how often should a catheter be changed

In this blog for nurses, Helen Cowan turns to the Cochrane Library to look for testify to inform her practice on urinary catheter intendance.

How ofttimes should indwelling urinary catheters be inverse? Are catheter washouts effective? Which type of catheter reduces rates of urinary tract infection?

After xiii years of nursing in acute surgery, hospice intendance and the nursing domicile setting, I was hoping to have answers to these questions.

When it comes to urinary catheters, I've seen it all

elderly woman and nurse

Poor fluid intake, decreasing renal office and advancing dementia provide new challenges to urinary catheter care

My first ever placement equally a educatee nurse was on urology, where catheters were passed with ease by expert mentors, flip-flo valves were fitted to the ends of catheters to train the bladder to hold increasing amounts of urine, and we nurses raced to empty bursting bags of urine as it flowed freely during mail service-surgical float lavage (one inventive nurse connected a chain of nighttime bags in succession to go along up with demand).

Since and so I've nursed in neurological rehabilitation, working with neurogenic bladders subsequently spinal cord injury, and in neurosurgery where I accept strictly monitored urine production after pituitary surgery to monitor for diabetes insipidus. Currently I work in the nursing home setting where poor fluid intake, decreasing renal role and advancing dementia provide new challenges to catheter intendance.

Information technology was, withal, when caring for a family member that I get-go realised that, for some people, a blocked urinary catheter can mean the divergence betwixt life and death. Autonomic dysreflexia is a medical emergency that tin can occur in the spinal string injured patient: a stimulus such every bit a blocked catheter can trigger an excessive sympathetic nervous response resulting in hypertension, stroke, convulsions, cardiac arrest and death (Cowan, 2022).

Claret, sweat and tears caused by catheters

Admittedly, autonomic dysreflexia is an extreme and rare condition. The presence of an indwelling urethral catheter is, however, unremarkably associated with other complications and adverse furnishings.

Blood in the urine is one such case, often as a result of urinary tract trauma (either during catheter insertion or when the catheter is inadvertently tugged). I've seen urine so filled with blood that it has been described as 'blackcurrant jam urine'.

people with indwelling catheters are upward to vi.5 times more likely to develop a urinary tract infection

Sweating due to fever can also result from catheter insertion: nearly all catheter users develop bacteriuria inside four weeks of catheter insertion (Cooper et al, 2022); people with indwelling catheters are up to six.5 times more likely to develop a urinary tract infection (Shepherd et al, 2022). The patient'southward own colonic and perineal flora, and the hands of health care professionals, human activity as the source of micro-organisms.

When I worked on cardiac surgery, gentamicin injection always preceded catheter insertion in lodge to minimise the risk of infection: especially important in a patient about to undergo cardiac valve replacement surgery, since catheter associated urinary tract infection (CAUTI) can pb to secondary bacteraemia in the blood (Shepherd et al, 2022).

And I've seen real tears shed equally a result of being catheterised: the very real pain of catheter insertion, catheter blockage and of inadvertently pulling out a catheter whilst the balloon is notwithstanding inflated; the embarrassment of pericatheter leakage. These factors undoubtedly affect a patient's quality of life. The financial cost of catheters may also make upkeep holders wince.

Throughout my nursing career, I've sought out studies related to catheter care in an attempt to minimise the claret, sweat and tears of life with a urinary catheter. I turned to the Cochrane Library to answer some questions about catheter care, concentrating specifically on long-term indwelling urinary catheters (those that stay in the float for a long time) rather than short-term indwelling catheters, or intermittent catheters (which are inserted to drain the bladder and then removed).

Do specially designed urinary catheters reduce risk of CAUTI?

Or, "should every catheter have a silver lining?" Some catheters are impregnated with antiseptic or antibacterial agents: silver is ordinarily called equally a bactericidal agent. Other catheters are coated with silicone or hydrogel, just piffling is known most relative rates of CAUTI when comparing catheter types.

Jahn et al (2012) conducted a Cochrane review in which the relative claim of unlike types of urinary catheter in reducing infection were considered. 3 small, and relatively old, studies were identified. In one study from 1996, 12 patients tested out silver and silicone impregnated catheters, swapping betwixt the catheter types every two weeks. In a randomised controlled trial from 1979, 21 patients used either PVC or latex or silicone catheters; some other trial from 1991 randomised 69 patients to hydrogel or silicone coated catheters.

what nigh agin events such as bleeding or discomfort?

