Internal and External Urinary Catheters: A Primer for Clinical Practice
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Index: Ostomy Wound Manage. 2008;54(12):18-35
Internal and external urinary catheters are used to manage urinary incontinence and incomplete bladder emptying. Bladder dysfunction cause determines whether short- or long-term catheter use is required which, in turn, determines whether an indwelling, intermittent, or external catheter should be used. The method of catheterization is based on the underlying bladder condition, the goals of treatment, and gender appropriateness. Complications such as infection (eg, catheter-associated urinary tract infection, sepsis) and its related sequelae have been found to be directly related to length of time of catheter use (eg, women are at greater risk for catheter-associated urinary tract infection when an indwelling catheter is in place >2 weeks); thus, catheter use must be medically justified and in the case of an indwelling catheter, involve the shortest period possible to ensure patient safety and regulatory compliance. Some newer catheter systems include coatings to prevent complications; complications specific to indwelling catheter use include obstruction from encrustations, urethral trauma and erosion, bladder stones and bladder cancer, and, in men, epididymitis. Complications from external catheters may occur when skin condition is compromised. Overuse of catheters has reimbursement ramifications. Numerous guidelines reflect the need for the judicious use of urinary catheters, particularly in long-term care patients. Because evidence-based research on long-term use of these devices is lacking, clinicians should use clinical experience when caring for patients with catheters.
KEYWORDS: urinary catheters, catheterization, complications, protocols, nursing care
Urinary Catheter Use
General indications. Catheters are used primarily to manage two types of bladder dysfunction: urinary incontinence (UI) and urinary retention (UR). Urinary incontinence is the unwanted leakage of urine and may be classified as urgency UI (urine loss following urgency and accompanied by overactive bladder symptoms of urgency and frequency) or stress UI (urine leakage with activity or effort —coughing, laughing, and overflow — due to blockage or obstruction in the urethra from an enlarged prostate, stricture, or pelvic organ prolapse). Catheters may be inserted intermittently into the bladder (intermittent catheterization or IC), placed in the bladder on a more permanent basis (indwelling urethral or suprapubic catheterization), or placed externally (condom catheters for men).
Urgency incontinence in men can be managed with an external catheter (EC); incontinence due to overflow may be managed short-term with an indwelling urinary catheter (IUC) and long-term with IC (see Table 11-5).
Urinary retention may be acute or chronic. Acute UR is the sudden and complete inability to void and requires immediate and rapid bladder decompression with a short-term IUC. An IUC is the preferred short-term method for draining the bladder in persons with acute or postsurgical (urologic or gynecologic) UR. Chronic UR is the ongoing inability to void that usually develops over months. As the bladder slowly stretches, patients may unknowingly adapt to the condition. Voiding involves abdominal straining. Severe chronic UR can expand the bladder to 2 to 3 L and lead to upper tract damage and renal failure. Chronic UR is usually treated with IC.