Avoiding complications with urinary catheter use

A urinary catheter is a thin flexible tube used to drain urine from the bladder. The common reasons for needing one are:

• Urinary leakage (incontinence)
• Cannot pass urine (urinary retention)
• Monitoring of urine output in the hospital following surgery or in a very unwell patient.

We’ve asked consultant urologist Mr Simon Choong for his expert advice on how to avoid developing any possible complications from the overuse of a urinary catheter.

What possible complications can occur?

Urinary catheter-associated urinary tract infections are very common and potentially very serious and can occur whether a person has either a short-term or a long-term catheter. Certain bacterial infections (urease producing bacteria such as Proteus and Klebsiella make urine very alkaline) cause rapid catheter blockages resulting in pain, urinary leakage and sepsis.

Some people are more likely to be affected than others. People who are faecally incontinent, immobile, elderly and who are immuno-compromised, including poorly controlled diabetics, are more susceptible.

The longer one keeps a catheter, the higher the risk of infection. A catheter should always be inserted using an aseptic technique and short-term catheters should be removed as soon as they are no longer needed.
 

How can catheter complications be avoided?

Prevention is better than cure! The following should be adhered to: 

• Infection of the bladder occurs from contamination of the catheter and the bacteria ascend back into the bladder.
• Hand hygiene is important whenever a catheter is handled by the patient or carer.
• Clean the rectal area thoroughly after every bowel movement.
• Always clean the rectal and the catheter areas separately and with different wipes.
• Indwelling catheters should be connected to a sterile closed urinary drainage system or catheter valve.
• Urinary drainage bags should be positioned below the level of the bladder to prevent urine from the bag from going back into the bladder, and the bags should not be in contact with the floor.
• The urinary drainage bag should be emptied frequently enough, at least once every 8 hours, to maintain urine flow and prevent reflux.
• The meatus and catheter should be washed daily with soap and water as part of routine daily personal hygiene.
• Ideally, change indwelling catheters once a month even though a catheter can be left in for up to 3 months.
   

How are urinary catheter complications treated?

Treatment is by appropriate antibiotics chosen by urine culture testing and antibiotic sensitivities. Some bacteria are resistant to certain antibiotics, which cannot treat the infection successfully.

• Maintaining good oral fluid intake is important to irrigate and cleanse the bladder and catheter.
• During a course of antibiotics treatment, the infected catheter is replaced by a new catheter.
• In some cases, such as faecal incontinence or recurrent infections, changing a catheter inserted through the water pipe (urethra) to a catheter inserted through the abdomen above the pubic bone (suprapubic) may reduce the risk of or prevent an infection.
• Surgery to enable the patient to pass urine (prostate surgery to trim an enlarged prostate gland blocking the bladder) and hence no longer needing a catheter.
• Insert a catheter intermittently to avoid having a catheter continuously.
• Use long-term low dose preventative antibiotics.
   

What new types of catheters are we starting to see?

We are now starting to see catheters coated by antiseptic silver or antibiotic, and specially-designed catheters that empty the bladder better and reduce inflammation.

Need to discuss your urinary problems with an expert? Do not hesitate to have a consultation with Mr Choong.