Some observations on catheter care

Abstract

FOR YEARS urologists have been dedicated to the elimination of the catheter as a means of urinary drainage. Their success in removing this urinary prosthesis is epitomized in CREEVY’S remarkable achievement of 0.6 per cent mortality in a series of 1000 cases of prostatectomy [l]. DEBENHAM and WARD in Great Britain [2] have gone so far as to attempt prostatectomy suns catheter although their mortality and infection figures are no improvement on those of others for the same procedure with catheter drainage. It is somewhat embarrassing then for an urologist to have to come to the defense of the urinary catheter when he and his predecessors have worked so hard to effect its safe removal from patients. However, because misleading charges have been cast at the catheter in the recent past [3], one whose practice involves the temporary use of this device is moved to defend the proper care of the catheter and to castigate those whose abuse has given it a poor reputation. This paper is divided into three parts. The first deals with single catheterization: the second is concerned with the problem of the indwelling catheter, and finally the closed drainage system of catheter care employed on the Urology Service at the University of Washington Hospital will be discussed. Single diagnostic catheterization. Clean-voided midstream specimens should be used for diagnostic urine cultures wherever feasible [4]. SANFORD’S revival of the colony count originally suggested by MARPLE [5] as a means of differentiating contaminants from pathogens has been most useful. However, there are situations in which diagnostic or therapeutic catheterization is unavoidable and PRYLES et ~2. [6] and JACKSON and GRIEBLE [7] suggest that the incidence of infection during a carefully carried out catheterization, while definite, is very low. This is also borne out by the series of 200 single catheterizations carried out in a local institution by TURCK et al. [8] in which no contamination resulted. In this respect it may be well to cite the work of PRYLES [6] who followed closely a group of children subsequent to catheterization. All were free from urinary tract infection within a period of 4-6 months following catheterization. Thus, while organisms were introduced into the urine of the children during catherization and in apparently significant quantities, long-term infection was not a complication. While properly collected clean-voided specimens may be used in most instances for making the diagnosis of bacteriuria in children, catheterization, when properly done, should not be withheld for fear of producing urinary tract infection. While all physicians should be alert to the