Blocked urinary catheters: what can nurses do to improve management?

Indwelling urinary catheters remain one of the most commonly used clinically invasive devices across the NHS, with over 1 million inserted every year in the UK. This represents up to 24% of all inpatients wearing an indwelling urinary catheter at some point during their stay (Feneley et al, 2015). This figure can be much higher in community settings, with almost 40% of community patients in some areas requiring a catheter (Wagg et al, 2005; Loveday et al, 2014).

Of the multiple recognised risks associated with catheter use, blockage and bypassing represent a large proportion of issues faced in the community setting. This leaves both staff and patients frustrated, with frequent out-of-hours visits or repeated call-outs to manage the pain, discomfort and non-drainage.

Encrustation is commonly caused by a build up of Proteus mirabilis, a urease-producing bacterium that causes biofilm formation on the catheter surface. This, in turn, encourages the production of magnesium phosphate and calcium crystals in the alkaline urine. These crystals attach to the catheter lumen and eyes, resulting in blockage of the lumen and drainage eyelets (Stickler et al, 2003; Feneley et al, 2015).