Indwelling Catheterization: The Maladies of a Medical Marvel

The advent of catheters

have leaped the tallest building by enhancing our quality of life.  However, who could have predicted the kryptonite of their overuse? When employed judiciously catheters  provide quality healthcare.   In the early 1930s, Dr. Frederic E. B. Foley improved the functionality of catheters by designing a latex retaining balloon near the tip of the tube. That made it possible for indwelling catheters to stay in the bladder without the need of external taping or strapping.   Interestingly, he did not invent the first catheter although we reference his name when asking for one.   Much earlier have they been implemented and have been very much in demand.

Even today

Hospitals rely on them for providing a convenient option for collecting and monitoring urine from attached and enclosed plastic collection bags. I’m sure this offered a more sanitary means than having patients’ urine drained in open buckets as they were at one time. Even home health agencies came to prefer them when providing caregiving services for those who may have complications with their bladders.  And certainly fast-paced Emergency room staffers reached for them when dealing with ailing seniors for quick urine analyses.  For short-term use, catheters are invaluable health care devices.

Unfortunately 

The problem arose when they were worn for an extended periods of time.  How can something so useful raise so many questions from patients and some medical circles concerning their implementation and long-term use? Make no mistake. They are great for temporary usage. However, catheters are notorious for presenting more than its share of maintenance problems, chronic infections, and being conveniently taken advantage of for monetary gains by the healthcare industry. Thus, we are quickly learning that Indwelling Catheterization for long term use has become a blessing and curse to many patients.

Indwelling Catheterization is really tough

on ailing seniors who have kidney stones. Funny thing is: doctors rarely tell you this. The prevailing advice and practice are that by drinking copious amounts of cranberry juice, it will help prevent urinary tract infections. Ascorbic acid and proanthocyanidins (active ingredient) in the juice have been known to prevent bacteria from bonding to cells in the urinary tract. Dutch studies have cast doubts on its efficacy. All in all, very few doctors or nurses will inform you of the fact that cranberry juice creates kidney stones. Large and small calcium oxalate stones find difficult passage through the urinary tract with catheter tubes blocking their exit out the urethra.

We experienced this

first hand when our mother’s Foley tube became blocked by stones around 2:45am early one Saturday morning. I tried repeatedly dislodging it by flushing distilled water through the small exterior port on the tube with a plastic syringe half-filled with sterile water. It failed. Many times in the past, I had unclogged them with ease. But, not today. So later on that morning, I called her home health supervisor to tell her about the blockage. I informed her that several hours after the blockage, our mom’s urine output had been unusually low, according to our daily desk journal. She told me to give her extra water. I replied that I had already given her 8ozs earlier through her gastric feeding tube.  And I had expressed my concern about giving her more due to the possibility of an over extended bladder.  I then began to doubt her medical advice.

So, once again I told her that our mom had not produced her normal urine output for that time of day. How would her urine properly drain in the plastic collection bag if it had been blocked, I reasoned? Then, the supervisor told me either to wait until Monday for a nurse to unblock/replace it or for us to take her to the Emergency room. I began feeling pangs of frustration and fear. I couldn’t believe that we had to wait out the rest of Saturday and Sunday for a nurse. Our mom could not eat solids. That meant we had to pour more liquid nutrition and water through her feeding tube. Surely, her bladder would become overly inflated without it being sufficiently drained. A healthy bladder can hold up to 16 ounces of urine comfortably for 2-5 hours.

Should I call the ER?

I certainly would not wait until Monday for the nurse’s visit. But, I really did not want to take our mom through that ER process. Rough handling, long waiting, and being subjected to unnecessary procedures had been something that I wanted to avoid–if possible. Besides, it was quite frigid that morning. I also knew that a Foley blockage (according to EMS) had been considered an urgency, not an emergency. My mom’s insurance would only pay for emergency transport. So, since I didn’t have $200.00, I thought of other options. Again I phoned her Supervisor and brought up the possibility of me deflating the balloon and carefully sliding out the Foley myself. This would allow mom to urinate on her own. She agreed. So that’s what I did. Shortly afterwards, she began urinating. I called the supervisor and told her. Then she reminded me to tell the visiting nurse who was scheduled on Monday to simply give her a new Foley. My sister and I were relieved. So was our mom. The small crisis had passed. …Or had it?

Monday arrived.

