From the Guidelines
Long-term urinary catheters are indicated for patients with chronic urinary retention that cannot be managed by other means, such as those with neurological conditions affecting bladder function, anatomical obstructions that cannot be surgically corrected, or end-of-life care where comfort is prioritized. They are also appropriate for patients with severe impairments who cannot manage intermittent catheterization, those with extensive stage 3-4 pressure ulcers contaminated by urine, and individuals with intractable urinary incontinence when all other management strategies have failed. The decision to place a long-term catheter should balance the benefits against significant risks including urinary tract infections, bladder stones, urethral trauma, and catheter encrustation.
Key Considerations
- Silicone or hydrogel-coated catheters are typically used for long-term placement and should be changed every 4-12 weeks depending on the specific catheter type and individual patient factors 1.
- Regular assessment of continued need is essential, as catheter use should be limited to situations where no viable alternatives exist due to the associated complications and impact on quality of life.
- Insertion of indwelling urinary catheters should be adequately secured to prevent movement and reduce urethral traction, and only inserted when essential for patient care, keeping them sterile and using a closed drainage system 1.
Important Factors
- The use of catheter irrigation with antimicrobials should not be routine to reduce or eradicate catheter-associated bacteriuria or urinary tract infections in patients with indwelling catheters 1.
- Catheter irrigation with normal saline should also not be used routinely to reduce catheter-associated bacteriuria, urinary tract infections, or obstruction in patients with long-term indwelling catheterization 1.
From the Research
Indications for Long-Term Catheter Use
- Long-term catheterization is often necessary for patients with incomplete bladder emptying, neurological disorders, or other conditions that affect bladder function 2.
- The decision to use a long-term catheter should be based on individual patient needs and medical history 3.
Factors to Consider for Long-Term Catheter Use
- The risk of catheter-associated urinary tract infections (CAUTIs) is a significant concern for long-term catheter users 4, 3, 5.
- Factors such as catheter material, size, and coating can affect the risk of CAUTIs 3, 5.
- Patient factors, such as urine production and residual urine volume, can also impact the risk of CAUTIs 4.
Strategies to Prevent CAUTIs in Long-Term Catheter Users
- The use of antimicrobial-coated catheters has been shown to reduce the risk of CAUTIs in some studies 3, 5.
- Other strategies, such as increasing fluid intake and reducing residual urine volume, may also help prevent CAUTIs 4.
- Further research is needed to determine the most effective strategies for preventing CAUTIs in long-term catheter users 2, 6.
Catheter Selection and Management
- The selection of a catheter should be based on individual patient needs and medical history 3.
- Catheter management strategies, such as regular cleaning and maintenance, can help reduce the risk of CAUTIs 3.
- The use of aseptic or clean technique for catheter insertion and maintenance may also help reduce the risk of CAUTIs, although the evidence is uncertain 2.