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Catheter rules |
Getting called out at 2am because of a blocked urinary catheter can be annoying, particularly if it is a preventable problem. In palliative care urinary catheters are often needed for home use. The following catheter rules, perpared by Richard Millard, professor of urology, University of NSW, may help us avoid most of the problems associated with home and hospital use of of urinary catheters on our palliative care patients. ~ Andrew Binns
Use an 18 or 20 French gauge silicone or silastic catheter
Silicone catheters encrust less easily and have good lumen size. 18F gives good drainage and few blockages. Catheters over 22F damage the urethra.
Use a 5ml balloon catheter only
A 5ml balloon is adequate to secure the catheter in place and is less irritating to the bladder than a larger balloon. Do not under inflate a larger balloon. Use water only.
Secure dependent free drainage
Water only flows downhill. Make sure tubing cannot kink.
Maintain closed system drainage wherever possible
Every time the system is breached there is a risk of infection. Catheter irrigation is both unnecessary and dangerous for this reason.
Anchor the catheter to the patient's thigh
By preventing both catheter avulsion and yawing, urethral irritation and colonisation is diminished. There is less likelihood of bacteria being carried into the bladder.
Change the catheter every FOUR WEEKS using sterile technique
Despite manufacturers claims, catheters become colonised. It is false economy to make catheters last too long. The money saved is much less than the cost of a course of antibiotics.
Ensure that the patient drinks three litres or more each day
High urine flow reduces infections and encrustation. This is the best way to irrigate a catheter. Get the patient to drink sufficient to make the urine look like gin.
Use anticholinergic agents to suppress bladder spasms
Bladder spasms are the commonest cause of leakage around a catheter and they may be painful. Suppress them with anticholinergics (Oxybutynin/Propantheline).
Take specimens for culture only after sterile change of catheter
Because of catheter colonisation, 50% false positive cultures result from specimens taken from old catheters. A sample taken through a sterile catheter is the only reliable guide to the bacteria in the bladder. Pyuria is always present with a chronic IDC and can be disregarded. There is no justification for routine testing of asymptomatic patients.
Treat only symptomatic, proteus or pseudomonas infections
Treat only significant pure growths which affect the patient. Treat with the simplest antibiotic for 7 to 10 days. Ensure eradication by retesting through a sterile catheter. Persistent or recurrent infections may indicate calculi. Review IVP and catheter management. Only a few patients need prophylactic antibiotics. Use low dose Trimethoprim or Macrodantin as Hiprex and Mandelamine are ineffective in the presence of an IDC.
Get IVP every two years
Don't forget the upper tracts
Look for stones
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