Urinary Catheter Care for Older Adults

  • Fri, 9/5/08 - 4:54pm
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Author(s): 

Mary H. Wilde, PhD, RN, and Kathryn Getliffe, PhD, RN

INDICATIONS FOR AND PREVALENCE OF URINARY CATHETERS
Indwelling urethral or suprapubic catheters are commonly used to treat urinary retention in those who cannot perform clean intermittent catheterization (CIC) due to limited hand dexterity or alterations in cognition. Retention can be caused by a neurogenic bladder that fails to empty satisfactorily or by obstruction to the bladder outlet.1 People with long-term urinary retention often include those with spinal cord injury/disease, multiple sclerosis, enlarged prostate, or cerebrovascular accident.2-5 Indwelling urinary catheters may be used as well to provide supportive care for those with severe incontinence who cannot manage otherwise, are terminally ill, or need short-term treatment of pressure ulcers. Many of these conditions increase in prevalence with advancing age. Other short-term indications include postoperative care, instillations into the bladder, and monitoring urinary output.1 However urinary catheters are associated with a number of risks or complications, including urinary tract infection, leakage, recurrent blockage, and long-term catheterization should only be considered when alternative care strategies are unavailable or unsuccessful.

Urinary catheter care is a significant clinical issue because of widespread prevalence of the device, and with the increased aging of the population, use is expected to increase. In nursing homes in the United States, it is estimated that about 100,000 people use indwelling catheters,6 or about 7.5-10% of the residents.7 Duration of catheter use in home settings may be rather long, with a median of 3-4 years, with some individuals using them for more than 20 years.3,5,8-10

CATHETER-ASSOCIATED COMPLICATIONS
Prevalence of urinary catheter use and urinary tract infection (UTI) are among the indicators used by the U.S. federal government to monitor quality of care in nursing homes. Because a long-term indwelling urinary catheter contributes to associated morbidity and mortality, catheter use is closely monitored by the Centers for Medicare & Medicaid Services (CMS).11

Individuals using long-term urinary catheters are at risk for many serious complications, some of which may be life threatening, including pyelonephritis, bacteremia, and bladder cancer.12-15 In addition, this population is susceptible to chronic obstructions due to urinary calculi and to periurethral infections, including epididymitis and prostatitis in men.13,16,17

Other than removal of the catheter, little is available to prevent UTI in this population. While bacteria are present in the urine of virtually all who have been catheterized for more than 30 days,18-20 the presence of bacteria may remain asymptomatic. A life-threatening situation can occur if symptomatic UTI is not controlled and develops into deadly sepsis.13,14,17,21,22 Moreover, preventive antibiotic treatment is not feasible as drug resistance develops easily; therefore, antibiotics are reserved for symptomatic infections.16,18,20,23

EVIDENCE FOR PRACTICE
Recent Cochrane systematic reviews indicate that there is a paucity of evidence to guide practice related to catheter care, particularly for people with long-term catheters who need to use them indefinitely. Most research focuses on hospitalized patients with short-term catheter use, and very few randomized clinical trials take place (in short- or long-term users).24,25 The lack of comprehensive research in this area restricts development of guidelines for evidence-based practice to inform and help long-term catheter users. Research on short-term catheter use also is limited.

References: 

References
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