Living with a urinary catheter
Catheter changes
Frequency of catheter changes
How long an indwelling catheter can be left in place depends on what the catheter it is made of, whether or not the catheter user gets frequent infections and blockages, and each person’s individual situation. Catheters usually stay in place between 2 and 12 weeks. Manufacturers guarantee that a catheter is safe to use for a number of weeks. Stuart said that his catheter had a warranty of 12 weeks, but Hayley said that her silver alloy coated catheter was licensed to be used for only four weeks.
A consultant explains why a catheter should be changed if it gets blocked. If a suprapubic...
A consultant explains why a catheter should be changed if it gets blocked. If a suprapubic...
SHOW TEXT VERSION
PRINT TRANSCRIPT
If a catheter became blocked, would you try to unblock it using a washout before changing it?
Yes, you can. No, I think the most straightforward thing is to change the catheter and get rid of it because as soon as you put a catheter in the bladder, a film forms on the surface of the catheter. We call it a conditioning film. And bacteria then attaches itself onto the surface of the catheter to form what we call a bio film. It’s in that bio film, especially if the proteus mirabilis organism is there, that we get these calcific deposit’s forming.
And if the catheter blocks as a result of encrustation, the best thing to do is to take it out and put in a clean catheter. And then maintain a high fluid intake and to drink those citrated fluids in order to reduce the risk of catheter encrustation.
People must realise with a suprapubic catheter that, if it does come out, if there’s a failure of the balloon as that can occur occasionally and the catheter comes out from the suprapubic track, then that track will close down very rapidly. And it is important that they can re-insert the catheter as soon as possible and just strap it in the bladder before that track closes itself quite spontaneously.
So do you encourage your patients to find out how to do it themselves or get a carer to do it?
Yes, I think that’s very important. I think it’s important that a patient with a suprapubic catheter does have a spare catheter available. And if it does fall out that they can re-insert it. Ideally the patient or their carer can re-insert the catheter.
But the suprapubic catheters do cause some nurses some concern. They are reluctant, for example, to change the catheter because they don’t feel very confident about the suprapubic catheter. This is a matter of training and, on the other hand, one’s known nurses who will put in suprapubic catheters under local anaesthetic and that’s, as I’ve explained before, is a minor operation. Which it can be quite routine as long as the rules are followed carefully. But it needs to be carefully taught how to do it.
When Peter Y had more infections than usual because of poor care and bad hygiene his catheter got...
When Peter Y had more infections than usual because of poor care and bad hygiene his catheter got...
SHOW TEXT VERSION
PRINT TRANSCRIPT
Everything went fine probably for two and a half or three years. I had very good care. I changed catheters every twelve weeks, on the day, and there was never any consideration of doing different. I was obviously free from infection of any kind for two and a half to three years, and that was a period of good care.
Then I had to change my care system. I simply couldn’t afford to pay for my own care all the time. Which I’ve not, because I had been given supplemented, a little bit for four or five years, but I’d been paying the full amount basically. And as my business had stopped, I couldn’t afford to do it anymore.
I then went onto local authority care, so there was no continuity of care. The standard is very low in terms of hygiene and, within six weeks, I started to get blockages. The first time it happened I had no idea what had happened. I just knew I needed a nurse very quickly because it hurt, you know headaches and so on.
Then I went, just got worse and worse and worse. So then I was having catheters changed every week, every two days. And it got so that the situation became untenable. I did have acetic acid bladder washes, a series of six for six weeks, and that did work. And that demonstrates that perhaps what the nature of the infection was I think.
Not all the people we interviewed knew why their doctor had decided to use a catheter made from one material rather than another. Roger was cross that no one could agree on which type of catheter was best for him. He had no idea why he was sometimes given a latex catheter and sometimes a silicone one.
Some people would ideally have liked their catheter to stay in for 12 weeks, but had it changed more frequently because of infections and blockages. The time that a catheter should be left in place is not always clear. Charles said he had never had a blocked catheter and his suprapubic catheter was usually changed every three months. But recently his urologist had told him that it would be better to change it every 6-8 weeks.
