Intended for healthcare professionals

Practice Practice Pointer

Managing long term indwelling urinary catheters

BMJ 2018; 363 doi: (Published 11 October 2018) Cite this as: BMJ 2018;363:k3711
  1. Catherine Murphy, senior research fellow1,
  2. Alex Cowan, expert patient,
  3. Katherine Moore, professor emerita2,
  4. Mandy Fader, professor of continence technology1
  1. 1School of Health Sciences, University of Southampton, Southampton, UK
  2. 2Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
  1. Correspondence to C Murphy c.murphy{at}

What you need to know

  • Before considering a long term catheter, explore alternatives such as pads, sheaths, collection devices, and intermittent catheters.

  • Leakage, blockage, and infection with catheters are to be expected.

  • Suprapubic catheters may suit patients for whom sexual function is important.

  • Valves reduce the inconvenience of a bag and may be linked to fewer infections.

  • If an infection is suspected, replace the catheter before taking a urine specimen to reduce contamination.

Around in 90 000 people in the UK live with a long term catheter (one that has been in place for four weeks or more).1 Use of catheters varies considerably, suggesting differences in how or whether they are used. For example, in a study of more than 4000 people aged over 65 receiving domiciliary care in 11 European countries, long term catheter use ranged from 0% (Netherlands) to 23% (Italy).2

Problems with long term catheters, such as infections or blockage, affect individuals’ lives and healthcare resources, particularly out-of-hours services.3 This article aims to help healthcare professionals address the needs of any person living with or making the decision to have a long term indwelling urinary catheter (examples shown in fig 1).

Fig 1

Examples of indwelling catheters

When are long term catheters used and what are the alternatives?

Urinary retention and urinary incontinence are the two main indications for long term catheters. An algorithm providing an overview of the process for deciding between a long term indwelling catheter and an alternative management options (box 1), is shown in figure 2.45678 Discussion about urinary problems and management options can involve a range of healthcare professionals, including those in primary, community, or secondary care, physicians, and nurses.

Box 1

Commonly used non-invasive incontinence management

  • Absorbent pads are the most common. They are available in a range of disposable and reusable designs. Choice depends on sex, level, and type of incontinence, and functional ability (eg, ability …

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