Indwelling Catheters

There are many procedures that are used commonly within the medical field. One of these procedures is the use of a catheter. A catheter is a hollow tube that is used to drain urine from the bladder. Catheters that remain in place for an extended period of time are called indwelling catheters. While indwelling catheters are a standard practice for some patients and can be an immense help with multiple benefits, there are substantial risks associated with them. By following the correct practices in using and maintaining indwelling catheters, the risks are minimized and can offer a patient the opportunity to live a comfortable and full life.

What is an indwelling catheter?

An indwelling catheter is tube that is placed into the bladder for a period of time which drains the urine into a bag, in most cases. Indwelling catheters are used for the long-term management of problematic urinary incontinence or bladder outlet obstruction that results in the retention of urine (Jones, 2005). While the most common method for using an indwelling catheter is by placing it through the urethra and into the bladder, a suprapubic catheter may also be utilized. This type of catheter is placed into the bladder through an incision that is made a few inches below the belly button (http://www.incontact.org/publications/indwelling-catheters.html). Due to the larger risks associated with suprapubic catheters, they are only used in extreme circumstances.

Catheters come in many sizes, materials, and types. For example a catheter may be made out of latex, silicon, or teflon. There are also a variety of styles of catheters, which include the Foley catheter, a straight catheter, and a coude tip catheter; however, the most common type of indwelling catheter is a latex Foley catheter (Jones, 2005). This catheter contains a small balloon at the end which is inserted through the urethra and into the bladder. The balloon is then filled with sterile water so that it cannot be removed from the bladder accidentally (http://www.incontact.org/publications/indwelling-catheters.html).

Who may require an indwelling catheter?

An indwelling catheter may be required when a patient cannot urinate normally. There are multiple reasons why an individual may not be able to urinate normally. These reasons range from medical conditions, such as prostate enlargement; after a surgery on the pelvis or urinary tract; due to an injury, such as a spinal cord injury; or even in the case of incontinence, when the individual cannot control their urine output (Nettina, 2006). An indwelling catheter may be required for a few days or weeks, or may be a long term solution and is required for the rest of the patient's life.

What are the benefits of indwelling catheters?

There are many advantages in using an indwelling catheter. For those individuals who struggle with urinary incontinence, it can help with preventing the breakdown of skin and other skin irritations due to urine being in contact with the integument system (Nettina, 2006). Indwelling catheters also allow a person with urinary incontinence more freedom and comfort in life due to the lack of embarrassment associated with incontinence. Such individuals who require indwelling catheters have multiple options for draining their catheters which is also an enormous advantage. These options include using a drainage bag or a catheter valve. There are two types of drainage bags, a leg bag and a down drain bag (http://www.incontact.org/publications/indwelling-catheters.html). The leg bag is usually worn during the day and fits discreetly under pants or a skirt. It is held in place with straps or a holster that fits around the thigh (Jones, 2005). This bag is also easily emptied into the toilet. The larger drainage bag, down drain bag, is often used at night and is hung on the bed or placed on the floor (http://www.incontact.org/publications/indwelling-catheters.html). The advantage of using the large bag at night is the ability for the patient to go a longer time without having to empty the bag. The catheter valve allows the urine to remain stored in the patient's bladder and then may be emptied directly from the catheter into the toilet (Jones, 2005). This may be more convenient for individuals who have active jobs or hobbies that might otherwise worry about limited movement or a leak in the leg bag. The catheter valve also retains the patient's bladder size as the continuous use of a drainage bag may, over an extended period of time, cause the bladder to shrink and require the continuous usage of an indwelling catheter with drainage bag (Nettina, 2006). Some patients using an indwelling catheter may be concerned about the ability to have sex. This is another benefit of a catheter; the patient will still be able to have sex as the indwelling catheter can be taped out of the way during this activity (http://www.incontact.org/publications/indwelling-catheters.html). While patients may be concerned about having to use an indwelling catheter, many have found it to be an advantageous solution to a difficult and often uncomfortable problem. One patient is quoted as saying, "Having an indwelling catheter and wearing a leg bag was very unusual at first, but I quickly got used to it. I find it offers the best solution for my problem." (http://www.incontact.org/publications/indwelling-catheters.html).

