It’s time to change the catheter: this ubiquitous but flawed medical device is letting patients downBMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1932 (Published 11 March 2014) Cite this as: BMJ 2014;348:g1932
- John Havard, general practitioner, Saxmundham Health, Lambsale Meadow, Saxmundham, Suffolk IP17 1DY, UK
The indwelling urinary catheter was designed by Frederick Foley in the 1930s—but it’s been stuck in a time warp ever since. It was originally intended only to provide haemostasis after transurethral prostatic surgery. Its inflatable balloon was unique, reliably enabling retention in the bladder. Now it is the most commonly implanted medical device, with 100 million in use in many different groups of patients around the world at any one time.1
Unfortunately, its use risks serious pathologies that are often difficult to treat. The Foley catheter is the most common cause of infections in healthcare facilities.2 Patients are so vulnerable because the catheter undermines the defences that usually protect the bladder against infection. The normal regular mechanical filling and emptying of the bladder help to wash out any bacteria that contaminate the urinary tract. The Foley catheter, with continuous drainage into a collection bag, does not allow the bladder to fill, and the retention balloon leads to a sump of residual urine below the level of the drainage eyes at the catheter’s tip.
Because urine …