Dishearteningly, all participants in all studies had CAUTI: no type of catheter was shown to significantly reduce rates of infection (though in the 1991 study, in that location is a possibility that hydrogel coated catheters afforded more protection than silicone blanket).

The authors of the review conclude that the studies were too small-scale, the confidence intervals were too broad to provide reliable evidence. Chiefly, the studies but considered rates of CAUTI: what about agin events such as haemorrhage or discomfort?

Are urinary catheter washouts effective?

I still call back the humiliation as a fairly new nurse on a neurosurgical ward when a senior nurse ordered me to finish performing a catheter washout. She spoke with authorization; I feared I had somehow inflicted harm.

Opinion remains divided about catheter washouts (Healthtalk, 2022). I take seen catheter blockages causing pain and distress; washouts, however, can cause bleeding through trauma. In a Cochrane Review, concern is expressed that "use of washouts can damage the bladder mucosa and increase infection rates due to opening the closed catheter system" (Shepherd et al, 2022: 7). The same review acknowledges that blood pressure changes and float spasms can too event.

3 cross-over studies and 4 randomised controlled trials were identified, comparison catheter washout versus no washout, or determining the relative merits of different washout regimens (saline, weak acrid, strong acrid and antimicrobial solutions were all included).

Methodological problems were, however, identified in the studies: some cross-over trials were based on between grouping differences rather than on private participant's differences for sequential interventions, some studies were small and i study mixed results for both suprapubic and urethral catheters. No trial considered patient satisfaction or condolement.

The authors conclude that "insufficient data exists providing reliable bear witness virtually the benefit or harms of washout policies". If proven beneficial, further questions include necessary frequency, timings and volumes of catheter washouts.

How oftentimes should a urinary catheter be changed?

nurse emptying a urinary catheter

Cochrane reviews confirm that defoliation continues to surround urinary catheter intendance

Every bit a nurse, I have witnessed a variety of unlike time intervals advised for catheter replacement: some settings advise strict adherence to a three monthly change policy, others advise change when clinically indicated. Frequent catheter change may reduce biofilm development that can harbour leaner; it may also crusade trauma that could contribute to infection (Cooper et al, 2022).

A recent Cochrane Review struggled to notice enlightenment in this area (Cooper et al, 2022): only one all-male study from 1982 was identified (n=17). When considering incidence of symptomatic CAUTI, no significant difference was found between those in whom catheters were changed simply when clinically indicated, and those in whom catheter changes occurred monthly too every bit when clinically indicated.

Further studies are needed, and they should also consider financial implications: are the increased costs of more frequent catheter changes offset by the savings resulting from reduced use of float washout solutions?

Whatsoever advantages to antibiotics?

Antibiotic prophylaxis at time of catheter alter is a controversial question. One small, underpowered report with inconsistent data showed no pregnant benefit of administering intravenous meropenem thirty minutes before catheter alter (Firestein, 2001).

A Cochrane review addressed the antibody question, just mainly with regards to intermittent catheterisation, which is not the focus of this article (Niël-Weise, 2022); the one included report in which urethral catheters were considered showed that antibiotic prophylaxis did reduce rates of CAUTI. The report was, however, small (n=34, with 11 participants not completing). Results also warned of antibiotic-induced development of resistant organisms: a well-known phenomenon that is threatening modernistic medicine (Cowan, 2022).

Confusion continues to surround catheter care

Cochrane reviews ostend the defoliation that surrounds catheter intendance. The questions are endless: does the home or the clinical environment provide the optimum setting for catheter care? Is catheter replacement a clean or an hygienic technique? Is chlorhexidine superior to saline for periurethral cleansing? Which lubricants should exist used? Are better outcomes achieved when patients or healthcare professionals manage their catheter care?

Until rigorous, adequately powered randomised controlled trials answer these questions – and specifically the questions that matter most to patients – catheterisation volition continue to be associated with bewilderment and blood, sweat and tears on all sides.

Helen Cowan has goose egg to disclose. Views are Helen's ain.

References may be found hither.