Indications for catheterisation and catheter selection

Table of Contents

1. Introduction
2. Assessing urinary incontinence
3. Indications for Catheterisation
   1. Contra-indications to catheterisation
4. Catheter Selection
   1. Intermittent versus Indwellling?
   2. Catheter Size
   3. Balloon Size
   4. Catheter Length
   5. Charrière size
5. Catheter Material
6. Summary
7. References

Intermittent versus Indwellling?

(c) Sue Woodward

The first consideration should be whether the catheter should be inserted intermittently, either by the patient themselves (intermittent self-catheterisation) or by a nurse or care-giver, or whether the catheter needs to be left in situ in the bladder.

Intermittent catheterisation is considered to be preferable to indwelling catheterisation for a number of reasons, but primarily because of the reduced risk of infection and other complications (Turi et al, 2006).

Task 7

1

Identify possible situations when intermittent catheterisation may be considered. Enter your answer in the box below and then select Check answer. - Long-term bladder drainage, especially for patients with neurological conditions - Post-operative urinary retention - During labour or following caesarean section - Measurement of post-void residual volume if using portable ultrasound is not possible.

While patients requiring long-term help with bladder drainage are often considered for intermittent catheterisation, this technique could be used more widely. There is evidence that intermittent catheterisation has reduced risk of infection in older people following hip replacement surgery, for example (Johansson et al, 2002). It can be used for the management of post-operative urinary retention in a range of patient groups (Bødker & Lose, 2003). Age is also no barrier to intermittent catheterisation (Pilloni et al, 2005), although nurses may be reluctant to consider using the technique and it is rarely used with older people.

Leaving a catheter in situ promotes the development of a biofilm, a living layer of bacteria, on the catheter that can increase the risk of infection. Removing the catheter reduces this risk.

If an indwelling catheter is necessary then it may be better for the patient's quality of life to have a supra-pubic catheter inserted.

Task 8

2

Identify possible situations when a supra-pubic catheter may be advantageous Enter your answer here and then select Check answer. - To enable patients who are wheelchair bound to manage their own catheter - it is easier to access on the abdomen - To promote sexual relationships in patients who are sexually active - To reduce the risk of infection - by removing the catheter from the perineum in females the risk of infection from gut flora can be significantly reduced.

Intermittent and suprapubic catheterisation are discussed further in the learning activity Suprapubic and Clean Intermittent Self-Catheterisation.