In an ideal world, patients who have a problem with continence would not have to resort to an
indwelling catheter to keep dry. As catheterisation is an invasive procedure, the introduction of a foreign body into the bladder puts the patient at risk of a number of complications, such as infection (Kleinpell et al, 2008; National Institute for Health and Care Excellence [NICE], 2012), encrustation or catheter blockages (European Association of Urology, 2012). It is good practice, therefore, to ensure that alternative management strategies, i.e. conservative treatment such as pelvic floor exercises (NICE, 2015), bladder retraining, intermittent or self-catheterisation (ISC), are explored before resorting to an indwelling catheter (Mercer Smith, 2003; Fenelly et al, 2015).
However, for some patients, long-term catheterisation is the only way they can be managed effectively,
Understanding long-term catheterisation for effective bladder drainage
either by inserting a catheter into the bladder via the urethra or a suprapubic incision. Reasons for this include (Geng et al, 2012):
Acute or chronic urine retentionNeurological disorders that affect sensation or control of micturitionThe need to accurately measure urinary output in critically ill patientsPerioperative use for certain surgical procedures
Prolonged length of surgery and intraoperative monitoringTo help open or sacral wounds heal in patients who are incontinentPatients who need prolonged immobilisationBladder irrigationTo prevent skin breakdown in intractable incontinenceTo promote comfort and dignity for patents at the end of lifeAcute urine output monitoringDetrusor failureBladder irrigation after urology surgery.
Caring for patients with long-term catheters can be challenging both to healthcare professionals and carers, and, indeed, patients themselves (Moore et al, 2009). Complications of long-term catheterisation include (Gibney, 2016):
Rachel Leaver, practitioner, urological care, University College Hospital; lecturer, London South Bank University
Patients in the community often have a long-term catheter in place and so their management inevitably becomes the responsibility of community nurses. As urinary incontinence can cause patients discomfort and have a negative impact on their day-to-day life, it is important that healthcare professionals understand the reasons
available, such as urethral and suprapubic, in order to provide patients with the most suitable device according to their needs and lifestyle. This paper explores the issues involved with indwelling catheterisation and looks at one new product range that aims to promote patient comfort and reduce associated risks.
THE SCIENCE — COMMON BLADDER SYMPTOMSSymptoms of bladder dysfunction include:
A sudden urge to go to urinate or difficulty ‘holding on’ is a symptom of urgency or urge incontinenceNeeding to urinate more than eight times in a single day can be a sign of urinary frequencyNocturia is signalled by repeated urination through the night; nocturnal enuresis is wetting the bed at nightUrination upon laughing, coughing, sneezing or exercise is a symptom stress urinary incontinence (SUI)Mixed incontinence is when an individual has symptoms of both stress and urge incontinenceOverflow incontinence is signalled by small leakages of urine that are not noticed by the individual.
Source: Bladder and Bowel Foundation: www.bladderandbowelfoundation.org
onitoringnitoringor sacral wounor sacral wounts who ts wh
44 JCN 2017, Vol 31, No 5
CONTINENCE
Bladder pain Bladder stones Difficult removal of the catheter.
Chronic infection may lead to kidney infections (pylonephritis) and kidney damage, and, as all patients with long-term catheters have bacteriuria (bacteria in their urine, whether symptomatic or asymptomatic), they are also at risk of septicaemia (Fenelly et al, 2015).
CHOOSING THE RIGHT CATHETER
The Foley indwelling catheter is the most common design of catheter generally used for both urethral and suprapubic catheterisation. It was first described by Frederick Foley in the 1930s and since then very little has changed in the design. However, what has changed are the materials used to manufacture the catheters (Fenelly et al, 2015). These continue to evolve in the quest to find the ideal catheter, which will not cause the user problems or at least minimise them. Healthcare professionals should be aware of the different types of catheter available and make sure that they select the best catheter for each individual patient. There is a huge choice of catheters available on the market nowadays, but looking at some of the evidence available can help with making an informed choice.
