Catheter Maintenance - Draft

Overview

Catheter maintenance is essential to minimise complications such as infections, blockages, and discomfort. Proper use of catheter maintenance solutions, alongside routine care, helps ensure optimal function and reduces risks.

Below are the key recommendations for catheter care, aligned with NICE guidelines -CG139 (1) and evidence-based practices.

General Principles of Care

• Aseptic technique: Always maintain an aseptic technique during insertion, manipulation, or maintenance of urinary catheters.
• Hand hygiene: Perform thorough hand washing and use appropriate personal protective equipment (PPE) before and after handling the catheter or drainage system.
• Closed drainage system: Maintain a closed drainage system to reduce the risk of infection. Avoid unnecessary breaks in the system.
• Patient hydration: Encourage patients to drink sufficient fluids to help maintain catheter function and reduce encrustation, tailoring fluid intake to individual needs.

Daily Maintenance

The following should be done on a regular basis to reduce risk of complications:

• Check catheter positioning: Ensure the catheter is not kinked or compressed and that the drainage bag is always positioned below the bladder to prevent backflow.
• Regular emptying of the drainage bag: Empty the drainage bag when it is two-thirds full using a clean technique. Avoid contact between the bag outlet and any surfaces.
• Secure the catheter: Use appropriate fixation devices to prevent unnecessary movement and reduce urethral trauma.

Catheter Maintenance Solutions

Catheter maintenance solutions may be used in specific cases to prevent or manage blockages and encrustation. These solutions are not required routinely but should be considered based on individual clinical indications:

• Saline Irrigation - Use sterile saline to flush the catheter if blockage or debris is suspected. Saline is often the first choice for gentle flushing due to its safety and compatibility with the urinary tract.
• Polyhexanide Solution - Polyhexanide-based solutions can reduce biofilm formation and microbial contamination within the catheter. They are often reserved for patients with recurrent catheter-associated infections or persistent blockages.
• Citric Acid Solution (e.g., Suby G or Solution R) - Citric acid-based solutions can dissolve calcium and magnesium deposits (encrustation) on catheters. These solutions are particularly beneficial for patients prone to encrustation due to alkaline urine.

Note: Routine use of catheter maintenance solutions is not recommended. They should be prescribed based on a clinician’s assessment of the patient's specific needs and in accordance with local antimicrobial stewardship policies.

Preventing Catheter-Associated Urinary Tract Infections (CAUTIs)

• Remove the catheter when no longer clinically indicated: Regularly review the ongoing need for the catheter and remove it as soon as possible.
• Avoid routine prophylactic antimicrobials: Do not use antimicrobials to prevent CAUTIs unless specifically indicated (e.g., history of recurrent infections). Follow local antimicrobial guidelines.
• Flushing protocols: Only flush the catheter or use maintenance solutions when clinically indicated to prevent unnecessary intervention and minimise risks.
• Patient and Caregiver Education - Educate patients and caregivers about proper catheter care, recognising signs of infection (e.g., cloudy urine, fever, or lower abdominal pain), and knowing when to seek medical advice. Provide written materials and reinforce key aspects of catheter maintenance during consultations.

When to Contact a Healthcare Professional

Patients or carers should contact a healthcare professional in the following scenarios:

• In cases of catheter blockage, persistent leakage, or reduced drainage.
• If signs of infection develop (e.g., fever, pain, or unusual urine changes).
• For any concerns about the catheter's position or function.

Resources

(1) Overview | Healthcare-associated infections: prevention and control in primary and community care | Guidance | NICE

(2) Catheter maintenance solutions | Medical devices | BNF | NICE

For additional resources or specific queries, please consult the BNSSG guidelines or contact your local infection prevention team.

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