Catheters are useful for draining urine from the bladder for patients who may be experiencing difficulty with voiding, such as those who have urinary incontinence or those who have had surgery that made a catheter necessary, such as prostate or gynecological surgery, according to the National Institutes of Health. Patients with medical conditions such as multiple sclerosis, a spinal cord injury or dementia are often cathetered as well.
Catheters are prescribed for either long-term or short-term use. They come in a variety of sizes and materials, such as latex, silicone and Teflon. The three main types of catheters are indwelling catheters, condom catheters and intermittent or short-term catheters. Generally, the smallest possible catheter is used.
However, when used inappropriately, catheters can cause complications such as cystitis, pyelonephritis, bladder stones, bladder spasms, bacteremia or renal damage. A catheter-associated urinary tract infection is caused by bacteria that enter the urinary tract along the foreign body.
“In the past we haven’t really weighed the risks versus the benefits to the patient of having a catheter,” said Dr. Mark Dougherty, an infectious disease physician with Lexington Infectious Disease Consultants. “But now we are asking: Is it really worth placing the patient at risk for a potential bloodstream infection from a Foley catheter to get the information we’re getting in terms of monitoring urine output? What is the risk versus the benefit of putting a Foley catheter in versus not putting it in at all or getting it out earlier? Does the patient who’s immobile really require a Foley catheter?” Alternatives in the latter case include a bedpan, a bedside commode or Depends adult diapers.
Dougherty said in some instances, nurses assess the necessity of inserting a catheter, with physician input. “In some of the hospitals where we work, we’ve instituted a program where a nurse on the floor is responsible for every patient on that floor that has a Foley catheter,” he said. The nurse is responsible for determining the patient’s need for the catheter. The nurse also discusses with the physician when it is best to remove the catheter from the patient.
“We’re trying to raise awareness of appropriate catheter use,” Dougherty said. “This might be somewhat of an exaggeration, but (in the past) almost every patient going to the ICU had a Foley catheter put in just because they got admitted to the ICU. That’s extreme, but it’s probably not too far off.”
Patients would also likely have a bladder catheter placed for most surgeries, whatever it entailed, unless it was a relatively brief surgery. This practice is being revisited.
“Now we discuss those issues with the surgeon and we say, ‘Is it really necessary to have the Foley catheter in? Are we really gaining enough benefit out of it to justify the potential risk?’” Dougherty said. “And in a lot of cases, the answer is ‘No, we’re not, and we need to leave the Foley catheter out.’ We’re using many fewer Foley catheters in surgery now than in the past, and we are encouraging the removal of all Foley catheters as soon as possible to reduce the risk of complications.”
By Tanya J. Tyler, Associate Editor, Kentucky Doc Magazine