Catheters are made from a number of materials such as latex, silicone, hydrogel or polytetrafluoroethylene (PTFE)-coated latex or pure silicone. A number of studies over the years have been carried out to determine the best material to reduce urethral trauma and improve bladder drainage, as well as combat UTI and subsequent encrustation and bypassing (Fenelly et al, 2015). Bacterial activity is the main cause of the problems with blockage and encrustation (Gibney, 2016). If a
consequently formation of biofilms and encrustation occurs later than on other catheter material (Morris et al, 1997; Tunney and Gorman, 2002; Verma et al, 2016).
However, on the negative side, when deflating the balloon to remove or replace the catheter, there can be more ‘cuff’ formation around the bottom end of the deflated balloon where it is attached to the catheter tip because of ‘creeping’ of the material. This cuff means that the catheter tip is no longer smooth and the ridge formed by the cuff can catch internally and hinder removal. While all types of catheters result in cuffing, silicone catheters are usually the most difficult to remove, especially suprapubically (Parkin et al, 2002). Removal may need more force than a softer latex catheter, resulting in pain and trauma for the patient (Robinson, 2003a; Evans et al, 2001; Lawrence and Turner, 2006b).
InnovationInnovation in catheter manufacturing focuses on tackling these universal problems, with new products becoming available on the market for healthcare professionals to try. One example are those by LINC Medical, with their Unibal® technology where the balloon is integral to the catheter itself with no bonded parts, promising a smoother insertion and removal and thus less trauma to the urethra (see p. 47). There are also catheters on the market which have coatings bonded to their surface specifically to try to minimise or delay urinary tract infection. Other innovations are the use of antimicrobial coatings on Foley catheters, such as impregnation with antibiotics or antimicrobial agents, with the aim of reducing infection and consequently encrustation and blockage (Stickler and Morgan, 2008).
catheter is left in for longer than 5–7 days, all catheterised bladders show an increase in bacteria in the urine, no matter what material or coating is used, although some materials are more resistant than others. However, after 30 days, these differences disappear and all patients have bacteriuria (Lee et al, 2004; Fenelly et al, 2015). Patients may not necessarily have symptoms, so may not need treatment, but they will still carry a bacterial load.
CATHETER MATERIALS AND BIOFILMS
The uneven surfaces of catheters allow bacteria in the urine to colonise catheters and form biofilms on both the internal and external catheter surface (Tunney and Gorman, 2002; Stickler et al, 2003). Studies have shown that silicone catheters are the smoothest when examined under electron microscopes. However, all catheters, including silicone ones, have cracks and uneven surfaces, which is down to the manufacturing process and the bonding of the catheter coatings to the latex base (Lawrence and Turner, 2006a). Bacteria attach themselves in these areas and rapidly multiply forming a thick matrix known as a biofilm. Once within the biofilm, bacteria are protected and very resistant to antibiotics or catheter maintenance solutions (Gibney, 2016).
Thus, even if treated, the bacteria may then reseed and infect the urine again (Ford et al, 2017). Ultimately, the bacterial activity results in a change in the pH of urine, making it more alkaline. Research has shown that urea-splitting bacteria such as Proteus mirabilis result in more alkaline urine (Stickler and Morgan, 2008). This alkalinity allows crystallisation of salts in the urine, which congregate around the area of the catheter tip and eventually build up to form encrustation which, in turn, leads to blockage of the ‘eyes’, i.e. the drainage holes at the catheter tip, resulting in urine bypassing and/or retention of urine (Gibney, 2016). A good flow of urine has been shown to prevent or delay encrustation. Silicone catheters usually have a larger lumen and kink less and so allow better drainage (Lawrence and Turner, 2006b), and
Practice point
Urinary incontinence can cause social isolation, distress, low self-esteem and possible mental health issues (All Party Parliamentary Group for Continence Care [APPCGG], 2013), thus choosing a treatment option with which the patient feels comfortable is vital.
Remember...
Always choose catheters for: Comfort Ease of insertion Ease of removal (Evans et al,
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Farco-fi ll Protect is a sterile solution for infl ating the catheter balloon. It contains an antimicrobial agent that can reduce encrustations, which are a common cause of catheter blockage.1
In a 4-week clinical evaluation of Farco-fi ll Protect in patients with a history of blocking, catheter wear-time was increased by an average of ten days, no catheter maintenance solutions were required and the total cost of prescriptions was reduced by 57%.2
Up to 50% of long-term catheterised patients experience catheter blockage due to encrustation.3 Help to reduce blockages with Farco-fi ll Protect.