Charles’s urologist wanted him to have his suprapubic catheter changed more often than every...
Charles’s urologist wanted him to have his suprapubic catheter changed more often than every...
SHOW TEXT VERSION
PRINT TRANSCRIPT
So can we go back to how often you have your suprapubic catheter changed?
Well, that is a contention now. Originally it was once every three months. They used to come in once every twelve weeks to change it. So four times a year.
In conversation with my urologist just in the last couple of months, it seems that he’s suggesting it should be changed more often. He’s not actually given us a date, but maybe once every two months or even six weeks.
There is an issue regarding indwelling catheters. And the way they work is that the catheter is put through the hole in your tummy into your bladder and a little balloon is blown up to keep the catheter in place. However, since it sits in your bladder and your bladder basically contains a solution of solids, those solids actually deposit on the balloon and the catheter. And because there are actually solid particles in your bladder, they are an ideal hiding ground for bugs, bacteria. And that’s where so many of the bladder infections come from. Because basically those solids which have been deposited round your catheter actually cause the problem.
That’s the reason for changing it quite often?
And what he’s saying is that it’s not the insertion of the catheter which is the problem, it’s the removal of the catheter. Because if you think about it, the balloon gets deflated. All that deposit breaks off and goes down into the bottom of the bladder. And it’s extra breeding ground for bacteria.
So he’s suggesting that the catheter be changed more often. And we have talked about it and I need to, I’m probably going to email him in the next, well, next few days to actually to say, “Well, how often?”, you know. “Tell my GP that the district nurse needs to do it, every, you know, six weeks, two months, rather than every three months.”
Urethral catheter changes
A urethral catheter may be changed in hospital or in a GP surgery but is usually changed by a district nurse at home. Most people got new catheters and other catheter equipment on prescription, and many said they had everything ready before the district nurse arrived. Some people found the procedure quite easy and painless, but others, particularly men with an enlarged prostate, found it difficult and painful. Nurses usually use a lubricant or anaesthetic gel when they insert the catheter.
Kenneth hated having his urethral catheter changed. He once went to hospital where three health...
Kenneth hated having his urethral catheter changed. He once went to hospital where three health...
SHOW TEXT VERSION
PRINT TRANSCRIPT
Can you go into a bit more detail about what it was like actually having to have a new catheter, having it replaced? Did they do that at home?
No. That was done at the surgery. It was something that, I just hated it. The catheter lasted about two to three months maximum, it should be. But, unfortunately, I used to try to leave it in as long as possible. But the drawback there is, of course, you can get an infection, which unfortunately I did a couple of times.
Before we go into what it was like when you had an infection, was it painful having a new catheter inserted?
Yes, very much so, unless you had somebody who was good at it. But, unfortunately, some of the medical people aren’t. When I was in the hospital, they tried to put one in one time and I think they had three different people, doctors and nurses doing it. And it just, each time my body rejected it and so I came away from it.
When you say your body rejected it, what do you mean by that exactly?
It wouldn’t accept it. Every time it went in, it came out.
Oh.
They just couldn’t get it to stay in.
So they never managed to get it right in to the bladder?
Apparently not.
Gordon had an enlarged prostate and found the urethral catheter change very painful. On the internet he found out about a herb called saw palmetto. He was convinced that it reduced the size of his prostate. His catheter changes are now much easier and pain free. Derek, who’d had an enlarged prostate, dreaded having his catheter changed because he often bled and felt uncomfortable for 2 or 3 days afterwards. Occasionally, he’d need an ambulance to hospital because of the bleeding.
Gordon’s catheter changes were very painful before he discovered saw palmetto. The catheter now ...
Gordon’s catheter changes were very painful before he discovered saw palmetto. The catheter now ...
SHOW TEXT VERSION
PRINT TRANSCRIPT
Apparently I’d got an enlarged prostate, which nobody seemed to be bothered about, only me. You can imagine, I don’t know whether you can imagine or whether you know about prostates. There’s two and they’re close together. And the pipe down to your bladder goes in between them.
