Urinary catheters

Audit of catheter management provided by District Nurses and Continence Advisors

District Nurses and Continence Advisors were surveyed by post to audit their management of long-term indwelling catheters. They were asked to outline, anonymously, their management strategies in response to common specified catheter-related problems. The responses to each question were graded for the appropriateness of strategy from A (best) to E (worst) by previously formulated criteria. Completed questionnaires were returned from all 10 Welsh Continence Advisors and 73 of 139 (53%) District Nurses in South Glamorgan regularly involved in catheter care. A greater proportion of Continence Advisors' than District Nurses' responses were graded A or B in all problem areas specified. In patients with marked bacteriuria, 60% of Continence Advisors but only 11% of District Nurses would assess whether the patient was ill; 53% of District Nurses would treat with antibiotics without such assessment. Whereas most nurses investigating suprapubic pain would consider catheter blockage, only one-third would consider further history taking or examination, and only 1 District Nurse considered constipation or detrusor spasm. Although two-thirds of nurses sometimes used bladder washouts, few considered them effective and most were aware of the potential risks. Thus wide variations were found in the community nursing management of indwelling catheters and care may frequently be suboptimal. Appropriate management guidelines should be developed and disseminated.