Find out more at www.clinimed.co.uk
CliniMed Careline: 0800 036 0100
1. Sperling H, et al. Der Urologe 2014;53:1512–1517. 2. CliniMed. Data on fi le. 3. Getliffe K. J Wound Ostomy Continence Nurs 2003;30:146–151.
Farco-Fill® Protect is a registered trademark of FARCO-PHARMA GmbH, Gereonmühlengasse 1–11, 50670 Köln, Germany www.farco-pharma.de and is distributed in the UK by CliniMed Ltd.
It is important to note, however, that most studies have shown that these latter types of catheters mainly work in patients in the short term (Johnson et al, 2006).
SUPRAPUBIC CATHETERS
For some patients, long-term suprapubic catheterisation may be the preferable option. It is seen as having fewer complications than urethral catheterisation and allows the patient more dignity, comfort and convenience when it comes to caring and changing the catheter (NHS, 2009). However, as previously said, they are not problem-free and complications such as UTIs, urine leakage around the abdominal catheter site or from the urethra, and bladder spasms are common (Addison and Mould, 2002). They are also prone to infection around the catheter site and granulation of tissue in this area, which can lead to pain and difficulty with catheter removal. This is not helped by catheter balloon cuffing.
Long-term complications for suprapubic catheters are identical to those of urethral catheters and there is the increased risk of stone formation. Patients who have suprapubic catheters long term have also been found to have thick debris and metaplastic changes in the bladder and there is some debate as to whether they should have regular cystoscopic surveillance, especially as all patients with urinary catheters in place are ultimately also at high risk of bladder cancer with long-term use (El Masri et al, 2014). Healthcare professionals need to be aware of this and anticipate problems. If patients
EDUCATING OTHER HEALTHCARE PROFESSIONALS
Gibney (2016) states that nurses are in an ideal position to improve catheter management. She recommends standardising practice and disseminating evidence to healthcare professionals to ensure that all who look after catheters are aware of the importance of regularly reviewing patients with catheters in place, monitoring urine pH, monitoring the patient’s fluid intake and encouraging citric drinks, as well as assessing the need and efficacy of using catheter maintenance solutions. Choosing the right catheter and maintenance products should also be part of the strategy to reduce complications and less crisis management and distress for patients and carers.
CONCLUSION
Caring for patients with long-term catheters can be challenging for community nurses. Long-term catheterisation leads to inevitable problems, requiring nurses to have the knowledge and skills to be proactive in care as well as being able to offer effective solutions for problems when they arise. Understanding the causes of these problems is key, as is keeping up to date with new research and innovations in catheter manufacture in order to minimise complications and improve the quality of patients’ day-to-day life.
are allergic to latex, the use of silicone catheters is the only option, and hopefully, newer products such as Uni-Flo® (LINC Medical), will make this a less traumatic experience for the patient.
EDUCATING THE PATIENT
Besides choosing the best catheter for the job, healthcare professionals should also educate the patient and carers on catheter care and personal hygiene and the importance of good fluid intake to ensure steady flow of urine through the catheters. Good flow has been shown to reduce infection and consequently encrustation and blockage. Catheter maintenance solutions may be used to irrigate the catheter and dissolve the encrustation, which may help prolong the life of the catheter. Some healthcare professionals advocate regular washouts with chemical solutions (e.g. Opitflo® G [Bard]), or normal saline (Gibney, 2016). However, Moore et al (2009) found no significant difference between carrying out regular washouts or not on patients with long-term catheters, and the reality is that their efficacy may differ from patient to patient (Moore et al, 2009).
It is well known that certain patients are often labelled as ‘blockers’, while others are ‘non-blockers’ (Gibney, 2016). This refers to the fact that despite all precautions and regular washouts, some patients will regularly have catheter blockages. In these cases, the only strategy would be to change the catheter routinely to pre-empt blockage (Moore et al, 2009). Encouraging the patient to consume lemon/citric-based drinks may also help reduce the alkalinity of urine, and thus lower the pH. Patients could also be advised to trial an open-tipped catheter, such as Supra-Flo® or Opti-Tip® catheters (LINC Medical), as they promote more drainage compared to standard catheters. Eating a healthy diet and drinking more fluids will prevent constipation, which may also impact on the flow of urine (Gibney, 2016). Gibney (2016) also advises monitoring when a patient’s catheter is prone to blockage and advocates proactive catheter changes to avoid crisis blockages.
