The Risks of Reusing Catheters BP

As in other cases with reusing single-use devices, reusing catheters that have already been used once or multiple times comes with risks and dangers to health and safety for any individual. Sterile catheters are classified as single-use devices (SUD). The Food and Drug Administration (FDA) states that a single-use device, also referred to as a disposable device, can be defined as a device intended for use on one patient during a single procedure. This device is not intended to be reprocessed (meaning cleaned, disinfected/sterilized) and used again. The labeling for a single-use device may or may not identify the device as single use or disposable and does not include instructions for reprocessing. Despite this information from the FDA, there are still multiple cases of catheters and other SUDs being reused. Especially when regarding patients that receive their care from home and outside of a hospital, it is not hard to imagine how single-use medical devices are not sterilized to adequate standards after reuse.

Reuse of SUDs involves regulatory, economic, medical, ethical, and legal troubles and has been a highly controversial topic for over two decades. In the case of catheters and why there are risks to reusing these devices, there are many crevices in which harmful bacteria can attach to and manifest, which could occur if the device has been reused and not properly cleaned. Depending on the SUD and how many times it has been reused, the product can become less effective or damaged after reprocessing as well. There is evidence from studies that even after careful and professional-level cleanings of catheters, these single-use devices are not always risk- and infection-free.

In one simulation study, catheters that had been deliberately contaminated were then reprocessed (sterilized) and reused and then tested for residual viruses via cell cultures and polymerase chain reaction (PCR). While testing, enterovirus was cultured from one (10%) of the catheters, but no less than six (60%) of the samples were enterovirus PCR positive and one (10%) contained detectable adenovirus DNA. This study was performed with professional and rigorous cleaning of the catheters before virus testing was commenced, and viruses were still found in the catheters. Based on this information, even if catheters are cleaned thoroughly after use and reused again, there is a still a real risk of infection to the patient. Some individuals believe that single-use devices are labeled for single use so that manufacturers of SUDs can maintain their profit margin and avoid liability. However, other individuals that are against reprocessing of SUDs argue that the risks outweigh the benefits and that research has not proven reprocessing to be safe.

When it comes to most everyday products that are used, disposable and usually one-time use products are thrown out without much thought from the average individual. While recognizing the different levels of cost and safety associated with everyday products, the same amount of responsibility of disposing should also be said for products such as catheters that are labeled as single-use. While usually more expensive than average daily products, catheters and other medical devices pertain to the well-being of patients and the public. Even if sterility can be guaranteed in the case of catheters, bacteria and residue may still remain on catheters that have already been used. Therefore, catheters should be disposed and taken care of properly to avoid any possible risks and/ or infections.

D.S. Luijt. “Risk of infection by reprocessed and resterilized virus-contaminated catheters; an in-vitro study,” European Heart Journal (March 1, 2001).
Dunn, D. “Reprocessing single-use devices–the ethical dilemma,” The National Center for Biotechnology Information (May 2002).
“Guideline for Disinfection and Sterilization in Healthcare Facilities,” Centers for Disease Control and Prevention (2008).
“Labeling Recommendations for Single-Use Devices Reprocessed by Third Parties and Hospitals,” Food and Drug Administration (July 30, 2001).


5 Ways to Reduce UTI’s

Urinary tract infections (UTIs) are the second most common infection in the body, and in some cases, it can lead to serious problems if left untreated or not recognized. Urinary tract infections are most commonly an infection in the bladder, a part of the urinary system that stores urine until it is ready to exit the body. In more severe cases, the kidneys can also become infected because of a urinary tract infection. More rarely, other parts of the urinary system can also become infected from UTIs. In the most basic sense, bacteria is what causes this uncomfortable infection, and women get urinary tract infections more commonly than men, due to women having shorter urethras (a part of the urinary system that connects the bladder and where urine exits the body).

Symptoms and further complications because of a urinary tract infection are dependent on where the infection is located in the urinary system. Urinary tract infections in the bladder can lead to symptoms such as a strong, persistent urge to urinate; burning when urinating; cloudy urine; blood in the urine; and pelvic pain, especially in women. Infection of the bladder specifically can cause symptoms such as blood in the urine, discomfort in the lower abdomen, and pelvic pressure. A UTI in the urethra, while rare, can result in symptoms such as discharge and burning with urination to occur.

In the most serious form, infection in the kidneys can lead to nausea; vomiting; upper back and side pain; shaking and chills; and high fever. If the infection does reach one or both of the kidneys, the bacteria can cause damage that will permanently reduce kidney function. Especially in individuals who experience kidney problems already, this is quite a serious problem. In the worst situation with the smallest chance, the infection can also reach the bloodstream through the kidneys, which allows the bacteria to potentially reach other organs.

