Small tube - big problem
Catheters are a common, but little considered aspect of many patients' care. But in this week's Scrubbing Up Mandy Fader, professor of continence technology at the University of Southampton, says there needs to be a rethink about how they are used.
Imagine you are going into hospital tomorrow - you might be expecting a few necessary but undesirable experiences - investigations, needles or examinations - but would it cross your mind that you might be getting a tube in your bladder?
Probably not - but about one in five people staying in hospital do.
Obviously it's not nice having a urinary catheter inserted into the urethra (the passage leading to the bladder) - and having to put up with your urine draining into a bag - but surely this would be for your own good?
Well yes and no. Urinary catheters are used for many important reasons - to monitor how much urine you pass; or to make sure that your bladder doesn't get overly full when you have a surgical operation for example - but there is growing evidence that catheters are over-used and that many could be avoided.
And it's not just another indignity either.
Urine infection is one of the most common hospital infections and catheters are the most common reason to get one.
Bugs can easily enter the bladder when the catheter is inserted - or track up the tube to the bladder via a "bio-film" - a thin slime filled with bacteria - to the warm wet environment of the bladder which is perfect for multiplication.
This is not new. Hospitals are well aware of the problem of catheter infection and, because the longer a catheter stays in the more likely you are to get an infection, there are many schemes designed to remove catheters early.
But is this enough? Surely catheter avoidance would be better?
Lack of 'space-age' materials
The reasons someone may need a catheter are not very clear and practitioners err on the side of caution - passing too little urine or a distended bladder can be dangerous.
What's annoying is that some solutions to catheter overuse are already available - such as bladder scanners to measure how much urine is in the bladder.
But these are expensive and most hospitals don't have nearly enough to go round. NHS Equipment budgets are tight, and different budgets are used to pay for catheters.
And what about the catheter itself? Surely such a common-place device - with well-known infection potential would by now be a state-of-the art product made with modern space-age materials and designed to minimise risks?
Far from it.
The lowly catheter has actually changed very little in the last 80 years.
True, there have been some attempts to make catheters out of materials with anti-bacterial properties.
But investment from industry has been low, and catheters are weakly regulated.
Unlike with new drugs, manufacturers do not need to show that any changes they make to catheters actually work on patients.
Over the years, manufacturers have produced catheters they claim reduce infections - but cost a lot more than standard catheters. A good example of this is silver alloy catheters.
The NHS spent millions of pounds on these before government funded research showed that they were no better than standard catheters.
The problem is even worse for people who need to use a urinary catheter permanently.
Poor bladder drainage or incontinence can mean that some people - such as those with a spinal cord injury - can have a catheter for years.
Catheter blockage and infection often results in frequent hospital visits and catheter changes, together with much misery.
What's needed is for industry to wake up and invest more heavily in new catheter designs and catheter materials that resist infection.
For too long catheters have been "easy money" - with demand remaining high without bothering with much innovation and improvement.
In particular, more research is required to understand how bio-films form so that catheter materials can be developed to resist them.
Research in this field has led to new coatings for the bottoms of ships because barnacles reduce efficiency and are expensive to remove.
Surely this thinking can be applied to catheters?
Patients deserve better catheters - but who is going to lobby for them? No-one in healthcare seems to "own" catheters - they cross the paths of surgeons, anaesthetists, physicians and nurses in particular - but usually only play a walk-on part.
It's time for them to become more centre stage.
We need to use fewer catheters. But the catheters we do use need to be better.
The dream is that one day they will be specialised technologically advanced products - designed to minimise infection risks - and used in exception, when patients really need them.