Well one of them got enlarged. And when they took the catheter out. It fell over onto the tube. So you can imagine putting the tube, the new tube back in, they had to shift the catheter over, which was a bit on the painful side. I had water in my eyes I’ll tell you, and that went on for about three years. And I was crippled with it, really was, I had some terrible times.
You lived with the pain for three years did you?
Yeah, and the doctors knew I’d got this doing [enlarged prostate], but they didn’t do anything at all about it. And one day, I have a computer, and one day I went on the computer and I put in ‘prostate’ actually. And I read all about it. And they said that, with an enlarged prostate, you can get a herb which reduces it. Well this is only about a year ago. And I got some and, in no time at all, that worked and it reduced it. And the catheter goes in and out with no bother at all.
Martin, who had a spinal cord injury, recalled three occasions when the district nurse had not inserted his urethral catheter correctly.
Martin was upset because the district nurse didn’t listen to him. The nurse had blown up the...
Martin was upset because the district nurse didn’t listen to him. The nurse had blown up the...
SHOW TEXT VERSION
PRINT TRANSCRIPT
The right way to put my catheter in, this is only for me, it might be different for other people, is to put the catheter right in up to that V and then, over a day or so, it gently slides out and that’s perfect.
And I’ve had three incidences in the last fifteen, twenty years, when the nurse has put the catheter in, and I’ve said to them because I’m very, very adamant of what, because it works, its works for me and I know the consequences. And as I say, this only happened beginning of November with one nurse. I said, “Look, that catheter’s not in right.” She goes, “Don’t tell me what to do.” This is it, this is what she said, “Don’t tell me, I’ve been, I don’t like putting catheters in, but I know what I’m doing.”
I said, “You don’t know what you’re doing. Make notes on your diary because that catheter isn’t in for me.” And she left it out eight inches. And I said, “That’s going to give me a problem.” She goes, “Look, I know what I’m doing,” end of matter. And I was really cheesed off as you can imagine. I wasn’t very well.
So that was bleeding in the night, so what she’d obviously done, I don’t know how much you know, but my urethra’s quite long by now. So she’d blown the balloon up in the urethra and that was where the blood was coming from. None in the urine, so she’d damaged my urethra, no blood or traces at all in the urine. So you could tell and then I was really ill, probably one of the illest I’ve ever been. I got up, because we phoned the nurses out to come and push it in further, which helps me. And they wouldn’t come out.
Right, the district nurse?
Yeah, absolutely. So I struggled to get up, really struggled. I was ill, my blood pressure was 200 over 160, you know that’s high.
Suprapubic catheter changes
A suprapubic catheter may be changed in hospital, particularly the first time it is changed, but later it is usually done at home by a district nurse or GP. A relative or carer may also change this type of catheter when trained to do it. Most people had the suprapubic catheter changed at home by a district nurse, though Gavin, who had a spinal cord injury, had his changed every 4 weeks at the spinal unit. Annie, married to a retired doctor, said her husband changed her catheter at home every 6 weeks.
Melanie’s first suprapubic catheter change in hospital went wrong. She had to have a urethral...
Melanie’s first suprapubic catheter change in hospital went wrong. She had to have a urethral...
SHOW TEXT VERSION
PRINT TRANSCRIPT
There was a little problem in that after, this would be after a month and they were going to change my catheter. I was in hospital for a year, so this was while I was still in hospital. They were doing my first catheter change, the first suprapubic catheter change and unfortunately when, maybe the hole wasn’t properly healed up, and when the doctor put the new catheter in it didn’t actually go into the bladder, it must have gone down the side.
Oh dear.
And so when the fluid and everything was poured in, it actually went into my abdomen, the cavity of my abdomen rather than into my bladder and so it was all a bit unpleasant. We had to go back at that point. They couldn’t get the hole open again
Oh dear.
I had to go back to a urethral catheter for I think a month or six weeks until they felt the bladder had sufficiently healed up to do another suprapubic procedure.
