LONG-TERM catheter (LTC) use, defined as use exceeding 28 days, affects around 90,000 individuals in the UK, with the majority being over 75 years of age. Conditions like intractable incontinence, spinal cord injuries, and chronic retention necessitate LTC use, often leading to significant challenges for both patients and the healthcare system. While LTC provides critical support for managing these conditions, adverse events such as catheter blockages and catheter-associated urinary tract infections (S-CAUTIs) remain prevalent and impactful. These complications not only diminish quality of life but also contribute significantly to healthcare costs through emergency interventions and unplanned hospital admissions.
Blockages are the most frequent complication, occurring in up to 70% of LTC users. Prophylactic catheter washouts, using saline or acidic solutions, have been explored as a potential solution to reduce blockages. These washouts aim to flush debris, prevent mineral encrustations, and possibly provide antimicrobial effects. The recent CATHETER II randomised controlled trial investigated the effectiveness of weekly prophylactic washouts in reducing blockages. Despite early termination due to the COVID-19 pandemic, preliminary results suggested favourable trends. Blockages per 1000 catheter days were lower in both saline and acidic washout groups compared to standard care alone. While these differences did not reach statistical significance due to the small sample size, they point to potential benefits worth exploring further.
S-CAUTIs, a major safety concern associated with LTC, were significantly reduced in the saline washout group, with rates dropping to 3.71 per 1000 catheter days compared to 8 per 1000 days in the standard care group. Although the acidic washout group also showed a reduction, it was less pronounced. Adverse events across all groups were minimal, with some variations in reported leakage and blood in urine. Patient acceptability of prophylactic washouts was high, supported by video training that enabled self-care and reduced dependence on healthcare resources. These findings underscore the potential for washouts to improve LTC outcomes while lessening the strain on healthcare services.
While current guidelines advise against prophylactic washouts due to limited evidence, the observed trends in CATHETER II suggest a need for larger trials. Such research could provide robust evidence on their effectiveness and cost-efficiency, potentially shaping future guidelines and enhancing care for individuals reliant on LTC.
Katie Wright, EMJ
Reference
Abdel-Fattah M et al. CATHETER II: a randomised controlled trial comparing the clinical effectiveness of various washout policies versus no washout policy in preventing catheter-associated complications in adults living with long-term catheters. BMJ Open. 2024;14(12):e087203.
