Catheters Flashcards
Indicators for catheterisation
- neurological conditions
- bladder outlet obstruction
- urinary retention
- peri/pre/post operative bladder drainage
Causes of neurological conditions causing bladder problems
- spinal cord injury
- MS
- spina bifida
Examples of bladder outlet obstruction causes
BPH
urethral stricture or injury
Examples of urinary retention causes
- neurological conditions/bladder outlet obstruction
- bladder injury
- malformations
Standard colour sizes for catheters
Light Green = 06 Blue = 08 Black = 10 White = 12 Dark Green = 14 Orange = 16 Red = 18 Yellow = 20 Purple = 22
Catheter modern materials
- silicone!!
- silver impregnated latex
Advantages of silicone catheters
- most common material for foley catheters
- less prone to encrustation
- tolerated by those with latex allergies
Bardex IC advantage
- reduces risk of infection
Normal length of use for foley catheters
- change every 4-6 weeks
- some approved for use up to 12 weeks
Complications of indwelling catheters
- UTIs
- bladder stones
- catheter blockages
- urethral and bladder trauma
Why is there a risk of UTI’s with indwelling catheters?
- 5% daily risk of bacteriuria
- 40% of nosocomial infection are catheter acquired urinary tract infections (CAUTI)
How do bladder stones form?
A biofilm of calcium and magnesium develops on the catheter balloon which then build up forming stones and can block the catheter eyelets
How can bladder/urethral trauma occur?
- severe encrustation = complications of catheter withdrawal
- LT urethral catheterisation = severe urethral erosion
Pros of suprapubic catheters
- no urethral trauma
- sex is still possible
Cons of suprapubic catheters
- no reduction in UTI risk
- bladder stones same risk as indwelling
- blockages same risk as indwelling
How is a suprapubic catheter placed?
- relatively minor surgical procedure
- passed through abdomen
- just above pubic bone
- into bladder
- inflate balloon
- 1st catheter inserted in hospital but then nurses/individual after this
- completely reversible
Define terms SCI, CIC, ISC?
SCI = spinal cord injury CIC = clean intermittent catheterisation ISC = intermittent self catheterisation
ISC Catheters Properties
- hydrophilic catheters
- coating binds water to the surface
- reduced urethral trauma
- reduced discomfort
- sterile single use
Material of ISC Catheters
- PVP = polyvinylpyrrolidone (also polyvidone or povidone)
- water soluble polymer
- also silicon (too soft for ISC users to handle well)
- PEBA (polyether block amide)
- POBE (polyolefin-based elastomer)
- PVC (moving away from this for environmental reasons)
Parts of an ISC Catheter
- connector/hub (colour coded by sizing)
- catheter body (variety of plastics - PVC for e.g.)
- coating (gel or hydrophilic)
- eyelets (on sides)
- catheter tip
Type of catheter tips
Nelaton (rounded)
Tiemann (curved and tapered)
Pros of ISC catheters
- reduced UTI risk compared to indwelling
- reduced stone risk compared to indwelling
- reduction in trauma compared to indwelling
- sexual function not impaired
- increased independence
- improved comfort
Cons of ISC catheters
- requires good hand function/dexterity to hold and insert
- does not prevent leakage between catheters
- more difficult for females (paraplegic women difficulty undressing/dressing/positioning)
Why is there increased independence with ISC catheters?
- less reliance of healthcare professionals
- more activity options = sports/shorts/skirts
NICE guidelines for indwelling catheters
- LT catheterization carries significant risk of symptomatic UTI which can lead to more serious complications
- should only be used after alternative methods of management have been considered
- discuss with patient about risks vs. other management options (higher incidence of bladder stones!)
EAU/EAUN guidelines
EUA (european association of urologists)
EAUN (european association of urology nurses)
- avoid indwelling transurethral catheterisation and suprapubic cystostomy when possible as associated with a range of complications as well as enhanced UTI risk
- indwelling only when clear indication
- first consider alternatives
- catheter is last resort when other options failed/proved to be insufficient
- to insert a catheter only for comfort of nursing staff is irresponsible
Mitrofanoff ISC
- procedure
- relatively rare
- allows increased independence, particularly for SCI women
- create a continent channel using a piece of bowel/appendix
- exits at the naval
- combine with a neobladder
What is a neobladder?
new bladder created from bowel
What is an indwelling catheter?
Catheter left in place and held in bladder by water filled balloon
Also known as a Foley catheter
Opposite to intermittent catheter
Why are UTI’s such a large problem?
- costs NHS around £1 billion a year
- antibiotic resistance increasing (20% to trimethoprim and 40% to amoxicillin)
What are suprapubic catheters designed for?
To overcome urethral trauma associated with urethral indwelling catheters
