Blockage of indwelling urinary catheters: the roles of urinary composition, the catheter, medication and diet

Burr, R G; Nuseibeh, I

doi:10.1038/sc.1993.42

Cited by 10 publications

(14 citation statements)

References 13 publications

(1 reference statement)

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“…The e ectiveness of acidifying or alkalinising agents is, however, in¯uenced by diet and needs to be taken into consideration when managing the individual patient. 61 …”

Section: Oral Antiseptic Acidifying and Alkalinising Agentsmentioning

confidence: 99%

Prevention of urinary tract infection in patients with spinal cord injury – a microbiological review

Galloway

1997

Spinal Cord

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The importance of urinary tract infection (UTI) in patients with spinal cord injury cannot be understated. Many patients with signi®cant bacteriuria are considered to be colonised rather than infected, and treatment should be reserved for those with clinical symptoms or other signs of infection. 1 Published research on the prevention and management of UTI in patients with spinal cord injury often has limitations due to di erences in de®nitions of UTI, studies on groups using di erent urinary drainage appliances, the mixture of newly injured and longstanding injured patients and studies being carried out predominantly on male patients. 2 The complications due to UTI and the di culties in treating established infection mean that prevention is essential. Close urological follow-up is crucial in ensuring that adequate bladder drainage is achieved avoiding the use of long term indwelling urinary catheters if at all possible. 3 For those patients who require long term urinary appliances patient education and strict attention to hygiene and catheter care policies is important. The role of antiseptic/ antibiotics is strictly limited in preventing UTI in patients with spinal cord injury and may even be harmful. Further study into which groups of patients may bene®t from the use of antiseptics or antibiotics is urgently required. Continued research into di erent methods of prevention eg by vaccination, immunotherapy, the use of receptor analogues and bladder interference should also be encouraged.

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“…The e ectiveness of acidifying or alkalinising agents is, however, in¯uenced by diet and needs to be taken into consideration when managing the individual patient. 61 …”

Section: Oral Antiseptic Acidifying and Alkalinising Agentsmentioning

confidence: 99%

Prevention of urinary tract infection in patients with spinal cord injury – a microbiological review

Galloway

1997

Spinal Cord

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“…22 Acidifying therapy may raise urine Ca without lowering urinary pH if urease-positive organisms are present. 23 In vitro studies have indicated that magnesium promotes the growth of deposits on catheters, 9 this ®nding has not been con®rmed in vivo 5 and may only be signi®cant at high pH. However, in some Blockers urine magnesium is elevated, frequently traceable to medication with a magnesium-containing antacid 5 or to a dietary component.…”

Section: 5mentioning

confidence: 99%

“…Grossly elevated pH associated with oliguria can be lowered by dilution. 5 It has been suggested that excessive¯uid intake may lead to hyponatraemia, 15 but no ®gure was suggested as to what is a maximum safe level of¯uid intake, and the occurrence of hyponatraemia appeared also to involve the presence of sepsis and low sodium intake. 15 The present data show no dierence in 24 h volume but greater variance of Ca concentration between B and NB patients suggesting that reduced catheter encrustation requires constancy of¯uid throughput and avoidance of concentrated urine.…”

Section: 5mentioning

confidence: 99%

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Urinary catheter blockage depends on urine pH, calcium and rate of flow

Burr

Nuseibeh

1997

Spinal Cord

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Urinary catheters tend to block when bio®lm from urease-producing organisms build up on the catheter surface. This is a locally-occurring process that in¯uences and is in¯uenced by the composition of the urine. In this work we relate urine pH and calcium to catheter blockage and suggest how to reduce the rate of encrustation. Sixty patients with indwelling urinary catheters were studied, 26 of them being troubled by frequent blockage of their catheters, 34 of them not. A series of small urine samples were collected during a 24 h period. Urinary pH and calcium concentration were combined into discriminant functions designed to separate Blockers from Non-blockers and achieved a 95% correct classi®cation. The results indicate that a high and uniform rate of¯uid intake is mandatory for the patient with a tendency for catheter blockage. Excessive total¯uid intake may be avoided by attention to uniformity. Other avoidable risk factors include: excess dietary calcium from certain protein supplements and antacids; excess dietary magnesium from certain beverages and antacids; alkali from eervescent tablets; excess dietary citrate from some fruit juices and cordials; intermittent dehydration from alcohol ingestion. Less tractable risk factors include infection of the urinary tract with urease-positive organisms, hypercalciuria of immobilisation, hyperhydrosis and postural oliguria. The processes involved in catheter encrustation and blockage provide a model for the formation of calculi in spinal cord injured patients. Therefore the above considerations may also be relevant to the management of stone disease in paraplegic and tetraplegic patients.

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“…1 Citrate excretion is reduced in spinal cord injured patients, a feature that may be related to the occurrence of renal stone disease. 2 Citrate forms soluble nonionised com plexes with calcium ions, thereby lowering the effective concentration of calcium in solution.…”

Section: Introductionmentioning

confidence: 99%

Creatinine, calcium, citrate and acid-base in spinal cord injured patients

1993

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The aim of this work was to recognise factors responsible for reduced citrate excretion, previously reported in patients with spinal cord lesions and possibly related to the occurrence of urinary tract stone or catheter blockage. Inter alia, a reference range for creatinine in plasma (34-88 .umol/I) was also obtained.Two groups of subjects were studied. The first group consisted of 64 male inpatients with spinal cord lesions and 20 male control sUbjects. The second group were 342 spinal patients who attended an outpatient clinic and 31 control subjects.Plasma calcium was within the normal range but higher in patients within 1 year of onset of the cord lesion than it was later or than was found in control subjects.Plasma pH and bicarbonate were within the normal range but higher in the patients than in the control subjects. When patients with urea-splitting infection were omitted the patients had a higher urinary pH and a lower urinary ammonium than the controls.Urinary and plasma citrate were lower in the patients than in the controls. Urinary citrate was related to urinary potassium and creatinine clearance. Fractional renal tubular reabsorption of citrate did not differ between patients with normal renal function and control subjects. Patients with normal glomerular filtration had lower filtered load of citrate than the controls.The coincidence of relative alkalosis and reduced citrate excretion may be relevant to the understanding of catheter blockage and urinary stone formation in spinal cord injured patients.

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Blockage of indwelling urinary catheters: the roles of urinary composition, the catheter, medication and diet

Cited by 10 publications

References 13 publications

Prevention of urinary tract infection in patients with spinal cord injury – a microbiological review

Prevention of urinary tract infection in patients with spinal cord injury – a microbiological review

Urinary catheter blockage depends on urine pH, calcium and rate of flow

Creatinine, calcium, citrate and acid-base in spinal cord injured patients

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