Catheters are specialized medical devices used to facilitate the release of fluids. They are some of the most frequently used devices, with millions of units sold every year. There are various types of catheters available, but indwelling catheters are some of the most popular. Catheterization is often employed for patients which require assisted fluid release. This medical procedure is often used for several weeks or even months, in specific cases. Because of their long term use, catheters must be properly cared for and maintained. In some cases, indwelling catheters should be replaced, according a patient’s medical condition and associated risks.
How long should an indwelling catheter be left in? Are there any recommendations regarding the frequency of catheter changes? These are some questions which almost all catheterized patients or family members have on their mind. Let’s shed some light on these questions:
According to current medical sources, catheter replacement depends vastly on specific medical cases, patients, future medical prospects and risks. The exact timing or frequency of replacements is highly specific and can only be determined together with medical professionals. In all cases, a prior medical assessment should be performed in order to prevent any associated risks. Although older medical guides or manuals suggest that indwelling catheter replacement should be done according to a fixed schedule (weekly, bi-weekly or monthly), this procedure is not recommended by modern guides.
Catheter replacement, according to modern guides, should be individualized, based on specific characteristics and medical needs. The most common reasons that may require replacement include obstruction, infection and leakage. Let’s go over each of these cases:
- Obstructions – This phenomenon is caused primarily by biofilm, a substance produced by Proteus mirabilis, a bacteria commonly found in urine samples. The biofilm buildup, called encrustation, is localized on the interior walls of the catheter. In time, the encrustation grows and causes a complete obstruction. Other causes for obstructions are mucus, glycocalyx, silica crystals or protein – all these elements are present in urine.
For instance, some patients may produce urine richer in calcium, protein or mucin, and these may require more frequent catheter replacement. On the other hand, some patients may produce less additional chemical compounds, which cause buildups.
The frequency of the obstructions is also highly dependent on the type and quality of the catheter. For instance, simple, plain latex catheters need to be replaced more frequently than hydrogel coated latex catheters. Also, silicone catheters have a longer lifespan, as latex is more prone to encrustation. Essentially, cheaper catheters need to be replaced more frequently than high end catheters.
- Infections – These are particularly common for patients who undergo catheterization for more than 30 days. The symptoms are: fever, rigors, cloudy urine, hematuria (blood in urine), catheter blockage or bladder spasms. Current procedures suggest that indwelling catheter should be changed before obtaining new sample specimens, to avoid further contamination.
- Leakages – They often occur in patients who have bladder spasms and have been catheterized for more than a week. Catheters should be replaced as soon as possible, whenever leakages occur. To avoid bladder spasms and catheter leakages, there are several drugs which can be used, such as oxybutynin chloride (Ditropan). In special cases, a larger catheter can be employed (with a larger tube width, but not more than 12 to 16 French, as they can cause mucosa irritations). If leakages do occur, use a small, 5cc balloon to collect the leaked urine. Don’t use larger balloons, as they can cause irritation or necrosis of the bladder neck, as well as blockage of the urethral glands or increased mucous secretion in the urethra.
Indwelling catheters are often used in long term healthcare, so they may need replacements. These should only be done after a careful assessment done by a doctor or a nurse. Similarly, the frequency of catheter replacement varies according to several factors, including a patient’s medical condition, urine sample tests or the quality of the catheters used.