Practice point
The Foley catheter is a hollow drainage tube that is held in the bladder by a small water-filled balloon. It is known as an indwelling catheter and is designed to remain in place for some time (Bard, 2004). There are two types of Foley catheters:
Urinary: where the tube is passed through the urethra to the bladder
Suprapubic: where the tube is passed through the lower abdominal wall to the bladder (Fenelly et al, 2015).
Red Flag
Catheters may not be suitable if the patient:
Has a high risk of developing a serious infection due to a heart defect, having only one kidney, being immunosuppressed or other medical issue (Pratt et al, 2007)Is disoriented or has cognitive impairment and so might pull the catheter out (Fenelly et al, 2015).
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JCN 2017, Vol 31, No 5 47
CONTINENCE
Table 1: Innovative tips in the LINC Medical catheter range
Opti-Tip
A new design that moves the balloon closer to the open catheter tip to prevent damage to the bladder mucosa and reduce spasms. There are also two extra eye holes below the balloon to allow drainage of residual urine
Uni-Flo Xtra A round tip catheter with eye holes above and below the balloon for extra urine drainage
Uni-Flo A round tip catheter for easy insertion. Removal is made easier by the ‘Unibal’ integral balloon with no bonded parts
Supra-Flo An open-tipped catheter that allows extra drainage for patients who are prone to blocking
LINC Medical is a family run company, which believes in producing quality products and ensuring that its experienced sales team build up one-to-one relationships with healthcare professionals to provide the best possible education and training about their products and listen to what their customers want. Their mission statement is to:... provide innovative solutions to today’s healthcare challenges.
The LINC all-silicone catheter range has been designed with an integral balloon within the lumen (tube) and innovative tips, to aid patient comfort and reduce the risk of problems occurring. Being silicone as opposed to latex, means that:
The lumen is bigger than on latex catheters to help urine drainage (Lawrence and Turner, 2006b)
The risk of catheter associated urinary tract infection (CAUTI) is reduced, as silicone has shown less bacterial colonisation than silicone-coated latex, and reduced biofilm (Verma et al, 2016)
Linc catheters are suitable for more people, as just under 1% of the population may be allergic to latex (Charous et al, 2002).
As said, LINC catheters also have the ‘Unibal’. This is an integral balloon which remains within the lumen and is level with the surface of the catheter, as opposed to most catheter balloons, which are 1–2mm wider than the catheter (Robinson, 2003b). This helps to:
Reduce cuffing upon catheter insertion and removal, following deflation
Make the tube slimmer and thus more comfortable to insert and remove.
In the Opti-Tip catheter, the tip design also:
Decreases the risk of damage to the bladder wall, due to the short distance from the catheter tip to the balloon. Case reports have shown that this can reduce the risk of CAUTI.
LINC Medical catheter range
Catheter balloon defusion, where the balloon once inflated slowly deflates, is another issue that LINC Medical have addressed. One hundred percent silicone catheters are inflated with sterile water that slowly passes through the balloon membrane (osmosis), and so slowly reduces the original balloon infill volume. To overcome this problem, LINC Medical includes within its 100% silicone catheters, a sterile pre-loaded syringe containing a 5% aqueous glycerine solution (the 12 Charriere [Ch] and 14 CH sizes have a 5ml syringe, and the 16 Ch and above a 10ml syringe).
These catheters also have a number of new tips (Table 1) to help patient comfort, lessen pain and reduce the risk of infection. The range also includes a round tip with extra holes below the balloon to assist with problematic drainage.
New technology with integral balloon promotes ease of use and patient comfort.
New Opti-Tip catheter.
