Indwelling urinary catheters remain one of the most commonly used clinically invasive devices across the NHS and social care in the UK. The problems associated with the prolonged use of catheters are widely referenced. Healthcare-acquired infections (HCAIs) currently result in 5,000 preventable deaths a year, with 20% of all HCAIs associated with the urinary tract. Many staff have learned catheterisation techniques in their early careers, with no need for a formal review of skills and knowledge. This has perhaps contributed to some historical and now outdated tasks still being performed. The evidence for best practice when managing indwelling catheters is reflected in national and international guidelines, which have recently undergone a complete overhaul. This article explores common practices and best practice evidence to assist with safe and effective management of these essential but often risky devices.
Indwelling urinary catheterisation is a common procedure especially within a community setting. However, healthcare professionals are sometimes unaware of what is current best evidenced-based practice. This article outlines the clinical indicators for insertion of a urinary catheter, rationale for catheter selection, including Charrière (Ch) or French gauge (Fg), length, balloon size and material of choice including any coating. Catheter insertion requirements are outlined and drainage and supporting/securing devices discussed. Complications of indwelling catheters, such as catheter-associated infections and encrustation are also discussed with recommendations for treating, and, finally, new innovations which may benefit in future care are identified — all with reference to current national guidance and best clinical evidence-based practice.
This article examines the various elements that community nurses need to consider when attempting to provide best practice in urinary catheterisation. The author seeks to challenge what is considered best practice — particularly the requirement for all practice to be evidence based — while encouraging community nurses to think proactively about the care they are providing. The article stresses that the first principle of urinary catheterisation is to avoid the procedure where at all possible — catheterisation is potentially dangerous and can even be life-threatening if performed inappropriately. Overall, the author poses some key questions, including: should there be a difference in the care provided by community and hospital nurses; do community patients have the same needs as those in hospital; and can the manufacturers of drugs/products help to make avoiding urinary tract infections (UTIs) easier?
Urinary catheterisation is one of the most common procedures undertaken in both primary and secondary care. However, the process carries a number of inherent risks, such as the potential for trauma and the introduction of infection. In addition, the inappropriate use of a catheter can cause long-term damage. This article outlines the indications for their use and the type to be used according to patient requirements.
Frank Booth RGN, DN Cert. Freelance Continence Specialist
Melanie Clarkson RGN Dip. He. Clinical Nurse Specialist, Continence Service for Blackpool Teaching Hospitals NHS
Foundation Trust
Article accepted for publication: March 2012
