Management of the long‐term urinary catheter in the asymptomatic patient in the Accident and Emergency department

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Abstract
Objective: To determine the management of long‐term urinary catheters in the asymptomatic patient in the Accident and Emergency (A&E) Department.Patients and methods: Using data obtained from patient records, a retrospective study was undertaken of 41 patients who presented to the A&E department of a large district general hospital, on a total of 80 occasions in a 6‐month period, with blocked or bypassing long‐term urinary catheters, but who were otherwise asymptomatic.Results: In 78% of presentations, patients had one or more investigations performed on their urine, which in 15% was on urine aspirated through an old, unchanged catheter. In 23% of presentations, patients were discharged only having had their catheters flushed, and in only 41% was the catheter changed as the first line of management. Finally, in 63% of episodes, patients were discharged with antibiotics, despite having no symptoms of a urinary tract infection.Conclusions: All patients with long‐term urinary catheters will have bacteriuria and performing investigations on this urine if the patient is asymptomatic is a waste of resources. Long‐term urinary catheters which become blocked usually do so by encrustation on the luminal surface of the catheter. Flushing these catheters may dislodge some of these encrustations, but ideally the catheter should be changed. The prescribing of antibiotics to asymptomatic patients with bacteriuria has no proven benefit, but on the contrary it may cause harmful side‐effects and also selects for antibiotic‐resistant bacteria. These patients should be managed in the A&E department with a simple catheter change.

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