Indwelling urethral and supra-pubic catheters

• Not all catheters are licensed for supra-pubic use. Check the manufacturer's instruction.
• Male: standard length, female: shorter length, paediatric: longer than female length, but significantly smaller lumen size.
  • It is critically important that a female catheter is not inserted into a male urethra due to the risk of adverse events (see NPSA Rapid Response Report April 2009).
  • Female length catheters should only be used in females.
• Wherever possible always use the smallest catheter size i.e. size CH 12-14 for urethral catheters in adults.
  • Supra-pubic catheters are larger i.e. CH 16-20.
• For supra-pubic catheterisation, prescription indicators, balloon size and equipment are the same as those for indwelling urethral catheter. The exception to this is catheter size, where currently a size CH 16 or CH 18 is usually used.
• Catheters can be prescribed with pre-filled balloons to ensure the correct amount of water is in the balloon. Large catheters and balloons are believed to increase bladder irritability causing spasms and leakage of urine.
• Small balloons are recommended for all patients, 10ml balloons for adults and 3-5ml balloons for children. Larger balloon sizes of 30ml for long-term catheterisation must never be used.

Prescription - individual item, prescribe 2 to ensure 1 is available for change at any time. Prescriptions should always state the brand required.

Please see local formulary guidelines if suspected catheter associated urinary tract infection (CA-UTI).

Maintenance of indwelling urinary catheters

Catheter care starts with assessment of the patient and a clear Care Plan developed from the outset of treatment, including a catheter risk assessment and regular reassessment. Urinary pH should be checked regularly, and all catheter events should be clearly documented. Repeated blockages require catheter reassessment and if there is bladder spasm, consider an anticholinergic.

The deposition, which occurs in catheterised patients, is usually chiefly composed of phosphate. Latex catheters are not recommended due to allergies. Biocath and 100% silicone catheters are used and are changed routinely every 12 weeks. Repeated blockages need reassessment and a change of maintenance plan. 100% silicone catheters are not recommended for supra pubic use, as cuffing occurs on deflation of the balloon.

Asymptomatic bacteriuria (ASB)

Patients with indwelling urinary catheters invariably have abnormalities on dipstick testing including nitrate, leucocyte esterase, blood and protein. 

The longer a catheter is in place, the more likely bacteria will be found in the urine; after 1 month, nearly all people have bacteriuria.

Antibiotic treatment is not routinely needed for asymptomatic catheterised patients with cloudy or crystalline urine, debris in urine, discomfort or bypassing of the catheter, please see Asymptomatic bacteriuria for information.

Indwelling catheters

Biocath Hydrogel Coated (Bard)

• Male sizes (£9.12 = 1 x 10ml balloon)
  • CH 12 (D226512), CH 14 (D226514), CH 16 (D226516), CH 18 (D226518), CH 20 (D226520), CH 22 (D226522), CH 24 (D226524), CH 26 (D226526)
• Female sizes (£9.24 = 1 x 10ml balloon)
  • CH 12 (D226912), CH 14 (D226914), CH 16 (D226916), CH 18 (D226918), CH 20 (D226920), CH 22 (D226922)

Notes

1. For up to 12 weeks use in situ.

Latex-free

Lubri-Sil Aquafil Hydrogel Coated Silicone (Bard)

• Male sizes (£10.47 = 1 x 10ml balloon)
  • CH 12 (D175812E), CH 14 (D175814E), CH 16 (D175816E), CH 18 (D175818E), CH 20 (D175820E), CH 22 (D175822E)
• Female sizes (£10.47 = 1 x 10ml balloon)
  • CH 12 (D176112E), CH 14 (D176114E), CH 16 (D176116E)

Notes

1. For up to 12 weeks use in situ.
2. Includes pre-filled syringe of sterile water.

Foley tray

Foley tray contains everything required to either catheterise or re-catheterise.

There is a catheter tray available through NHS Supplies and available on FP10 for the initiation and routine change of catheters. Staff ordering on FP10 will need to be aware that the trays contain all that is required to catheterise patients and therefore they may not need to order other consumables for this procedure.

• Facilitates non-touch technique (ANTT) to reduce the risk of catheter associated urinary tract infection (CAUTI).
• Promotes and standardises best practice using a two layer system, layer 1 catheter removal kit, layer 2 catheter insertion kit.
• The contents of a catheter pack include: one empty 10mL syringe to deflate the balloon during re-catheterisation, one pre-filled 10mL syringe of sterile water to inflate the newly inserted catheter balloon, BIOCATH Hydrogel Coated Foley Catheter pre-connected to your choice of collection system, protective waterproof sheet and fenestrated drape, two pairs of latex gloves, cleansing solution and gauze, apron for the healthcare professional, STATLOCK Foley Stabilisation Device, and a syringe of lubricating gel.

Biocath Comprehensive Care Foley Tray (Bard)

• Male sizes (£18.67 = 1 x 10ml balloon)
  • Short: CH 12 (D22655S12), CH 14 (D22655S14), CH 16 (D22655S16)
  • Medium: CH 12 (D22655M12), CH 14 (D22655M14), CH 16 (D22655M16)
  • Long: CH 12 (D22655L12), CH 14 (D22655L14), CH 16 (D22655L16)
• Female sizes (£18.67 = 1 x 10ml balloon)
  • Short: CH 12 (D22695S12), CH 14 (D22695S14), CH 16 (D22695S16)
  • Medium: CH 12 (D22695M12), CH 14 (D22695M14), CH 16 (D22695M16)
  • Long: CH 12 (D22695L12), CH 14 (D22695L14), CH 16 (D22695L16)

Notes

1. For up to 12 weeks use in situ.
2. All in one kit includes a pre-connected leg bag. Subsequent leg bags should be one of the formulary choices.

Latex-free

Lubri-Sil Comprehensive Care Foley Tray (Bard) 

• Male sizes (£19.71 = 1 x 10ml balloon)
• Small: CH 12 (D17585S12), CH 14 (D17585S14), CH 16 (D17585S16)
• Medium: CH 12 (D17585M12), CH 14 (D17585M14), CH 16 (D17585M16)
• Large: CH 12 (D17585L12), CH 14 (D17585L14), CH 16 (D17585L16)
• Female sizes (£19.71 = 1 x 10ml balloon)
• Small: CH 12 (D17615S12), CH 14 (D17615S14)
• Medium: CH 12 (D17615M12), CH 14 (D17615M14)
• Large: CH 12 (D17615L12), CH 14 (D17615L14)

Notes

1. For up to 12 weeks use in situ.
2. All in one kit includes a pre-connected leg bag. Subsequent leg bags should be one of the formulary choices.

Silver Coated Catheters

Silver alloy coated catheters are claimed to reduce the risk of catheter associated urinary tract infection. There are no randomised controlled trials conducted in primary care settings on which to base this nor are there any trials conducted in patients using catheters on a long-term basis.

Evidence to support use in short-term catheterised patients in hospitals is conflicting. Most of the randomised controlled studies assessing this are of low methodological quality whilst a higher quality study found no significant benefit over standard catheters.

There is insufficient evidence to recommend the routine use of silver coated catheters over standard catheters whilst they remain more expensive.