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Why have we still not learned the lessons of catheterisation?

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Sadly there have been 114 incidents of male patients being catheterised with female-length catheters, prompting advice from the National Patient Safety Association.

This blog post might be described as a little rant on what I consider to be a mistake so obvious that there should be no nurse or doctor in the NHS that would make it. So please forgive me for being angry but you can make up your own mind and chastise me at the end if you wish.

At around 3,000 BC we have the first recorded evidence of early catheters. Understandably in those days they didn’t use them very often because many people who had them inserted died as a result. Dried onion skins, bamboo shoots or hollowed out metal bars were the order of the day. Just the thought makes one’s eyes water.

So the principle was set: if it is so dangerous, don’t catheterise unless you really have to.

Sounds good, doesn’t it? Now let’s wind forward 2,000 or so years to the 1950s, 1960s and 1970s when I was just a lad. The principle remained, but for some reason the numbers of people catheterised seemed to grow and with it catheter-related infections and catheter-related deaths and other complications.

Over time we seemed to come to a conclusion that some people, perhaps many, were being catheterised for our convenience. Moods and fashions change but surely good practice rarely changes and where it does there is usually sound evidence.

Has ‘good practice’ in catheter care changed significantly? I’m not convinced that it has and this is based on articles published in the many respected journals over many, many years.

Certainly commercialism has gone into overdrive and in the last 20 or so years we saw many innovations but have these changed best practice? Remember best practice 2,000 years ago? “Don’t do it’!” That hasn’t changed. Leave the catheter in for as short a time as possible; that hasn’t changed. So what has changed?

There are three catheter classifications to work with.

Adults (male and female) and children. These have been standardised to three lengths and generally named as male and female and child. This seems to be simple and straightforward and when we now look at a patient it should be simple to identify what their gender (male/female) or age (adult or child) is.

So why have there been 114 errors in the last few years, according to NPSA? As female catheters are a relatively recent innovation (the last 30 years or so) the male-length catheter was properly titled ‘standard length’. ‘Male length’ actually doesn’t exist.

Catheter length is surely a no brainer. Male is for MALE, female for FEMALE. Or is it that simple? Nothing is ever simple. A standard-length catheter can be used in female patients but you should justify why and if practical use the female length.

Always seek advice from your paediatric nurse if you are considering catheterising a child. Your reason for catheterisation of a child must be more than impeccable. What is a child? My advice here would be to simply look at the young person. Most girl and boy children up to 11-12 years of age may well fit into the ‘CHILD’ category. From teenage onwards, physical size (height) will determine when you cross over to an ADULT catheter and this can only be determined on a case-by-case basis.

Length of time that a catheter can be left in place depends on the manufacturer’s instruction/guidance as much of this is about product liability. Read the label and do what it says on the packet. A general ‘rule of thumb’ for in-dwelling catheters is:

* short term (up to seven days), medium term (up to 28 days) and long term (up to 12 weeks).

Now the most important part of all of this is the ‘UP TO’ element. A catheter, for example, that is medium term ‘can’ or ‘may’ last up to 28 days but no manufacturer will guarantee this. The term of use must always be considered as the maximum period it is considered suitable or acceptable. Because of this it is vital that the practitioner makes a judgement on time frame before the catheterisation is performed.

Remove at the first viable opportunity, when the reason for the catheter is no longer a problem. But best of all - don’t catheterise in the first place. If you must catheterise then please ensure that no-one is allowed to do it just for convenience. Incontinence per se is not a reason for catheterisation (it is only one option amongst many). Retention, acute or chronic may not need indwelling catheterisation, there are other possibilities.

Do not allow untrained staff to catheterise, simply get them trained. When you read the press you will see many papers expounding the virtues of new types of catheter/bag systems and many wonderful new innovations, But you will reduce infection, clinical risk, death and save millions of pounds if you do not catheterise in the first place and then only where there is clinical need.

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