LumenLumen
12 Ch12 Ch
14 Ch
Competitorcatheter:externalballoon
LINC catheter: integral balloon
LINC solution: integral balloon
Balloon moved closer to tip to reduce bladder wall damage
Holes below balloon encourage drainage of residual urine
Addison R, Mould C (2002) Risk assessment in suprapubic catheterisation. NursStandard 14(36): 43–6
All Party Parliamentary Group for Continence Care (2013) ContinenceServices. England. Survey Report. Available online: www.appgcontinence.org.uk/pdfs/Continence%20Care%20Services%20England%20Report%202013.pdf
Charous BL, Blanco C, Tarlo S, et al (2002) Natural rubber latex allergy after 12 years: Recommendations and perspectives. J Allergy Clin Immunol 109(1): 31–4
El Masri WS, Patil S, Prasanna KV, Chowdhury JR (2014) To cystoscope or not to cystoscope patients with traumatic spinal cord injuries managed with indwelling urethral or suprapubic catheters? That is the question! SpinalCord 52: 49–53
European Association Urology (2012) Catheterisation: indwelling catheters in adults. Available online: www.nursing.nl/PageFiles/11870/001_1391694991387.pdf
Evans A, Godfrey H, Fraczyk L (2001) An audit of problems associated with urinary catheter withdrawal. Br J Community Nurs6(10): 511–19
Fenelly RCL, Hopely IB, Wells NT (2015) Urinary catheters: history, current status, adverse events and research agenda. JMed Engineering Technol 39(8): 459–70
Ford J, Hughes G, Phillips P (2017) Literature review of silver-coated urinary catheters. Medidex Medical Device Index. Available online: www.medidex.com/research/856-silver-catheter-review-2016-update.html (accessed 11 October, 2017)
Geng V, Cobussen-Boekhorst H, Farrell J, et al (2012) Catheterisation: indwelling catheters in adults. European Association of Urology Nurses, The Netherlands
Gibney LE (2016) Blocked urinary catheters: can they be better managed? Br J Nurs 25(15): 828–33
Johnson JR, Kuskowski MA, Wilt TJ (2006) Systematic review: antimicrobial urinary catheters to prevent catheter-associated urinary tract infection in hospitalized patients. Ann Intern Med 144(2): 116–26
Kleinpell RM, Munro CL, Giuliano KK
Having read this article,
Why some patients need indwelling catheterisation
How you choose the right catheter for your patients
Your knowledge of suprapubic catheters.
Then, upload the article to the free JCN revalidation e-portfolio as evidence of your continued learning: www.jcn.co.uk/revalidation
RevalidationAlert
(2008) Targeting health care–associated infections: evidence-based strategies. In: Hughes RG, ed. Patient Safety and Quality: an evidence-based handbook for nurses. Agency for Healthcare Research and Quality, Rockville, USA: Chap 42
Lawrence EL, Turner I G (2006a) Characterisation of the internal and external surfaces of four types of Foley catheter using SEM and profilometry. J Mater Sci: Mater Med 17: 1421–31
Lawrence EL, Turner IG (2006b) Kink, flow and retention properties of urinary catheters part 1: Conventional foley catheters. J Materials Sci: Materials in Medicine 17: 147–52
Lee S, Kim AW, Cho Y, et al (2004) A comparative multicentre study on the incidence of catheter-associated urinary tract infection between nitrofurazone-coated and silicone catheters. Int J Antimicrob Agents 24S: S65–S69
Mercer Smith J (2003) Indwelling catheter management: from habit-based to evidence-based practice. Ostomy Wound Management 49(12): 34–45
Moore K N, Hunter K F, McGinnis R, et al (2009) Do catheter washouts extend patency time in long-term indwelling urethral catheters? A randomised controlled trial of acidic washout solution, normal saline washout, or standard care. J Wound, Ostomy Continence Nurs 36(1):82–90