Because urinary tract infections in the bladder are common to happen, knowing how to prevent UTIs is important. Below are 5 ways to reduce these infections:

1. Refrain from using the same catheter more than once.

Although sterilizing/ washing and reusing catheters may work for some individuals, the majority of people experience recurring urinary tract infections when catheters are reused. Using a urinary catheter one time and disposing of it can reduce urinary tract infections significantly. Luckily, most major insurance companies, such as Medicaids, Medicare, and even VA, cover sterile and single-use catheters. Reusing catheters and using indwelling catheters can often lead to infections, which can cost insurance companies more.

2. Hydrophilic catheters can be the answer to reduce infections.

These types of catheters help you avoid discomfort and infection by lessening friction and injury to the urethra, which can occur with other types of catheters. Unlike conventional catheters, hydrophilic catheters have a surface that remains smooth and slippery all the way from insertion to withdrawal, due to a layer of lubrication that is bound to the catheter surface and water-activated. Since the pre-lubricated coating is activated by sterile water, there is no need to touch it, which reduces the risk of contamination that can arise because of stray bacteria or pathogens that may be on your hands.

3. Use catheters that have an introducer tip attached, such as a closed system catheter.

Most closed systems have an additional safety feature known as an introducer or insertion tip. The introducer tip permits the pre-lubricated urinary catheter to bypass the highest concentrations of bacteria found in the first few millimeters of the urethra, rather than pushing the bacteria further into the urethra whilst inserting the catheter. This will help fight against and prevent urinary tract infections.

4. Catheterizing correctly is key.

Learning and knowing how to catheterize correctly can help avoid irritation and infections, such as UTIs, that can occur when a technique is executed incorrectly. Your doctor or primary care nurse can help and show you how to catheterize properly once you are comfortable with a catheter. They can also show you how to keep the equipment sterile for usage.

5. Use insertion supplies.

Insertion supplies are conveniently packaged along with the urinary catheter in most closed system kits, many hydrophilic catheters, and some intermittent catheters to assist in creating a disinfected environment. Insertion supplies usually comprise of benzalkonium chloride wipes, sterile gloves, an underpad, and a col


Catheterization for Spinal Cord Injuries

Spinal Cord and Spinal Injuries

The spinal cord is located within the spinal column and has two basic functions. It can act as a nerve center and can work without the brain. The spinal cord carries sensory impulses to the brain and motor impulses from the brain. The fibers of the sensory root carry stimulations to the spinal cord (position sense, touch, pain, and temperature) from joints, tendons, and body surfaces. The motor roots carry signals from the spinal cord. The spinal cord also controls stretch reflexes, bladder, and bowel control. Thirty-one pairs of nerves exit from the spinal cord and innervate the entirety of the body and the limbs. Spinal nerves communicate to where it emerges and passes through the spinal vertebrae. There are eight cervical (neck), twelve thoracic (chest), five lumbar (lower back), five sacral (sacrum bone) and one coccygeal (tailbone) nerve(s). The spinal cord also acts as a nerve center between the brain and the rest of the body. It is a crucial part of the body, which means an injury to the spinal cord can be catastrophic to a person’s life and health.

The National Spinal Cord Injury Statistical Center (2014) estimated that the annual incidence of spinal cord injury, not including those who die at the scene of the injury, is approximately 40 cases per million population in the U.S. Injuries to the spinal cord more often than not begin with an unexpected, devastating strike to the spine that fractures or dislocates the vertebrae. The damage occurs in the same moment of injury and impact, when bone fragments, disc material, or ligaments that have been displaced bruise or tear into the tissue of the spinal cord. Depending on what has been injured, people with spinal cord injuries can also have their bowel and bladder control, as well as stretch reflexes, impacted by the trauma of the injury. Every injury to the spinal cord depends on the situation. Some individuals will be able to have a nearly full recovery of the injured areas and body. Other injuries will unfortunately result in complete paralysis. These factors all depend on how severe the injury is, where the injury occurred, and what caused it.

Causes of injuries to the spinal cord can vary. Common causes, however, are usually vehicle crashes, falls, and acts of violence (i.e. gunshot wounds). The National Spinal Cord Injury Statistical Center (2014) outlined that motor vehicle accidents account for 38 percent of reported spinal cord injury cases, which accounts for the majority of injuries. The second most common cause of injuries is falls at 30 percent, followed by acts of violence at 14 percent—primarily gunshot wounds. Other causes can be injuries from sports, diving, and industrial accidents.