Dave described what it was like to have a suprapubic catheter changed in hospital. He found it...
Dave described what it was like to have a suprapubic catheter changed in hospital. He found it...
SHOW TEXT VERSION
PRINT TRANSCRIPT
Did you have to go back to theatre for that [the catheter change] or did they do it at the bedside?
No, that was done at the bedside. After the insertion of the suprapubic catheter I didn’t go back to a theatre for any changes or anything beyond that. It was always done at the bedside.
Can you just go through what happens when you have your catheter changed at the bedside?
Having your catheter changed at the bedside requires obviously the area to be sterile. And the balloon on the inside of your bladder is deflated. The water is taken out of that balloon, then the existing catheter is taken out, a new one put in, and the balloon is then inflated. That’s about it really. Certainly the first time my catheter was changed after the theatre, it was done by a doctor.
Subsequently, it was then done by nurses. And then when you’re released, it’s a district nurse. And when you become quite familiar, you can do it yourself and do it at home, and it’s done that way.
So apart from the emergency time when it was blocked, when you were in hospital, how often did they change the suprapubic catheter?
Yes, four, every four weeks because of the susceptibility of spinal cord injury patients to debris in the bladder and risk of blockages. So they say that every four or five weeks it should be changed. I know that outside of spinal injuries, I think it’s changed every couple of months, maybe every two or three months. But I certainly change mine more regularly than that.
Could you feel anything at all when that was being changed?
Yes, it is uncomfortable when it’s changed. It’s not too bad. I find that helping the situation is to use a mildly anaesthetic based lubricant. Instillagel is what I use. You just use it round the site. It makes sure that it comes out a bit easier. When the new one goes in, it numbs around the area. So I certainly think that that helps and that’s what I do.
After Dave left hospital, the district nurse changed his catheter a couple of times. He then...
After Dave left hospital, the district nurse changed his catheter a couple of times. He then...
SHOW TEXT VERSION
PRINT TRANSCRIPT
How often do you change your catheter now?
Every four weeks.
And who does that now?
That’s done by a carer in conjunction with me. I don’t have the manual dexterity to do it all myself. So that’s done lying on the bed. And, yes, having seen it done numerous times. I guess it was probably done under the supervision of the district nurse once or twice. But then it’s very straightforward and you know what to do. And you have to be less careful than in a hospital about the cleanliness. But obviously still wear gloves, put Instillagel round the site and, you know, just generally make sure everything’s kept clean.
So is this a carer from a care agency?
I employ a carer myself.
Sometimes agencies don’t allow their people to do things like that.
No. I have used care agencies in the past and I don’t think they, well, no, they didn’t ever change a catheter. But I employ help directly now and, yes, the, the person that I employ…
Does what you want to?
Yes. And I’m pretty particular about, you know, changing a catheter and what has to happen. I know exactly what I’m doing.
People said that some nurses were very careful about following hygiene practices while others weren’t. Richard praised the district nurses who changed his, saying ‘Overall they’ve been very good’ but wished they’d all follow exactly the same procedure every time. Sometimes, district nurses and GPs may lack experience in changing suprapubic catheters and this can lead to problems (see ‘Perceptions of health professionals and health care’). Ian had had to go to Accident & Emergency once when a district nurse couldn’t insert a new catheter.
When Roger left hospital and went into a nursing home, the nurses didn’t know how to change his...
When Roger left hospital and went into a nursing home, the nurses didn’t know how to change his...
SHOW TEXT VERSION
PRINT TRANSCRIPT
Do you go back to a hospital to have that done [catheter changed], or do you have that done here?
Well, it’s a fairly long story. Initially when I arrived [in the nursing home], they said, “Yes, of course, yes there’s no problem about changing catheters. Our experienced staff know how to do things like that”. Then, when it came to my first change, they started scratching their heads and looking at it, askance, “Hmm, don’t think I could trust myself changing that, we’ll get the GP to do it”.
