Internal and external
urinary catheters are used to manage
urinary incontinence and incomplete bladder emptying. Bladder dysfunction cause determines whether short- or long-term
catheter use is required which, in turn, determines whether an indwelling, intermittent, or external
catheter should be used. The method of catheterization is based on the underlying bladder condition, the goals of treatment, and gender appropriateness. Complications such as
infection (eg,
catheter-associated
urinary tract infection,
sepsis) and its related sequelae have been found to be directly related to length of time of
catheter use (eg, women are at greater risk for
catheter-associated
urinary tract infection when an
indwelling catheter is in place >2 weeks); thus,
catheter use must be medically justified and in the case of an
indwelling catheter, involve the shortest period possible to ensure patient safety and regulatory compliance. Some newer
catheter systems include coatings to prevent complications; complications specific to
indwelling catheter use include obstruction from encrustations, urethral
trauma and erosion,
bladder stones and
bladder cancer, and, in men,
epididymitis. Complications from external
catheters may occur when skin condition is compromised. Overuse of
catheters has reimbursement ramifications. Numerous guidelines reflect the need for the judicious use of
urinary catheters, particularly in
long-term care patients. Because evidence-based research on long-term use of these devices is lacking, clinicians should use clinical experience when caring for patients with
catheters.