A scoping review of important urinary catheter induced complications
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A scoping review of important urinary catheter induced complications K. H. Dellimore • A. R. Helyer • S. E. Franklin
Received: 21 February 2013 / Accepted: 30 April 2013 / Published online: 10 May 2013 Springer Science+Business Media New York 2013
Abstract This study presents a scoping review of the literature on the morbidity and mortality associated with several common complications of urinary catheterization. Data gathered from the open literature were analyzed graphically to gain insights into the most important urinary catheter induced complications. The results reveal that the most significant catheter complications are severe mechanical trauma (perforation, partial urethral damage and urinary leakage), symptomatic bacterial infection, and anaphylaxis, catheter toxicity and hypersensitivity. The data analysis also revealed that the complications with the highest morbidity are all closely related to the mechanical interaction of the catheter with the urethra. This suggests that there is a strong need for urinary catheter design to be improved to minimize mechanical interaction, especially mechanical damage to the urinary tract, and to enhance patient comfort. Several urinary catheter design directions have been proposed based on tribological principles. Among the key recommendations is that catheter manufacturers develop catheter coatings which are both hydrophilic and antibacterial, and which maintain their antibacterial patency for at least 90 days. Abbreviations CAUTI Catheter associated urinary tract infection Fr French gauge PVC Polyvinylchloride PTFE Polytetrafluoroethylene
K. H. Dellimore (&) A. R. Helyer S. E. Franklin Philips Research, High Tech Campus 4, 5656 AE Eindhoven, The Netherlands e-mail: [email protected]; [email protected]
1 Introduction Urinary catheters have been used to treat patients with urological problems such as urinary incontinence and retention since Greco-Roman times [1–4]. Today over 4 million patients undergo urinary catheterization in the United States [5] with more than 30 million urinary catheters inserted annually [6]. Currently there are three main types of urinary catheters which are commonly used in clinical settings: condom (i.e., external) catheters, indwelling (i.e., long-term; typically up to 90 days) catheters and intermittent (i.e., short or medium-term; typically between 14 and 30 days) catheters [7, 8]. Condom catheters are most often used in elderly males with severe functional disabilities such as dementia or restricted mobility [4, 9]. Indwelling and intermittent catheters are indicated for use in patients with chronic urinary incontinence and retention, as well as in individuals who have undergone surgical operations or are suffering from conditions such as multiple sclerosis, enlarged prostate and spinal cord injury [7, 8, 10–12]. Urinary catheters are also indicated for intermittent use for the measurement of bladder residual volume, obtaining uncontaminated urine for microscopy and culture, intravesical installation of drugs, urod
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