From the Guidelines
Catheter tug is a sensation or discomfort felt when a medical catheter is pulled or moved unexpectedly, causing tension on the insertion site, and can be prevented by securing the catheter properly using appropriate fixation devices like StatLock or adhesive dressings, as recommended by guidelines 1. This commonly occurs with urinary catheters, central venous catheters, or other indwinding tubes when they catch on clothing, bedding, or during patient movement. To prevent catheter tug, it is essential to:
- Secure the catheter properly using appropriate fixation devices like StatLock or adhesive dressings
- Ensure adequate slack in the tubing
- For urinary catheters, attach the collection bag to the bed frame below bladder level, not the bed rail
- For patients with long-term catheters, use leg straps or catheter holders to minimize movement If catheter tug occurs, it is crucial to assess the insertion site for displacement, bleeding, or inflammation, and reposition the catheter and securing devices as needed. Preventing catheter tug is important because tension can cause tissue trauma, increase infection risk, and potentially dislodge the catheter, requiring painful reinsertion and increasing complication risks, as highlighted in the ESPEN guidelines on parenteral nutrition 1. Key considerations for preventing catheter-related complications include:
- Appropriate catheter stabilization using manufactured catheter stabilization devices
- Avoiding routine use of stitches for securing catheters
- Minimizing insertion damage to the vein wall during catheter placement
- Using silicone or polyurethane catheters, which are less thrombogenic than polyethylene or PVC ones
- Positioning the catheter tip in the lower third of the superior vena cava, or at the atrio-caval junction, or in the upper portion of the right atrium 1.
From the Research
Definition of Catheter Tug
- Catheter tug, also known as catheter traction or pull, refers to the force applied to remove a catheter from the body.
- This technique is used in various medical procedures, including the removal of peritoneal dialysis catheters and urinary catheters.
Catheter Tug in Peritoneal Dialysis
- The "pull technique" is a method used to remove peritoneal dialysis catheters, where the silicon tube is pulled out, leaving the Dacron cuffs within the abdominal wall 2, 3.
- This technique has been shown to be safe and effective, with a low risk of infection and complications.
- The appropriate peak force of pull traction for removing peritoneal dialysis catheters is approximately 12-13 pounds 3.
Catheter Tug in Urinary Catheters
- Catheter tug can also be applied to urinary catheters, where the catheter is pulled out of the urethra.
- However, there is limited research on the specific technique and force required for removing urinary catheters.
- One study found that the formation of a "cuff" of residual balloon material can occur when removing all-silicone Foley catheters, which can lead to complications 4.
Complications and Considerations
- The use of catheter tug must be done carefully to avoid complications, such as infection, breakage, and trauma to the surrounding tissues.
- The technique and force required for removing catheters may vary depending on the type of catheter and the individual patient's condition.
- Further research is needed to fully understand the safety and efficacy of catheter tug in different medical contexts.