Indwelling catheterisation in adults – Urethral and suprapubic (2024)

11. PATIENT QUALITY OF LIFE

11.1 Impact of the catheter on the patient

An indwelling urinary catheter is often placed at the outpatient clinic or emergency room in patients who are in a stress situation. Patients may be referred because of urinary retention. Or the indwelling catheter may be the last alternative after all other treatments have failed; for example, clean intermittent catheterisation, medication, use of pads or male external catheters.

Urinary catheters may be commonplace to health care professionals but wearing one may not be that easy because living with an indwelling urethral catheter or with someone who has one creates a strain in terms of managing the physical, psychological and social consequences, leading to restrictions in activities of daily living. [210-212]

A questionnaire sent to 14,268 multiple sclerosis patients showed equal positive or negative impact on health-related quality of life (HRQoL) in those wearing an indwelling catheter (169 patients). [213] Despite the fact that patients and carers acknowledge that urinary catheters are necessary, many patients feel that urethral catheter management can be a source of anxiety and pain that reduces their QoL. [214] Patients can be faced with different issues, such as urinary catheter equipment, how to deal with sexual activities, UTIs or even sepsis, emptying bags, catheter changes, clothing adjustments, positioning of tubing, (hand) hygiene, meatal cleansing, falling out of the catheter, odour, and kinking of catheter. [51, 212, 215, 216] Wilde et al. [217] investigated the effect of a self-management intervention on health outcomes and HRQoL consisting of 3 home visits and a telephone call. The participants in the intervention group were taught how to conduct self-monitoring using a 3-day urinary diary to record observations and measurements of fluid intake and output, urine characteristics, and sensations of flow and how to react to the observations. They found that the intervention group had less catheter blockage during the first 6 months, but after 12 months they were comparable to the control group. (LE 1b)

11.2 Sexuality and body image

There is a lack of research on how sexual intercourse is affected by catheter use. Patients with indwelling catheters can experience not only physical problems but also emotional problems. [218]

Several constraints may impair teaching/counselling about sexuality, including lack of privacy because of several carers in the home, insufficient information about a patient’s neurological status, cultural taboos, or views that chronically ill people do not have sexual needs and desires. Making adjustments in sexual activities can be a challenge for patients, requiring support, open communication, and sensitivity of nurses. However, by not bringing up this sensitive subject, nurses put their patients in the uncomfortable position of having to introduce the topic themselves. It should be a part of the routine teaching. [212, 214]

Advice which can be given:

• Discuss with the patient that sexual behaviour encompasses a range of activities from caressing, kissing and masturbation to penetration of the vagina by the penis. [219]
• Patients (or partners) can be taught to remove the catheter and replace it after intercourse.
• Women can tape the catheter on to the abdomen.
• Men can tape the catheter along the erect penis and secure it under a condom. [166]
• The drainage bag, once emptied, can be positioned out of the way in the bed.
• Alternatively, the drainage bag can be disconnected from the catheter and a valve attached during intercourse.
• A water-based lubricant can be used to facilitate insertion (oil-based lubrication can damage the catheter).
• A suprapubic catheter, whenever possible, rather than a urethral catheter should be used.
• A different position during intercourse can be discussed. The position should be comfortable for the patient, so they can relax. Some positions can cause increased traction on the catheter in women, such as a face-to-face position with the partner on top. Traction can be reduced by placing a pillow under the woman’s bottom to raise the pelvis.

11.3 Social support

Patients living with an indwelling catheter want more information about managing a social life. [220] Wearing a catheter is often not a choice, and the experience leads to a time of embodied change, altering one’s view of self within the world. [216] Many urological patients live with chronic illness and require ongoing care. It is generally argued that those with low levels of social support experience poorer QoL and adjustment to illness.

When patients are not offered social support they try to solve problems through trial and error or they go to the internet for information; therefore, nurses should provide patients with contact details to reliable websites or patient organisations. [220] In some countries there are foundations for patients, such as the Bladder and Bowel Foundation in the United Kingdom or the PelvicFloor4All Foundation in The Netherlands. On the internet, there are possibilities to meet other patients.

11.4 Patient and carer instruction on dismissal

Living with a long-term indwelling catheter can be a challenge, but with support and information about the best practice, individuals can adapt to this change. [210] The extra time required to carry out daily tasks is frequently reported, and while older patients seem to prefer to travel to familiar places or skip travelling, younger patients are often determined not to let the catheter restrict activities. [221]

Many patients develop special skills in observing their bodies in relation to the catheter, such as the use of their hands to check periodically for leg-bag filling, or they feel the weight on their leg increasing. Most participants empty the bag on a schedule similar to most people’s daily micturition pattern. Other skills include awareness of changes of urine flow through the catheter, checking the tube for kinks, and especially for spinal cord injury patients, symptoms of triggering of autonomic dysreflexia. [124, 212]

Patients and carers should be provided with written and verbal information to support the following:

• Knowledge about simple anatomy of the urinary tract
• What is a catheter, and position of the catheter in the bladder in relation to function?
• Hygiene and hand washing
• Care of the drainage system and obtaining further supplies
• How to set up a link system and care for a free-standing bag
• Frequency of catheter and bag changes
• Information on who will change their catheter
• Avoiding constipation, fluid intake advice
• How to recognise the onset of problems such as blockage and infection
• How to deal with specific problems, where and when to seek further advice (nurse specialist, urologist or urology department), date of re-catheterisation and who will do this
• Contact numbers to access advice and support [35, 51, 217, 221]

11.5 Supply and reimbursement of catheter equipment

It is recommended that patients receive catheter packs from the hospital pharmacy or other medical suppliers, to ensure that the patient can start at home immediately. Equipment may vary, but consists mostly of a new catheter, leg bags, night bags, straps/stockinet holder, bed holder and/or a catheter valve. For a suprapubic catheter, sometimes a dressing may be required if secretions soil clothing, but this is not essential. [51]

Reimbursement differs in European countries as each country has its own health care insurance system and the personal insurance schemes also vary.