Management of indwelling urinary catheters in palliative care

ACI Urology Network - Nursing, 2014ACI Urology Network - Nursing, 2014

For patients with palliative care needs, an indwelling urinary catheter can reduce the need for movement to void and controls distressing incontinence. This is an invasive procedure with some risk; carefully consider the patient’s preferences, prognosis and goals of care. The patient and their carers can be taught how to care for the catheter; additional support may be provided by community nursing services if required. Some patients are eligible for funding and supply of catheter equipment; seek advice from a nurse continence specialist or palliative care specialist.

Long-term indwelling catheters can be associated with complications, such as:

• urinary tract infection—urinary tract colonisation with bacteria is inevitable if a catheter stays in place for more than a few days. Antibiotic therapy should not be used unless the patient is symptomatic or systemically unwell; see the Antibiotic guidelines
• bladder debris causing catheter blockage—regular bladder washouts may reduce the build-up of bladder debris and subsequent catheter blockage. Other measures to manage catheter blockage may include using a larger catheter, ensuring adequate oral fluid intake if possible, and a bowel care regimen to prevent constipation
• bladder spasm and pain—in addition to the recommendations for symptomatic treatment (see Bladder pain in palliative care), nonpharmacological management of bladder spasm and pain caused by a urinary catheter includes partial deflation of the catheter balloon (to reduce irritation of the bladder neck), and use of a leg bag (to reduce traction on the bladder trigone).

To prevent the above complications, long-term indwelling urinary catheters are usually changed every 4 to 6 weeks. However, for patients with palliative care needs, the catheter may be changed more or less frequently depending on the patient’s clinical condition, the complications experienced and the burden of recatheterisation. Patients who develop complications may prefer to have their catheter removed and use incontinence pads instead.