Morris NS, Stickler DJ, Winters C (1997) Which indwelling urethral catheters resist encrustation by Proteus mirabilis biofilms? Br J Urol 80: 58–63
National Institute for Health and Care Excellence (2012) Healthcare-associated infections: prevention and control in primary and community care. NICE, London. Available online: www.nice.org.uk/guidance/cg139
National Institute for Health and Care Excellence (2015) Urinary incontinence: the management of urinary incontinence in women. NICE, London. Available online: www.nice.org.uk/guidance/qs77
NHS (2009) Rapid Response Report: Minimising risks of suprapubic catheter insertion (adults only). National Patient Safety Agency. Available online: www.nrls.npsa.nhs.uk/resources/patient-safety-topics/medical-device-equipment/?entryid45=61917&q=0%c2%acsuprapubic+catheter%c2%ac
Parkin J, Scanlan J, Woolley M, Grover D, Evans A and Fenely RCL (2002) Urinary catheter ‘deflation cuff’ formation: clinical audit and quantitiative in vitro analysis. BJU International 90: 666–71
Pratt RJ, Pellowe CM, Wilson JA, et al (2007) epic2: National evidence-based guideline for preventing healthcare-associated infections in NHS hospitals in England. JHosp Infect 65 Suppl 1: S1–64
Robinson J (2003a) Suprapubic catheter removal: the cuffing effect of deflated catheter balloons. Br J Community Nurs8(5): 205–8
Robinson J (2003b) Deflation of a Foley catheter balloon. Nurs Standard 17(27):33–8
Stickler D, Young R, Jones G, Sabbuba N, Morris N (2003) Why are Foley catheters so vulnerable to encrustation and blockage by crystalline bacterial biofilm? Urol Res 31(5): 306–11
Stickler DJ, Morgan SD (2008) Observations on the development of the crystalline bacterial biofilms that encrust and block Foley catheters. J Hosp Infect 69: 350–60
Tunney MM, Gorman SP (2002) Evaluation of a poly(vinyl pyrollidone)-coated biomaterial for urological use. Biomaterials23: 4601–08
Verma A, Bhani D, Tomar V, Bacchiwal R, Yadav S (2016) Differences in bacterial colonization and biofilm formation property of uropathogens between the two most commonly used indwelling urinary catheters. J Clin Diagn Res 10(6): PCO1–PCO3
1 Data on file: Assessing the Effectiveness of 3M™ Cavilon™ Durable Barrier Cream versus Medi DERMA-S® Barrier Cream. 2016.2 Data on file: Assessing the Effectiveness of 3M™ Cavilon™ Durable Barrier Cream versus Sorbaderm® Barrier Cream. 2016.3 Beeckman D et al. Proceedings of the Global IAD Expert Panel. Incontinence-associated dermatitis: moving prevention forward.
Wounds International 2015.4 3M data on file 2011: LIMS 6766
Does your barrier cream work as hard as you do?
Barrier effectiveness
In the presence of moisture, barrier creams should resist removal, providing peace of mind that your patient’s skin is protected.
The bottom line...
3M™ Cavilon™ Durable Barrier Cream
remains on the skin even after water
exposure1,2
Cost-effectiveness
Cost in use, rather than unit cost, is the most accurate measure of the cost-effectiveness of a barrier cream.
The bottom line...
3M™ Cavilon™ Durable Barrier Cream
is significantly more cost effective over
time than DERMA-S® Barrier Cream and
Sorbaderm® Barrier Cream
6p42pCost/day/patient
36p Cavilonsaving
Cost/day/patient
6p42pCost/day/patient
Scenario based on 3 incontinence episodes in a 24 hour period.Assumes 2g of product applied. Calculation is a factor of cost per gram, application quantity and application frequency. Price taken from Drug Tariff October 2017.
Impact on adhesion
A good barrier cream should protect and hydrate the skin without reducing the adhesion of medical devices such as tapes and dressings.
The bottom line...
