Indwelling Catheter Management: From Habit-based to Evidence-based Practice
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A disadvantage of silicone catheters is the permeability of the balloons, resulting in loss of fluid over time18; silicone balloons should be checked regularly, adding fluid as needed. Another disadvantage of silicone catheters is the tendency of the balloons to form creases or cuffs when deflated, which can lead to painful and difficult removal.10,13 Finally, patients may complain that silicone catheters are firmer and cause more discomfort than softer latex catheters.
Silicone-elastomer. Silicone-elastomer coated catheters are sometimes confused with 100% silicone catheters; these catheters are actually latex catheters coated inside and out with silicone. The difference between silicone-coated and 100% silicone catheters is worth noting for two reasons: 1) patients who are latex-sensitive should be managed with all-silicone catheters, not silicone-coated catheters, and 2) patients who are not latex-sensitive may prefer silicone-coated catheters to all-silicone catheters because these catheters combine the strength and flexibility of latex with the durability and reduced encrustation typical of all-silicone catheters.
Hydrogel coating. Hydrogel-coated catheters (eg, Lubricath®, C.R.Bard, Inc. Covington., Ga.) are soft and highly biocompatible. Because they are hydrophilic, they absorb fluid to form a soft cushion around the catheter; thus, reducing friction and urethral irritations.
Antimicrobial coatings. The newest technology involves the use of antimicrobial coatings designed to reduce bacterial attachment, colonization, and migration with the goal of preventing catheter-associated urinary tract infection (CAUTI) and nosocomial urinary tract infections (NUTI). One type of coating combines a thin layer of silver alloy with hydrogel (Bardex® IC, C.R. Bard, Inc. Covington, Ga.). Multiple studies have shown this coating to be effective in reducing CAUTI without causing bacterial resistance.3,19 A randomized double blind study of 850 catheterized patients demonstrated that use of these catheters for up to 20 days provided a 30% reduction in CAUTI.3 Numerous randomized studies support the effectiveness of these catheters against NUTI3,19; as yet, these catheters have not been studied in patients with long-term indwelling catheters to determine efficacy and cost effectiveness. Silver-hydrogel coated catheters are available in latex and silicone.
A catheter coated with nitrofurazone is also available. Studies have shown that this catheter (Release-NF, Rochester Medical, Stewartville, MN) can reduce UTI rates for up to 7 days; however, they failed to provide a significant reduction in infections caused by organisms resistant to nitrofurazone, and clinicians are concerned that this coating could lead to selective antimicrobial resistance.3
The prevailing guideline for catheter size is to use the smallest diameter that will provide good drainage, typically a 14 to 18 French unless the patient has blood clots or sediment that occlude the lumen. Larger catheters are uncomfortable for the patient, can lead to urethral erosion, and impair paraurethral gland function. The paraurethral glands produce mucous that protects against ascending bacteria; compression of these glands can result in urethritis or ascending infection.20 Nurses commonly ask about management of a patient who already has a large catheter (>18 French) in place. In this case, the catheter should be downsized with each catheter change until the catheter is in an acceptable size range.
Straight-tipped versus Coude-tipped Catheters
For routine catheterization, a straight-tipped catheter should be used. Coude-tipped catheters have a firm, curved tip designed to negotiate the male prostatic curve and may be helpful for difficult insertions.
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