So what happens, yes, the GP comes and the first time, although his hand was shaking very badly, I think he had some neurological problem. I thought, “Ooh this isn’t going to be any good with the hands shaking like that.” Eventually he concentrated and his glasses fell off and he eventually managed to get it in and inflate the balloon. And said, “Well, that’s no problem that.’ So once or twice the GPs did that.
The third time I believe it was, one of the main GPs at this practice came in and was looking even worse for wear than he usually does. He had the nurse with him. He said, “Well, don’t forget”, and I, no I reminded him, I said, “Don’t forget, I was told by the consultant you must put the new one in immediately you take the old one out otherwise there could be serious problems. The hole will start to close up and he won’t be able to get it in.”
He said, “Yes, yes”. So what does he do? Yes, he didn’t know the size I had, although it was on my care sheet, at least I think it might have been. It should have been size sixteen. So they turned up with a size fourteen and they said, “Well we haven’t got the sixteen.”
Then eventually they found a sixteen at the top of a cupboard somewhere, or a bottom of a cupboard. And he deflated the balloon, took the old one out, thought, “Oh this is good, this is easy”. Then he was just about to put the new one straight in when he dropped it on the carpet you see.
I said, “Oh you’re not putting that in are you?” So the nurse, poor nurse, he said, “Hmm, get another one”.
So the nurse sprinted, I mean she wasn’t a professional sprinter, she was Romanian and quite fit. She sprinted down the corridor and searched various drawers, eventually, a little belatedly, came back with another similar catheter. And with this one, I don’t think he dropped it again, but he said. “I can’t get this in, I can’t get it in now…you’ll have to go to hospital.”
So I went to hospital and fortunately somebody eventually managed to get it in that first time, at the local big [Hospital] here. So having spent, oh I think probably a day and a night in the hospital because of this incompetence on the part of the GP, I was all right for another six weeks.
When changing the catheter people usually use a little local anaesthetic called Instillagel. Jennifer said she was allergic to the lignocaine in Instillagel so used some KY jelly instead. Frances said that, occasionally, muscle spasms made it hard for the district nurse to remove the catheter. She used a cannabis based mouth spray, prescribed by her doctor, called Savitex, which helped. Badg also had bladder spasms. He usually took a couple of paracetamol before the nurse arrived to change his catheter. Sharon’s last catheter change had been ‘horrendous’ because of her bladder spasms (see ‘Bladder spasms’). Hayley recalled that sometimes her catheter got stuck and was difficult to remove.
Jade had such bad bladder spasms that, when the nurses tried to remove her catheter, they couldn...
Jade had such bad bladder spasms that, when the nurses tried to remove her catheter, they couldn...
SHOW TEXT VERSION
PRINT TRANSCRIPT
I had such bad bladder spasms they couldn’t [remove the catheter]. The nurses and doctors would try and pull it out when I was awake and they wouldn’t be able to get it out. And so it ended up being that, every four to six weeks, I used to have to go to theatre to have another general anaesthetic for them to try and get it out. So I used to end up having at least twelve anaesthetics a year, every year.
What was it like being in hospital all that time? Did you just go for the night or for the day?
Well, when I had my suprapubic I used to get a lot of infections. So I probably was in hospital for two weeks, out for two weeks, back in for two weeks. Like it was, it was not, it wasn’t great back then.
Was that a local hospital?
Yes, yes, it was. But it wasn’t a good time.
When a suprapubic catheter is changed, the new one should be inserted quickly because the opening (stoma) can close up quickly. Some people didn’t mind having their catheter changed. Emlyn, for example, whose suprapubic catheter was changed at the hospital every three months, said, “You don’t feel a thing, honestly, it’s no problem at all.” A few other people (mainly those with a spinal cord injury, who had very little sensation below their waist) also said that their catheter changes were painless.
Stuart, who had a spinal cord injury, was not apprehensive about his suprapubic catheter change, but sometimes when it was changed there was some bleeding and he had a curious and unpleasant feeling in his head. Michelle also said that when her suprapubic catheter was changed she sometimes had symptoms of autonomic dysreflexia. Badg felt nervous before a catheter change – he said, ‘it knocks me sideways for the rest of the day.’