Where are the risks of indwelling catheters?

There are many risks in using indwelling catheters. These complications can include urinary tract or kidney infections, septicemia, urethral injury, skin breakdown, and hematuria (Nettina, 2006). After many years of catheter use, there is even the risk that bladder cancer may develop. One of the most common risks are urinary tract infections. Symptoms of urinary tract infections include the external urethra opening may become irritated and raw, or infected, fever, shaking, chills or sweats, lower abdominal pain, or cloudy, bad-smelling urine (Nettina, 2006). Male catheters are longer than in women. Due to this women are more likely to get urinary tract infections as bacteria from the anus can be easily passed up the urthera. Despite this, men are still at risk for urinary infections. Another very common risk is injury to the urethra. This could be due to tugging or pulling on the catheter or bag leading to the catheter (Jones, 2005). According to recent studies of indwelling catheters in multiple patients, there is an increased risk of fatailty due to their use. Lindsay Nicolle's study The Chronic Indwelling Catheter and Urinary Infection in Long-Term Care Facility Residents states, "residents with chronic indwelling catheters have increased morbidity from urinary infection compared to bacteria uric residents without chronic catheters." It states that patients who exhibit symptoms should be evaluated clinically as well as microbiologically. This increased morbidity is confirmed from Roe and Brocklehurst's, Study of Patients with Indwelling Catheters which states, "therewas a stepwise increase in mortality with duration of catheterization. Patients who were catheterized for 76% or more of their daysin the nursing home were three times more likely to die withina year." While there are substantial risks in utilizing indwelling catheters, a caregiver must decide what the appropriate course of action is for an individual patient.

What are the usual practices regarding indwelling catheters?

There are many procedures which medical professionals must practice in order to maintain the health and well-being of their patients. In regards to indwelling catheters, one practice that is recommended is the use of the smallest size of catheter (http://www.incontact.org/publications/indwelling-catheters.html). While some people may require larger catheters in order to control leakage or if the urine contains large amounts of sediments, larger catheters may increase the likelihood of damage to the urethra. Another procedure that is essential in the health of a patient is development of allergies to latex because of long-term latex catheter use (Jones, 2005). These patients should be switched immediately to silicone or Teflon catheters. Indwelling catheters require regular changing, approximately every 4 to 12 weeks to prevent encrustation and bacteria growth (Jones, 2005). Another recommended procedure of indwelling catheter use is water intake to help prevent urinary tract infections. Some healthcare providers may recommend drinking cranberry juice or using a Vitamin C supplement to help reduce the risk of urinary infections (Nettina, 2006). While these are some practices, there are many other procedures that must be followed regarding the use of indwelling catheters to ensure the health and well-being of a patient.

Summary

Catheters are tubes which drain urine from the bladder. If used for an extended period of time, they are referred to as indwelling catheters. Indwelling catheters are used in patients who cannot urinate normally. There are many benefits in utilizing indwelling catheters, but there are also substantial risks which must be considered. Many of these risks can be eliminated or reduced by the utilizing proper practices. Indwelling catheters when used properly can increase a patient's comfort, mobility, and well-being and should be considered in each individual case.

References

InContact . (2006). In Contact. Indwelling catheters. Retrieved April 2, 2007, from http://www.incontact.org/publications/indwelling-catheters.html.

Jones, T. V. (Ed.). (2005). The merck manual of health & aging: the comprehensive guide to the changes and challenges of aging- for older adults and those who care for and about them. New York: Ballantine Books.

Nettina, S. M. (2006). Lippincott manual of nursing practice, eighth edition. Philadelphia: Lippincott, Williams & Wilkins.

Nicolle, Lindsay E., MD. (2001). The chronic indwelling catheter and urinary infection in long-term care facility residents. Chicago: The Society for Healthcare Epidemiology of America.

Roe, Brenda H., MSc. & Brocklehurst, J. C., MD. (1987). Study of patients with indwelling catheters. New York: Journal of Advanced Nursing.