Catheter Blockage Maggie Rew RN MBA

Some causes of blockage twisted tubing drainage bag very full constipation bladder spasm bladder calculi suction of mucosa into catheter eyes catheter encrustation by mineral deposits calcium phosphates, struvite (magnesium ammonium phosphate)

Biofilm - a city of microbes (‘pillars, mushrooms and water channels’) Copyright (2001) by the Center for Biofilm Engineering, Montana State University–Bozeman, Bozeman, MT 59717-3980, (406) 994-4770.

Biofilms – cell to cell communication Copyright (2001) by the Center for Biofilm Engineering, Montana State University–Bozeman, Bozeman, MT 59717-3980, (406) 994-4770.

Scanning electron micrograph of biofilm

How Fast do Organisms Multiply? Pseudomonas aeruginosa 2hrs on a 100% Silicone Foley Catheter Pseudomonas aeruginosa 18hrs on a 100% Silicone Foley Catheter

Proteus mirabilis

Causes of catheter blockage Urine normally slightly acidic Infection with urease-producers Urine pH alkaline Urease splits urea to release ammonia Struvite & calcium phosphates precipitate Encrustation and blockage 30

SEM of struvite crystal and calcium phosphate 33

Catheter maintenance solutions. Suby G or Solution G 3.23% citric acid solution, pH 4, with magnesium oxide Solution R 6% citric acid solution, pH 2, containing magnesium carbonate Saline 0.9% A neutral solution, pH 7, flushing of debris and small blood clots. Chlorhexidine 0.02% An antiseptic solution aimed at preventing or reducing bacterial growth, in particular E. coli and Klebsiella species

Cross-sections of two catheters (I and II) both subjected to encrustation, following instillation of an acidic washout to one 36

Uro-Tainer Twin Evidence Based and Nurse Innovation double instillation more effective at dissolving/ reducing encrustation in the catheter (Getliffe 2000) Kinder in Use Smaller volumes – 30ml in each chamber No agitation – gravity fed and respects patients tolerance Reduced infection risk Quick to use 5 minutes instillation time per chamber (Getliffe 2004) 14

Preventing catheter blockage consider catheterisation as a last resort catheter choices intermittent versus indwelling catheterisation catheter material and type ? catheter valve pro-active care identifying ‘blockers’ and ‘non-blockers’ use of catheter maintenance solutions planned changes: identifying ‘catheter-life’