Unlike some barrier creams,
3M™ Cavilon™ Durable Barrier Cream does
not reduce the adhesion of dressings1,2
Global skin care experts3 recommend that
the products you choose to prevent and
treat sore skin caused by incontinence
should have the following characteristics:
Clinically proven to help IAD
Close to skin pH
Low irritant
No sting
Transparent or easy to remove
Does not increase skin damage
No interference with incontinence management products
Compatible with other products
Accepted by patients, residents, clinicians and caregivers
Minimises products and time required
Cost-effective
Hard working protection
• Safe to use on intact and injured skin
• Durable long-lasting protection – apply morning and evening as part of a daily skin care routine
• Concentrated – apply sparingly in pea-sized increments
• Easily absorbed into the skin – allowing easy visualisation of the skin
• No need to remove between applications – saving time and improving patient comfort
• Will not block incontinence pads or transfer to bedding/clothing
• Allows tapes to stick – does not decrease tape or dressing adhesion4
3M™ Cavilon™ Skin Care Products have them all
3M™ Cavilon™
Durable Barrier Cream
3M Ireland Limited
The Iveagh Building,The Park, Carrickmines,D18 X015Ireland
+353 (0)1 280 3555
www.3M.co.uk/cavilon
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CONTINENCECONTINENCE
Urinary continence is the first thing we are actively taught to achieve as infants, this is usually accompanied by huge amounts of praise from parents when we are successful. When there is any malfunction of the lower urinary tract (LUT) resulting in either incontinence or retention, it can have a profound effect not only on an individual’s physical health, but also on their psychological health — they lose confidence in themselves and often withdraw from social situations, which can lead to depression. All too often district nurses are asked to perform assessments with the intention of providing patients with pads to contain their incontinence, rather than treat it. Pads, unfortunately (although occasionally the only option available for some individuals), reinforce the patient’s feelings of ‘being a child’.
While conservative treatments are extremely effective in the majority of cases when support is available — and district/community nurses are well placed for giving this support — unfortunately, as this article states, not all patients are suitable for conservative measures of treatment and the use of a long-term urethral or suprapubic catheter may be the only option to maintain their general physical and mental health.
The complications of indwelling urinary catheters are well documented. I was made aware of one particular problem early in my career as a specialist nurse, and this was that silicone catheters, due to their external balloon, made removal of the catheter extremely difficult through the suprapubic fibrous stomal tract.
It was then, and remains, one of the main reason people with suprapubic catheters are referred to me by primary care teams. Generally, hydrophilic-coated latex catheters were used as an alternative, but as the internal lumen in a latex catheter is 2 Charrier (Ch) smaller than that of a silicone catheter, they are more prone to blockages.
urethral or suprapubic, but also, because of the low profile tip, reduces bladder discomfort and pain, as the tip does not dig into the bladder wall to the same degree as a ‘bullet’ tip catheter when the bladder empties. This company has now brought out the Opti-Tip catheter, which again is open tipped, with the balloon when inflated being almost level with the tip of the catheter, a further two drainage holes lie beneath the balloon. This makes the catheter particularly helpful for those patient with large amounts of sediment. For example,
one of my patients (a long-term user of suprapubic catheters) trialled the Opti-Tip and finds it not only very comfortable, but also that infection rates have dropped by 80% in the nine months of using it.
Another benefit of thiscompany is that their catheters come complete with anaesthetic gel and deflation syringe, as well as the fluid to inflate the catheter balloon, saving money for the community clinical commissioning groups (CCGs).
I totally agree with the author in this article regarding the improvements to patient care which could be achieved through her suggestions around education. However, I feel it would be helpful if there were regular meetings with a multidisciplinary team comprising a community nurse from each practice in a given area, a physiotherapist, community continence advisor and a specialist nurse from the acute setting to increase all our knowledge in this area and, in so doing, increase the care and support of our patients.
Jane Miles, specialist nurse, urology, Frimley Park Hospital
CONTINENCE
LINC Medical open-tipped (bottom) and normal silicone catheter with balloon inflated.
Expert commentary
LINC all-silicone
LINC all-silicone catheters, same size but with a bigger lumen.
Latexcatheter
Sixteen years ago I was introduced to the Supra-Flo catheter (LINC Medical); an open-tipped catheter with the balloon incorporated into the wall of the catheter. This not only reduces trauma on removal, whether it be a
Be a part of our teamEvery day we are changing people’s livesAre you thinking of changing yours?We are looking for dynamic, self-motivated nurses and therapists with a passion for what they do
As a social enterprise focussed on wound care and lymphoedema, having a skill in this area would be valuable but it is not a must have as we will train you in the ‘Accelerate’ way of working
If you need to revitalise your goals and would like to join an organisation that applauds ideas and innovation, Then pick up the phone and give us a call…we’re waiting!
Every day we’re changing people’s lives. See how we can change yours.
