Indwelling catheters Resources

Over 124,000 people in the UK have long-term indwelling catheters (Gage et, al, 2017; Nazarko, 2017). Indwelling urinary catheters increase the risks of infection and ill health (Feneley et al, 2015; Public Health England [PHE], 2016). They can leak, block and management can be burdensome for the person with the catheter, caregivers and health service (Cottenden et al, 2013). This article updates readers on how to reduce the risks of infection, leakage and catheter blockage, and how to manage these problems when they occur.

Indwelling urinary catheters remain one of the most used clinically invasive devices in the UK, with approximately 90,000 people living in community settings in England currently using long-term urinary catheters. There has been a plethora of clinical evidence published demonstrating the risks of prolonged use of indwelling urinary catheters and the increased risk of significant infection, sepsis, and, in some cases, fatality. While the use of an indwelling urinary catheter is in some cases wholly justified and unavoidable, it is the responsibility of healthcare professionals to ensure that risks are mitigated/reduced wherever possible. Use of a catheter valve system may improve the chance of normal bladder function resuming following the removal of the catheter. It is a relatively simple intervention that can be managed by many patients and offers more discretion and dignity. Use of catheter valves should always reflect latest national guidance on best practice and be incorporated into local policy. This article explores some of the clinical evidence supporting the use of catheter valves and advice on best practice.

Patients in the community may often have a long-term urinary catheter in place. The management of this usually falls to thecommunity nurse therefore he or she needs to understand the basic procedures involved in urethral and suprapubic catheterisation, as well as being familiar with potential complications and how to troubleshoot. Catheter blockages are the most common problem encountered in long-term catheterisation and it is important that the nurse knows how to address this methodically and identify and treat the cause. This article offers practical and evidence-based advice on some of the common issues that can arise in the management of people who have long-term catheters in place

Caring for patients with indwelling catheters is common in nursing practice in all settings (Foxley, 2011), despite being the last resort for patients with long-term bladder control problems. Community nurses in particular will regularly encounter patients with indwelling catheters, ranging from those with nerve damage such as spina bifida, multiple sclerosis (MS), stroke or spinal injury; those with debilitating or terminal illness with loss of mobility; to those who may lack the cognitive ability or sufficient awareness to use the toilet. Catheterisation carries a high risk of infection, resulting in an increased burden of care and cost to healthcare providers. It can also negatively impact on patient wellbeing. Providing for these patients 'around the clock' can be a particular problem in the community, with carers and patients requiring education in how to manage both the catheters themselves, as well as the accompanying equipment at night. This article provides a background to long-term catheterisation, before looking at ways of preventing infection as well as the techniques and equipment that can better enable 24-hour care.

It has been estimated that around 4% of patients on community caseloads have long-term indwelling catheters (Pomfret, 2000). Healthcare professionals have a responsibility to be aware of the different closed drainage systems available, so that they can offer patients choices to suit their lifestyle and preferences. Leg bags are one option, which can be customised to maximise patient comfort and dignity. This paper discusses the impact that urinary incontinence can have on patient quality of life, and one range of leg bags that has been developed to meet patients’ specific needs.