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CONTINENCE CARE MATTERS
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UROLOGY AND CONTINENCE CARE TODAY
2018,Vol 1, No 1
7
All urologists will welcome articles such as this one that increase the awareness of
healthcare professionals and patients to the correct use of urinary catheters.
It is not controversial to claim that no one wants to have a catheter, that is until you
can’t pass urine! Retention of urine is not only very painful but also potentially life-
threatening. Seeing the immediate relief of pain by draining the bladder with a catheter
is wonderfully satisfying for the healthcare professional who inserts it, never mind the
patient. How humans managed without catheters beggars belief. Egyptians used reeds
that they found along the river Nile.
Modern catheters are designed to be comfortable and avoid complications, such as infection and blockage.
However, the longer a catheter is in place, the more likely problems will occur. So, this article is correct to
encourage more education on the correct use of catheters, on how to avoid complications, and how to treat
them should they occur. So much suffering and cost could be avoided with good training. As a general
principle, catheters should be avoided unless absolutely essential. If they are used, they should be used
properly and expert advice taken on how to sort out the problem necessitating their use in the first place.
Alan Doherty,
consultant urologist, Birmingham Prostate Clinic
catheter care knowledge (Jaeger at
al, 2017).
Providing a catheter passport is
particularly important on discharge,
as many patients leaving hospital
with a catheter do not have enough
information about how to care for
the equipment at home, which can
lead to physical and psychological
issues. For example, full drainage
bags can ‘drag’ on the catheter, which
is uncomfortable for the patient and
increases the risk of the catheter
being torn out. Similarly, it is
essential that patients leave hospital
with the correct length of drainage
bag tubing; for example, men may
want longer tubes so the drainage
bag can be secured below the knee,
while women may require a shorter
tube so it fits to their thigh.
Many patients are also
discharged without leg socks, which
can hold the drainage bag in place
more comfortably. Stabilisation
devices that secure the catheter
discreetly with foam anchor pads are
also available.
THE FUTURE
The catheter is here to stay, but its
current design faces much criticism.
Feneley et al (2015) echo Professor
Fader’s insistence that there is an
urgent need for the development of
an alternative indwelling catheter
system, which:
Guttmann L, Frankel H (1966) The value of
intermittent catheterization in the early
management of traumatic paraplegia and
tetraplegia.
Paraplegia
4(2):
63–84
Houghton M (2017)
Urinary Catheter
Care Guidelines. Southern Health NHS
FoundationTrust
. Available online: www.
southernhealth.nhs.uk/_resources/
assets/inline/full/0/70589.pdf (accessed
15 February, 2018)
Jaeger M, Fox F, Cooney G, Robinson J
(2017) A qualitative study exploiting the
value of a catheter passport.
Br J Nurs
28(15):
857–66
Lapides J, Diokno AC, Silber SJ, et al (1972)
Clean intermittent self-catheterization in
the treatment of urinary tract disease.
J
Urol
107:
458
Loeb M, Hunt D, O’Halloran K, et al (2008)
Stop orders to reduce inappropriate
urinary catheterization in hospitalized
patients: a randomized controlled trial.
J
Gen Intern Med
23(6):
816–20
National Institute for Health and Care
Excellence (2017)
Healthcare-associated
Infections: Prevention and Control in
Primary and Community Care
. Clinical
guideline 139. NICE, London
Nicolle LE (2014) Catheter associated
urinary tract infections.
Antimicrob Resist
Infect Control
3:
23.
Prieto J, Murphy CL, Moore KN, et al
(2014) Intermittent catheterisation
for long-term bladder management.
Cochrane Database Syst Rev
. 2014 Sep
10;(9):CD006008
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Is safe, easy to insert, either
urethrally or suprapubically
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Can be retained reliably in
the bladder
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Can empty without damage to
the bladder
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Has control mechanisms
appropriate for all users.
Whether we’ll have to wait
another 80 years for this to happen is
yet to be seen.
REFERENCES
Academic Health Science Network (2016)
Catheter care improvement programme
brings about 30% reduction in infection
rate
. Available online: http://atlas.
ahsnnetwork.com/catheter-care-
improvement-programme-brings-about-
30-reduction-in-infection-rate/
Christison K,Walter M,Wyndaele JJM, et al
(2017) Intermittent catheterization: The
devil is in the details.
J Neurotrauma
6
Nov [Epub ahead of print]
Feneley RC, Hopley IB,Wells PN (2015)
Urinary catheters: history, current status,
adverse events and research agenda.
J Med Eng Technol
39(8):
459–70
Global Urinary Catheter Market (2017–
2023) — Increasing incidences of
urinary incontinence to drive
growth — research and markets.
Available online: www.businesswire.
com/news/home/20171115005759/
en/Global-Urinary-Catheter-Market-
2017-2023---Increasing