Living with a urinary catheter

Catheter changes

 
Frequency of catheter changes
 
How long an indwelling catheter can be left in place depends on what the catheter it is made of, whether or not the catheter user gets frequent infections and blockages, and each person’s individual situation. Catheters usually stay in place between 2 and 12 weeks. Manufacturers guarantee that a catheter is safe to use for a number of weeks. Stuart said that his catheter had a warranty of 12 weeks, but Hayley said that her silver alloy coated catheter was licensed to be used for only four weeks.
Not all the people we interviewed knew why their doctor had decided to use a catheter made from one material rather than another. Roger was cross that no one could agree on which type of catheter was best for him. He had no idea why he was sometimes given a latex catheter and sometimes a silicone one.
Some people would ideally have liked their catheter to stay in for 12 weeks, but had it changed more frequently because of infections and blockages. The time that a catheter should be left in place is not always clear. Charles said he had never had a blocked catheter and his suprapubic catheter was usually changed every three months. But recently his urologist had told him that it would be better to change it every 6-8 weeks.
Urethral catheter changes
 
A urethral catheter may be changed in hospital or in a GP surgery but is usually changed by a district nurse at home. Most people got new catheters and other catheter equipment on prescription, and many said they had everything ready before the district nurse arrived. Some people found the procedure quite easy and painless, but others, particularly men with an enlarged prostate, found it difficult and painful. Nurses usually use a lubricant or anaesthetic gel when they insert the catheter.
Gordon had an enlarged prostate and found the urethral catheter change very painful. On the internet he found out about a herb called saw palmetto. He was convinced that it reduced the size of his prostate. His catheter changes are now much easier and pain free. Derek, who’d had an enlarged prostate, dreaded having his catheter changed because he often bled and felt uncomfortable for 2 or 3 days afterwards. Occasionally, he’d need an ambulance to hospital because of the bleeding.
Martin, who had a spinal cord injury, recalled three occasions when the district nurse had not inserted his urethral catheter correctly.
 
Suprapubic catheter changes
 
A suprapubic catheter may be changed in hospital, particularly the first time it is changed, but later it is usually done at home by a district nurse or GP. A relative or carer may also change this type of catheter when trained to do it. Most people had the suprapubic catheter changed at home by a district nurse, though Gavin, who had a spinal cord injury, had his changed every 4 weeks at the spinal unit. Annie, married to a retired doctor, said her husband changed her catheter at home every 6 weeks.
People said that some nurses were very careful about following hygiene practices while others weren’t. Richard praised the district nurses who changed his, saying ‘Overall they’ve been very good’ but wished they’d all follow exactly the same procedure every time. Sometimes, district nurses and GPs may lack experience in changing suprapubic catheters and this can lead to problems (see ‘Perceptions of health professionals and health care’). Ian had had to go to Accident & Emergency once when a district nurse couldn’t insert a new catheter.
When changing the catheter people usually use a little local anaesthetic called Instillagel. Jennifer said she was allergic to the lignocaine in Instillagel so used some KY jelly instead. Frances said that, occasionally, muscle spasms made it hard for the district nurse to remove the catheter. She used a cannabis based mouth spray, prescribed by her doctor, called Savitex, which helped. Badg also had bladder spasms. He usually took a couple of paracetamol before the nurse arrived to change his catheter. Sharon’s last catheter change had been ‘horrendous’ because of her bladder spasms (see ‘Bladder spasms’). Hayley recalled that sometimes her catheter got stuck and was difficult to remove.
When a suprapubic catheter is changed, the new one should be inserted quickly because the opening (stoma) can close up quickly. Some people didn’t mind having their catheter changed. Emlyn, for example, whose suprapubic catheter was changed at the hospital every three months, said, “You don’t feel a thing, honestly, it’s no problem at all.” A few other people (mainly those with a spinal cord injury, who had very little sensation below their waist) also said that their catheter changes were painless.
Stuart, who had a spinal cord injury, was not apprehensive about his suprapubic catheter change, but sometimes when it was changed there was some bleeding and he had a curious and unpleasant feeling in his head. Michelle also said that when her suprapubic catheter was changed she sometimes had symptoms of autonomic dysreflexia. Badg felt nervous before a catheter change – he said, ‘it knocks me sideways for the rest of the day.’ 
Whoever changes a catheter must wear gloves and use a sterile technique to prevent infection. Charles said that it might be a good idea to take an antibiotic before and after a catheter change to prevent infection, but Hayley warned against taking antibiotics unless really necessary. She had become resistant to the antibiotic trimethoprim, having taken it too often in the past. The NICE (National Institute for Health and Clinical Excellence) guidance is that antibiotics to prevent infection (prophylaxis) should not be used when changing catheters unless the patient has a history of catheter associated urinary tract infections or is at risk of endocarditis. Endocarditis is inflammation of the inside lining of the heart chambers and heart valves (Infection Control (CG139) NICE clinical guidance March 2012).

Last reviewed June 2015.

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