Catheterization

Indwelling catheterization

Indwelling catheters are overused in certain settings, especially in institutionalized patients. Chronic use can cause complications such as chronic bacteriuria, recurrent infections, and bladder stones. Chronic indwelling catheters should therefore be used only with specific indications.

When chronic indwelling catheters are used, it is important to maintain a sterile closed system. Routine irrigation and vigorous cleaning of the urethral meatus are not advised. It is not useful to do routine cultures- bacteriuria is inevitable and usually polymicrobial. Urinary tract infections should be treated only if symptomatic, and the symptoms may be nonspecific.

Intermittent catheterization

Intermittent catheterization is often not feasible in older patients, who may lack the mobility, dexterity, sensation, visual acuity, or cognitive ability to manage self-catheterization and who may not have a caregiver or family member who is able to manage the catheter. A further problem is that men with BPH may be difficult to catheterize at all for anyone without specialized skills or equipment. In the institutional setting, intermittent catheterization is often not feasible because of time constraints, the common presence of anatomical distortions in both men and women, and the difficulty and expense of maintaining sterility.

When intermittent catheterization can be done, it should usually be done 2 to 4 times a day, depending on the PVR. If done at home, the catheter should be kept clean, but not necessarily sterile. A home health agency nurse will be able to help with education and monitor technique regularly.