Around 10:00am, the nurse rang our doorbell (“for whom the bell tolls”). She entered my mom’s room. Immediately she noticed that the Foley had been missing. After we explained to her what had happened, she became furious that I had taken out the Foley myself. It made little difference even after I told her that I had discussed the issue beforehand with her supervisor. I repeatedly told the nurse that the supervisor approved of what I did. Still she denounced my actions. So, she took out her pen and wrote me up for violating policy. Two days later, my mom had been booted from their agency. We ended up searching for a substitute. Policies before patients had been her rule.

The whole incident

had been quite interesting.  My sister and I both knew that the Foley should not had been left in our mom for as long as it had been in the first place. Frankly, all the visiting nurses were doing was making numerous visits to unclog and replace dirty bags. This is why I feel that indwelling catheterization is a great device to have for short periods—when feasible. When they are there for other questionable reasons, it places unnecessary burdens on the patient and the family with too many maintenance issues when the tube become frequently blocked by kidney stones. And if you run into a situation like we did, you may find yourself searching for another home health agency. Eventually, we took her off Foleys all together. She did quite well without them for the rest of her years—with less infectious outbreaks.

Even at hospitals,

Indwelling catheter can cause their share of problems. It had been reported by HealthlineNews that 1.7 million Americans developed hospital-acquired infections (HAI) each year. And of that number an amazing 99,000 die of HAIs annually. However, doctor’s offices and nursing homes are the main culprits. 3/4 of those infection begin there. The economic burden to the U.S. may be as high as $45 billion per year. According to OxfordJornal.org, up to 25 % of all hospitalized patients have urinary catheters inserted during their time there. Nearly every visit my mom took to the hospital doctors required that she wore a catheter. And most often they stayed on longer than they should had. It became the rule instead of the exception. The sad truth is: most urinary catheters are commonly left in place even when they are no longer needed.

So while they are left in place

A host of deadly bacteria are passed on to unsuspecting patients. According to an article at emedicine.medscape, enteric pathogens like E. Coli are the most common culprits. However, Enterococcus, Pseudomonas, Staphylococcus aureus, coagulase-negative staphylococci, Enterobacter, and yeast infections are not far behind on the list. Proteus and Pseudomonas species are the organisms most commonly associated with biofilm growth on catheters. Unfortunately, Many patients become infected by various deadly bacteria–especial ailing seniors–because of catheter insertions.

What I don’t understand

is why do not more hospitals place extra urgency on dealing with these kinds of infections and death? It has been found that hardly any effective actions are forthcoming to prevent these hospital-borne fatalities. According to OxfordJournal.org, a national study to examine the current practices used by hospitals to prevent hospital-acquired UTIs had been made. And even though there existed a huge connection between urinary catheters and subsequent UTIs, the study bore out that no prominent plan had been widely used to prevent hospital-acquired UTIs. Hospitals are still dragging their feet.

And why shouldn’t they?

There is a huge amount of money to be made dispensing these medical products. Costs are even higher these days as most medical agencies have switched from latex catheters to expensive silicone. Home health take in quite a bit of money maintaining indwelling Foleys on seniors at home. It becomes quite expensive when these agencies make home visits to provide maintenance. With my mother, those tubes deteriorated in no time at all. They became kinked, blocked, gummy, discolored, smelly and cracked. They also leaked and occasionally needed reinsertion from inadvertently pulled out tubes. These agencies also got a premium every month from selling them to us. Medical agencies can “rack up” a ton of money replacing and servicing these medical devices—especially for “end of life“ seniors. Certainly Foleys are “cash cows” for them. No wonder there is scant urgency in addressing the matter in spite of lives being “on the line. Catheters continue to be a hot item because there is much money to be made from their usage. Sadly, greed may be greater than need.

Through the years

Catheters have been a Godsend in the short run. They provide easy access and convenience when urine samples are needed for analyses and monitoring. They also are great clock savers for time conscious nurses who are assigned caregiving duties for bed bound seniors who are incontinent.  Who has time to keep changing soiled underwear—right?  And of course when hospitals perform surgeries, catheterization is almost a necessity for controlling bodily functions under anesthesia.  Foleys are worth their weight in urine. 

Consequently

The medical field have grown overly dependent on the various benefits of catheters.  This over dependence has now, however, become a growing danger to many unsuspecting patients–especially ailing seniors. They are risking their health and lives for convenience. Studies have shown that long-term use of indwelling catheters presents far too many maintenance problems and deadly infections. Also, who can deny that profit-minded healthcare agencies find them opportunistic cash sources from selling them or from providing numerous home visits when they need to be serviced. Sadly, the long-term use of indwelling catheterization has become a medical product of inherently diminishing returns

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