Catheters are made of different materials depending upon the function and length of time to be in situ (in the bladder). The management of the device needs to be fully understood if problems are to be avoided.

The Foly self retaining catheter has the following functions:

• rests the bladder
• allows swelling to reduce after surgery
• empties the bladder if in retention
• provides an effective management of incontinence

It is important to remember that the rules of basic plumbing need to be applied.  Water will only drain down hill, so make sure the collecting bag is placed below the bladder.  You also need to ensure that there are no kinks in the tubing or pressure from sitting on it or clamping it. 

Each time the collecting device is emptied, wash your hands before and after to reduce the risk of infection to yourself or the carer.

Catheter management and problems

It is essential to drink at least 4 pints of fluid each day to keep urine flowing through the catheter.  If insufficient fluid is taken, the urine gathers debris (urates and tissue from the bladder lining).  These can calcify and lead to stone formation if the catheter is used for long-term management.

During night hours when fluid volume is reduced, the flow through the catheter slows as the debris collects and it may block, leading to retention of urine.

It is also wise to encourage good diuresis at night by increasing fluid intake.  Catheters do not always provide an effective method of management for intractable incontinence.

By-passing can occur if the bladder muscle is unstable.  As it contracts (squeezes down), urine is pushed past the balloon retaining the catheter in the bladder.

The balloon itself may be an irritant, provoking a bladder contraction resulting in by-passing.  If this occurs it may be necessary to reduce the volume of urine in the balloon.

It is important to follow the manufacturers recommendation as to balloon volume.  The catheter of choice should be small in size and use a small balloon.  Sometimes anticholinergic medication may help to resolve the problem

Persistent blocking of the catheter can be resolved by bladder wash out, the very best being by mouth (drinking well) or by a special preparation instilled into the bladder to flush out the debris.  Regular washouts are necessary until the problem is resolved.
 
Bladder spasms can sometimes be helped by medication.  A change of catheter size and or material can help.  Most importantly, the doctor or nurse should make sure that it is correctly in situ.

In terms of incontinence management, the catheter can be problematic and out-weigh the benefits.

ISC (intermittent self catheterisation)

In recent years ISC has come back into vogue as catheter materials have improved.  If the bladder will not empty without help, a small catheter can be inserted through the urethra to facilitate drainage.

You will be asked to do this several times a day to keep the bladder empty to avoid a urine tract infection arising because of the residual urine.  This method of management can be effective at reducing the number of urinary tract infections.

ISC can also be a successful way of managing retention of urine if it is preferred choice for both doctor and patient.

Following epidural anaesthesia

The use of epidural anaesthesia has become common in recent years for relief of pain during child birth; or as a chosen method for people with respiratory problems (asthma, bronchitis); and for those not considered medically fit to undergo a general anaesthetic.

Following this form of anaesthesia, it is important to remember that you will be unaware of a full bladder.  The bladder should not be left full for long periods of time, as it may become over-stretched.  The muscle tone may be lost, and in some cases not regained sufficiently to completely empty the bladder.

20/05/2009