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Updating the basic catheter design
isn’t just about aesthetics. As well
as the potential trauma involved
in encrustation and subsequent
blockages, catheters present a very
real infection risk. Catheter-associated
urinary tract infections (CAUTIs) are
one of the most common healthcare-
associated infections (Nicolle, 2014),
costing the NHS £1–2.5 billion per
year and accounting for around 2,100
deaths (Feneley et al, 2015).
However, it’s not only a lack of
innovation that accounts for the risks
involved in catheter care: patient
education and the role of nurses in
passing on best practice also has a
case to answer.
According to National Institute for
Health and Care Excellence (NICE)
guidelines, the risks associated with
catheters are greatly reduced with best
practice (NICE, 2017). This includes
nurses understanding when a catheter
is appropriate; being familiar with
catheter maintenance; and knowing
that the catheter should be removed
when it is no longer necessary. Nurses
also need to be aware of the advice
that they need to pass on to patients.
For example, the catheter must be
kept clean during bowel movements,
especially in those people who have
less control over their bowels and risk
faecal matter coming into contact with
the catheter.
As well as the risks involved in
having a catheter
in situ
, many people
are embarrassed by the lack of dignity
involved.This can impact on a person’s
quality of life, leaving them isolated at
home and fearful of socialising in case
they experience a leak or find that their
drainage bag is visible under their skirt
or through their trousers, for example.
Everyday activities such as
swimming or sexual intercourse
may have to be put on hold for the
duration of the catheterisation, which
can add to an individual’s distress. In
December 2017, a nursing home in
HighWycombe was put into special
measures due to‘undignified care
practices’. One male resident was
discovered walking around with his
trousers rolled up to his knees and his
drainage bag clearly visible; another
Intermittent catheterisation — the reusable debate
Intermittent urethral catheterisation has a very
long history, however it was not until 1949, at
Stoke Mandeville, that it began to be performed
by nurses as a matter of routine as a sterile ‘no
touch’ procedure (Guttmann and Frankel, 1966).
Intermittent catheterisation continued to be
undertaken as a sterile procedure until 1970 when Lapides (1972), after
finding that a patient had admitted dropping her catheter which was
therefore no longer ‘sterile’, realised that using a ‘clean’ technique only
did not apparently increase the infection risk.
The initial catheters used for clean intermittent catheterisation (CIC)
were reusable plastic or rubber ones, with a water-based lubricant
applied as necessary, and washed in between use.This practice of
reusing catheters continued until the 1980s when the first hydrophilic
single-use catheters were produced. Later on, a wide range of catheters
for single-use were developed and this soon became the norm,
particularly within the UK.
However, in some countries, the spiraling costs meant that single-
use catheters were not becoming a viable option and many reverted
to reusing catheters.This caused a debate as to whether single-use
catheters were worth the extra cost, as there was an opinion that there
was no difference of increased risk of infection between single- or
reusable catheters.
To try and address this issue, Cochrane carried out a review in
2014 to evaluate and compare the infection risk of the two methods
of catheterisation (Prieto, 2014).They concluded that: ‘... there is still
no convincing evidence that the incidence of UTI is affected by use of
aseptic or clean technique, coated or uncoated catheters, single (sterile) or
multiple-use (clean) catheters, self-catheterisation or catheterisation by
others, or by any other strategy.’
However, in 2017, this review was withdrawn following peer review
feedback which felt that their own clinical experience did not reflect the
findings of the review (Christison et al, 2017). Christison et al (2017)
also voiced concerns regarding the handling of cross-over and multi-arm
trials, as well as corrections and clarifications of data used.These issues
are currently being addressed, as well as changes that are required to
reflect current methodological standards.
It is now suggested that until evidence can conclusively
demonstrate that catheter reuse is as safe as single-use, healthcare
professionals should advocate the latter.This is important, as currently
there is no standardised and universally accepted cleaning method for
catheters, which would be the prerequisite for safe multiple use — the
debate continues!
June Rogers MBE,
specialist continence advisor,
Bladder & Bowel UK
CONTINENCE CARE MATTERS
i
UROLOGY AND CONTINENCE CARE TODAY
2018,Vol 1, No 1
5
resident sat in a chair with their
drainage bag resting on the carpet
(http://bit.ly/2Bz2VtN).
Following best practice in catheter
care is literally a matter of life and
death. In December 2017, an 87-year-