1. Catheter Blockage
Maggie Rew RN MBA

3. Some causes of blockage
twisted tubing
drainage bag very full
constipation
bladder spasm
bladder calculi
suction of mucosa into catheter eyes
catheter encrustation by mineral deposits
calcium phosphates, struvite (magnesium ammonium phosphate)

5. Biofilm - a city of microbes (‘pillars, mushrooms and water channels’)
Copyright (2001) by the Center for Biofilm Engineering, Montana State University–Bozeman,
Bozeman, MT , (406)

6. Biofilms – cell to cell communication
Copyright (2001) by the Center for Biofilm Engineering, Montana State University–Bozeman,
Bozeman, MT , (406)

7. Scanning electron micrograph of biofilm

8. How Fast do Organisms Multiply?
Pseudomonas aeruginosa
2hrs on a 100% Silicone Foley Catheter
Pseudomonas aeruginosa
18hrs on a 100% Silicone Foley Catheter

9. Proteus mirabilis

10. Causes of catheter blockage
Urine normally
slightly acidic
Infection with
urease-producers
Urine pH
alkaline
Urease splits urea
to release ammonia
Struvite & calcium
phosphates precipitate
Encrustation
and blockage 30

11. SEM of struvite crystal and calcium phosphate33

12. Catheter maintenance solutions.
Suby G or Solution G
3.23% citric acid solution, pH 4, with magnesium oxide
Solution R
6% citric acid solution, pH 2, containing magnesium carbonate
Saline 0.9%
A neutral solution, pH 7, flushing of debris and small blood clots.
Chlorhexidine 0.02%
An antiseptic solution aimed at preventing or reducing
bacterial growth, in particular E. coli and Klebsiella species

13. Cross-sections of two catheters (I and II) both subjected to encrustation, following instillation of an acidic washout to one 36

14. Uro-Tainer Twin Evidence Based and Nurse Innovation
double instillation more effective at dissolving/
reducing encrustation in the catheter (Getliffe 2000)
Kinder in Use
Smaller volumes – 30ml in each chamber
No agitation – gravity fed and respects patients tolerance
Reduced infection risk
Quick to use
5 minutes instillation time per chamber (Getliffe 2004) 14

15. Preventing catheter blockage
consider catheterisation as a last resort
catheter choices
intermittent versus indwelling catheterisation
catheter material and type
? catheter valve
pro-active care
identifying ‘blockers’ and ‘non-blockers’
use of catheter maintenance solutions
planned changes: identifying ‘catheter-life’