Ranges in Injuries

Loss of neurologic function and paralysis typically occurs below the level of the injury. Therefore, the higher the spinal injury is on the spinal column, the greater loss of function is in the body. Below is a list of nerves, where they are located, and what part of the body is impacted when those areas are injured.

Cervical spinal nerves (C1 to C8) can be found on the spinal cord in the neck area and control impulses to the back of the head, the neck and shoulders, the arms and hands, and the diaphragm.
The thoracic spinal nerves (T1 to T12) emerge from the spinal cord in the upper mid-back area and have control over signals to the chest muscles, certain back muscles, many organ systems, and even some parts of the abdomen.

Lumbar spinal nerves (L1 to L5) emerge from the spinal cord in the low back region of the body and control stimulations to the lower parts of the abdomen and the back, some parts of the leg, the buttocks, and some parts of the external genital organs.

The sacral spinal nerves (S1 to S5) are located on the spinal cord in the low back and have control over any signals to the thighs and lower parts of the legs, the feet, most of the external genital organs, and the area around the anus.

Injuries to the spinal cord can be categorized as either tetraplegia or paraplegia in most cases. Tetraplegia (also known as quadriplegic) normally results from to an injury between the C1 and T1. This type of injury is typically associated with a loss of feeling or movement in the upper body such as the head, neck, shoulder, arms, hands and/or fingers. Paraplegia may result from an injury between levels T2 and S5. This type of injury can affect the lower part of the body the most, which includes the stomach, hips, legs, and feet/toes.

Incomplete tetraplegia and paraplegia is when the spinal cord’s ability to transport messages to or from the brain is not completely lost. Those with incomplete injuries to the spinal cord can still retain some sensory function if treated immediately, and they may still have motor activity below the injury site that they can control. On the other hand, complete tetraplegia and paraplegia entirely stops nerve communications between the brain and spinal cord to parts of the body below the site of injury. In these cases, there is a total absence of sensory and motor function in the sacral sections S4-5.

Neurogenic Bladder

The National Spinal Cord Injury Statistical Center proclaim 40 new cases of spinal cord injury per million of the population per year. More than 80 percent of those same individuals display at least some level of dysfunction in the bladder. Neurogenic bladder is the overall name for most bladder issues after an injury or illness. Neurogenic bladder is a complication where a person lacks bladder control due to a condition with the brain, spinal cord, or nerves.

Various muscles and nerves must work in combination with each other for the bladder to hold the urine, until it is ready to be emptied. Nerve messages also go back and forth between the brain and the muscles that control the bladder. If these nerves are harmed by injury, the muscles may not be able to constrict or relax at the correct time. Most spinal cord injuries affect the functions of the bladder because the nerves that control the involved organs originate in the segments near the lower end of the spinal cord. Although the kidneys continue to produce urine after injury, bladder control can be lost entirely. The chance of bladder and urinary tract infections (UTIs) increases at this point.

Disorders of the central nervous system commonly cause neurogenic bladder as well. These disorders can include birth defects of the spinal cord, spinal cord injury, multiple sclerosis, cerebral palsy, Parkinson’s disease, spinal cord or brain tumors, and Alzheimer’s disease. Damage or disorders of the nerves can also cause neurogenic bladder. This includes nerve damage (neuropathy), nerve damage because of long-term and heavy alcohol use, nerve damage due to long-term diabetes, and nerve damage from a herniated disk or spinal canal stenosis. Symptoms of neurogenic bladder depend on what the cause is of the neurogenic bladder.

Clean Intermittent Catheters

Spinal cord injuries will often require individuals to perform intermittent catheterization, or take other medical steps to help manage their bladders. This could include behavioral techniques, physiotherapy such as massage therapy, transurethral and suprapubic catheters, as well as condom catheters and penile clamps. Intermittent catheterization is when a catheter is meant to be inserted and removed throughout the day in order to drain the bladder. This is an excellent choice for anyone with a condition or injury that does not allow them to empty their bladder properly or if urinary incontinence is being experienced.

Spinal cord injuries often require catheterization because the trauma to the spine may cause damage to the nerves that control the functions of the bladder. As seen above, there are numerous options for catheterization. Depending on your situation and condition/ injuries, as well as what other treatments your body responds to, catheterization may be best for your health and comfort. Choosing which catheter is best suitable for spinal cord injuries relies on where the injury is located and how complete or incomplete the injury is. Consulting your doctor and following the care and health regimen they order for you should always be a top priority.