [BAUS], 2017).
Catheter-associated urinary
tract infection (CAUTI)
Urinary tract infections (UTIs) are the
most common healthcare-acquired
infection (HCAI), accounting for
17.2% of all HCAIs, and between
43 and 56% of UTIs are associated
with an indwelling urethral catheter
(Loveday et al, 2014).
CAUTIs are likely to prolong
hospital stays (an estimated
0.5–5 extra days), and increase
readmissions and mortality (HERU,
2015). They are estimated to cost the
NHS up to £99 million each year or
£2,000 per episode (Loveday et al,
2014). They can also adversely affect
quality of life, particularly older
people, who are also more likely
to be using catheters that are not
appropriate for their needs. In the
author’s clinical opinion, the aim
should always be to:
›
Reduce avoidable harm to
patients from inappropriate
catheter days and CAUTI
›
Practice point
Comprehensive assessment is key
for effective continence care and
is vital in ensuring that the most
suitable catheter is chosen for each
individual patient.
›
Practice point
Patients with invasive devices, such
as urinary catheters, are at a greater
risk of developing an infection
(NICE, 2012).