Catheters can cause infection and even lead to kidney failure: The needless indignity that's leaving patients like Emma in agony
00:13 GMT, 25 September 2012
When Emma Campbell was admitted to hospital, like millions of patients every year she was fitted with a cannula, a small tube inserted into her arm to deliver fluids or take blood samples; and a catheter, a thin, flexible tube put into the bladder to drain urine.
Emma was having surgery to relieve pressure on a nerve that was causing severe pain in her cheek, chin and forehead — a condition known as trigeminal neuralgia.
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'I'd been unhappy they had put in a catheter when I went down to theatre without telling me,' said Emma Campbell
As well as nausea and dizziness, she was suffering from hot and cold flushes; her arm was red and swollen, with the skin erupting in sores; the genital area was red and swollen; and she was so uncomfortable she couldn’t sit up or use the bathroom.
‘I’d been unhappy they had put in a catheter when I went down to theatre without telling me,’ says Emma, 28, a shop assistant from Dartford, Kent.
But when she complained, she was told the catheter was necessary because it was ‘inappropriate’ for her to get out of bed to go to the loo.
As for the post-op symptoms, the medics put these down to the anaesthetic.
Emma was discharged from hospital after three days.
But 24 hours later she received a call to say a blood test showed she had contracted the superbug MRSA.
She was readmitted immediately and spent three weeks in hospital on a cocktail of antibiotics.
‘It was horrendous and debilitating,’ says Emma.
It’s also had longer-term consequences — for the three years since, she’s suffered from chronic urinary tract infections.
Emma is one of thousands of patients who develop complications from catheters each year — they are responsible for 80 per cent of hospital-acquired urinary tract infections (which cost an average 1,122 to treat, according to a Department of Health study) and patients have a 10 per cent chance of developing an infection for every day a catheter is in place.
Emma has suffered from chronic urinary tract infections
This is because they provide an easy route for bacteria on the surface of the skin to enter the body.
The bacteria infect urine, tissue or blood, with potentially fatal consequences.
Older patients who develop an infection from a urinary catheter have an almost three-fold increased risk of death, according to the Journal Of The American Geriatrics Society.
Yet many cases may be needless, say experts, who warn too many patients are given catheters unnecessarily because it’s easier for hospital staff (as they don’t have to help patients to the loo) or they do it through out-of-date nursing habits.
Catheters are meant to be inserted under sterile conditions to minimise the risk of infection.
However, by the nature of the location, the conditions can never be sterile.
Poor hygiene practices also increase the risk of infection.
Furthermore, if they’re not inserted properly, catheters can cause internal bleeding and damage to the urinary tract.
Many patients also find them uncomfortable and painful; they can cause the skin in the area to break down and trigger bladder stones, causing pain and difficulty passing urine.
Worryingly, sometimes the wrong type is used.
There are different catheters for short and long-term use, and for men and women. In women, the urethra, the tube that carries urine from the bladder out the body, is shorter.
If a man is given a female catheter, the balloon at the end of the tube (which is inflated with water to stop it sliding out of the body) inflates in the urethra, not the bladder.
A report by the National Patient Safety Agency found that between June 2006 and December 2008, 114 female catheters were inserted into male patients, causing pain, blood in the urine and penile swelling. Seven caused significant haemorrhages and two led to acute kidney failure.
Yet despite these risks, thousands of patients in hospitals and care homes are fitted unnecessarily with a catheter — according to an official report in 2008, between 41 and 58 per cent of catheters inserted were not needed.
Other studies have shown that in 21 per cent of hospital patients with long-term catheters there was no medical reason for having it.
So why are so many being used
‘The problem is that for years part of the process of going to theatre was to insert a drip and catheter. It was what medical and nursing staff were taught to do,’ says Liz Smith, a former intensive care nurse and programme manager for 1,000 Lives Plus in Wales, a campaign to reduce harm in NHS hospitals.
‘However, we now know how much harm catheters can cause.
‘They should be used only when there is a clinical need — for example, where a patient is not able to pass urine following pelvic or bowel surgery, or major operations where monitoring of kidney and bladder function is necessary.’
Instead of using catheters routinely, she says patients should be monitored before and after surgery to make sure they are drinking and passing urine.
Older patients who develop an infection from a urinary catheter have an almost three-fold increased risk of death
‘If they are not, this could be a sign of dehydration or kidney damage, which needs to be treated. And that may be with a catheter.’
Earlier this year, Liz launched a campaign to reduce unnecessary catheterisation across Wales.
Called STOP (Stop, Think, Options, Prevent), the aim is to make medical staff pause before they insert a catheter and think why they are putting it in and if it is really needed.
‘It is about keeping a close eye on patients rather than relying on a device,’ says Liz.
Since the campaign started, a spot check on one 28-bed surgical hospital ward revealed that not one patient had a catheter.
‘In the past, I’d have expected half of the patients to have one,’ says Liz.
Improvements have also been seen in A&E and general admission wards, but the next big drive in Wales is care homes, where many patients are catheterised for months or even years.
While in some cases this may be medically necessary — for example, if a patient has dementia, incontinence or a neurological condition — ‘social catheterisation’, as it is known, can be a way of cutting the amount of care required.
‘In some cases, catheters are put in to make it easier for carers to manage a patient and reduce the amount of cleaning up that has to be done rather than there being a medical need,’ says Gordon Muir, a consultant urologist at London’s King’s College Hospital and London Bridge Hospital.
‘Old age alone should not be a reason for catheterisation.’
Nevertheless, there will always be a significant group of patients for whom a catheter is essential and scientists are trying to come up with new designs that reduce the risk of infection.
One of the most promising devices, developed by University College London, is a catheter that uses light to fight infections.
Researchers have found a way to modify the silicone that catheters are made of so it kills bacteria when it is exposed to light from a laser or ordinary room lighting before the device is inserted.
The process involves dipping the silicone in a solution, where it bonds with organic dyes.
After a few minutes of exposure to light, this generates molecules that are toxic to bacteria, preventing them from attaching to the catheter.
The device will be tested on animals next year and, if all goes to plan, should be available in hospitals within five years.
Meanwhile, Emma’s experience has left her anxious about being admitted to hospital.
It’s been discovered that her facial pain is caused by a benign tumour that requires surgery every five years to relieve the pressure in her brain. This means she is expecting to have surgery in three years’ time.
‘I’m already dreading it,’ she says.
‘This was a terrible hospital ordeal and the impact it’s had has been devastating.’