Catheter care and infection control

Table of Contents

1. Introduction
2. Catheter Care and Infection Control
   1. Meatal Cleansing
   2. Managing drainage systems
   3. Catheter Valves
   4. Taking catheter specimens of urine
   5. Catheter Care Bundles
   6. Troubleshooting catheter problems
   7. Bypassing
   8. Encrustation and blockage
3. Summary
4. References

Encrustation and blockage

Up to 50% of patients with long-term catheters will experience recurrent blockage from encrustation (Getliffe 2004).

Task 11

1	In your opinion, what is the cause of encrustation? Enter your answer in the box below and then select Check answer. Encrustation is the result of a bacterial biofilm building up on the catheter causing crystalline deposits to build up inside the catheter lumen.

The following is the process by which biofilms and encrustation occur:

- Urease producing bacteria, especially Proteus mirabilis, build up on the catheter

- The enzyme urease is secreted by the bacteria, which splits urea into carbon dioxide and ammonia

- Ammonia is a strong alkali and causes urinary pH to rise

- Struvite, calcium phosphate and magnesium phosphate crystals deposit out of this alkaline solution onto the catheter - urine normally has a slightly acidic pH which would ensure these crystals remain dissolved

(Stickler 2008)

Some clinicians advocate the use of bladder instillations, also sometimes referred to as catheter maintenance solutions (Rew 2005), to prevent encrustation and catheter blockage (Moore et al, 2009), but there is a lack of high quality evidence on which to base recommendations (NICE, 2012).

There is some evidence that the flushing effect of opening a catheter valve can help to reduce the risk of encrustation in long-term catheters (Sabbuba et al, 2005).

To reduce catheter blockage from encrustation the practitioner should:

- Document the patient's catheter history including any incidents of encrustation and blockage

- Consider planned catheter changes based around the patient's history of blockage

- Increase fluid intake