Alex’s suprapubic catheter change was quite easy. The continence nurse changed it and her husband...
Alex’s suprapubic catheter change was quite easy. The continence nurse changed it and her husband...
SHOW TEXT VERSION
PRINT TRANSCRIPT
How often do you have to have the catheter changed now?
For me, I have it changed every five weeks because I found with my body, about the time of five weeks, it would start to start blocking. So I found that if I change it every five weeks, that’s fine, I don’t get that problem.
And is it changed here at home?
Yes, the continence nurse comes and changes it. My husband also has changed it several times when it has blocked. It’s actually quite easy to do. It’s not painful and it just takes a bit of preparation.
I have a kit that I’ve put together. My emergency catheter change bag, which contains a catheter, gauze swabs, Micropore tape, Steripod with sterile waters that clean me, a spare empty syringe in case the brand of catheter I’m using doesn’t have its own syringe to take the water out of the balloon, a spare bag and flip flow valve.
I can’t remember exactly everything but, for me, it really works to have an emergency bag ready. I keep one in the car and one in my bathroom. So I know that if it blocks, I’ve got everything ready there to be able to do it.
And, as I said, my husband’s done it. He doesn’t find it terribly onerous at all or difficult. Obviously he’d rather he didn’t have to do it. I’d rather he didn’t have to do it but, actually, it can be done pretty easily and painlessly.
The district nurse changes Melanie’s catheter quickly. Melanie doesn’t feel very much and has had...
The district nurse changes Melanie’s catheter quickly. Melanie doesn’t feel very much and has had...
SHOW TEXT VERSION
PRINT TRANSCRIPT
My suprapubic catheter is changed once a month. The district nurse comes in. After my carers have been, they dress me but I stay in bed. And so my district nurse comes and she sets up on my bedside table and she does it very quickly. She uses the gel, the antiseptic and anaesthetic gel, so I don’t feel very much. I only feel it if sometimes, when she puts it in she can knock the bladder and I can feel it knock against the side of the bladder.
But it’s not too uncomfortable?
No. No. No, it’s not too uncomfortable at all.
And there have never been any problems doing it at home?
No. Touch wood, no problems at all. It works fine.
Whoever changes a catheter must wear gloves and use a sterile technique to prevent infection. Charles said that it might be a good idea to take an antibiotic before and after a catheter change to prevent infection, but Hayley warned against taking antibiotics unless really necessary. She had become resistant to the antibiotic trimethoprim, having taken it too often in the past. The NICE (National Institute for Health and Clinical Excellence) guidance is that antibiotics to prevent infection (prophylaxis) should not be used when changing catheters unless the patient has a history of urinary tract infections after cathereter change or experiences trauma during catheterisation (Infection Control (CG139) NICE clinical guidance March 2012).
Charles described how the district nurse changed his suprapubic catheter. It was usually ‘a very...
Charles described how the district nurse changed his suprapubic catheter. It was usually ‘a very...
SHOW TEXT VERSION
PRINT TRANSCRIPT
Does the district nurse come here to do it [change the catheter]?
Yes, she comes here to do it and it’s a very smooth operation. It takes, I don’t know, the whole process takes 5, 10 minutes, if that. One of the things it’s important to do is have a bladder which is partly filled, so the catheter goes in to liquid, you know, a bladder which has got some space in it.
Also, because of the possibility of infection, it might be a good idea to start taking antibiotics a day before and then for a couple of days after because of disturbing things in the bladder.
It’s probably a good idea to do a test before the catheter is changed to make sure there are not too many bugs around, because you know, as I said, when you change the catheter, extracting the catheter may be a problem.
By a test, do you mean send it off to the laboratory, or just a dip stick?
No, no, no, just, just a dip test.
Last reviewed October 2018.
Last updated October 2018.
Copyright © 2024 University of Oxford. All rights reserved.