Catheters can cause infection and even lead to kidney failure: The needless indignity that’s leaving patients in agony
When Emma Campbell was admitted to hospital, like millions of patients every year she was fitted with a cannula, a small tube inserted into her arm to deliver fluids or take blood samples; and a catheter, a thin, flexible tube put into the bladder to drain urine.
Emma was having surgery to relieve pressure on a nerve that was causing severe pain in her cheek, chin and forehead — a condition known as trigeminal neuralgia.
By the time the catheter was removed after 12 hours and the cannula after three days, Emma felt unwell.
As well as nausea and dizziness, she was suffering from hot and cold flushes; her arm was red and swollen, with the skin erupting in sores; the genital area was red and swollen; and she was so uncomfortable she couldn’t sit up or use the bathroom.
‘I’d been unhappy they had put in a catheter when I went down to theatre without telling me,’ says Emma, 28, a shop assistant from Dartford, Kent. But when she complained, she was told the catheter was necessary because it was ‘inappropriate’ for her to get out of bed to go to the loo.
As for the post-op symptoms, the medics put these down to the anaesthetic.
Emma was discharged from hospital after three days. But 24 hours later she received a call to say a blood test showed she had contracted the superbug MRSA. She was readmitted immediately and spent three weeks in hospital on a cocktail of antibiotics. ‘It was horrendous and debilitating,’ says Emma.
It’s also had longer-term consequences — for the three years since, she’s suffered from chronic urinary tract infections.
Emma is one of thousands of patients who develop complications from catheters each year — they are responsible for 80 per cent of hospital-acquired urinary tract infections (which cost an average £1,122 to treat, according to a Department of Health study) and patients have a 10 per cent chance of developing an infection for every day a catheter is in place.
This is because they provide an easy route for bacteria on the surface of the skin to enter the body. The bacteria infect urine, tissue or blood, with potentially fatal consequences.
Older patients who develop an infection from a urinary catheter have an almost three-fold increased risk of death, according to the Journal Of The American Geriatrics Society.
Yet many cases may be needless, say experts, who warn too many patients are given catheters unnecessarily because it’s easier for hospital staff (as they don’t have to help patients to the loo) or they do it through out-of-date nursing habits.
Catheters are meant to be inserted under sterile conditions to minimise the risk of infection. However, by the nature of the location, the conditions can never be sterile. Poor hygiene practices also increase the risk of infection.
Furthermore, if they’re not inserted properly, catheters can cause internal bleeding and damage to the urinary tract.
Many patients also find them uncomfortable and painful; they can cause the skin in the area to break down and trigger bladder stones, causing pain and difficulty passing urine.
Worryingly, sometimes the wrong type is used. There are different catheters for short and long-term use, and for men and women. In women, the urethra, the tube that carries urine from the bladder out the body, is shorter.
If a man is given a female catheter, the balloon at the end of the tube (which is inflated with water to stop it sliding out of the body) inflates in the urethra, not the bladder.
A report by the National Patient Safety Agency found that between June 2006 and December 2008, 114 female catheters were inserted into male patients, causing pain, blood in the urine and penile swelling. Seven caused significant haemorrhages and two led to acute kidney failure.
Yet despite these risks, thousands of patients in hospitals and care homes are fitted unnecessarily with a catheter — according to an official report in 2008, between 41 and 58 per cent of catheters inserted were not needed.
Other studies have shown that in 21 per cent of hospital patients with long-term catheters there was no medical reason for having it.
So why are so many being used? ‘The problem is that for years part of the process of going to theatre was to insert a drip and catheter. It was what medical and nursing staff were taught to do,’ says Liz Smith, a former intensive care nurse and programme manager for 1,000 Lives Plus in Wales, a campaign to reduce harm in NHS hospitals.
‘However, we now know how much harm catheters can cause. ‘They should be used only when there is a clinical need — for example, where a patient is not able to pass urine following pelvic or bowel surgery, or major operations where monitoring of kidney and bladder function is necessary.’
Instead of using catheters routinely, she says patients should be monitored before and after surgery to make sure they are drinking and passing urine. ‘If they are not, this could be a sign of dehydration or kidney damage, which needs to be treated. And that may be with a catheter.’
Earlier this year, Liz launched a campaign to reduce unnecessary catheterisation across Wales. Called STOP (Stop, Think, Options, Prevent), the aim is to make medical staff pause before they insert a catheter and think why they are putting it in and if it is really needed. ‘It is about keeping a close eye on patients rather than relying on a device,’ says Liz.
Since the campaign started, a spot check on one 28-bed surgical hospital ward revealed that not one patient had a catheter. ‘In the past, I’d have expected half of the patients to have one,’ says Liz.
Improvements have also been seen in A&E and general admission wards, but the next big drive in Wales is care homes, where many patients are catheterised for months or even years.
While in some cases this may be medically necessary — for example, if a patient has dementia, incontinence or a neurological condition — ‘social catheterisation’, as it is known, can be a way of cutting the amount of care required.
‘In some cases, catheters are put in to make it easier for carers to manage a patient and reduce the amount of cleaning up that has to be done rather than there being a medical need,’ says Gordon Muir, a consultant urologist at London’s King’s College Hospital and London Bridge Hospital.
Nevertheless, there will always be a significant group of patients for whom a catheter is essential and scientists are trying to come up with new designs that reduce the risk of infection.
One of the most promising devices, developed by University College London, is a catheter that uses light to fight infections.
Researchers have found a way to modify the silicone that catheters are made of so it kills bacteria when it is exposed to light from a laser or ordinary room lighting before the device is inserted.
The process involves dipping the silicone in a solution, where it bonds with organic dyes. After a few minutes of exposure to light, this generates molecules that are toxic to bacteria, preventing them from attaching to the catheter.
The device will be tested on animals next year and, if all goes to plan, should be available in hospitals within five years.
Meanwhile, Emma’s experience has left her anxious about being admitted to hospital.
It’s been discovered that her facial pain is caused by a benign tumour that requires surgery every five years to relieve the pressure in her brain. This means she is expecting to have surgery in three years’ time.
‘I’m already dreading it,’ she says. ‘This was a terrible hospital ordeal and the impact it’s had has been devastating.’
The intolerant war on “parochial pensioners”
In forever fretting about the ‘bigoted attitudes’ of ordinary people, Britain’s political class exposes its own prejudices
When it comes to describing everyday people, the words ‘extremist’ and ‘bigot’ are an integral part of the British political establishment’s vocabulary. Deputy prime minister Nick Clegg might have hurriedly recalled a press release that branded opponents of gay marriage as bigots, but that only demonstrated that his minders have told him to keep his real views to himself. Poor Gordon Brown’s ‘Bigotgate’ moment, when, during the 2010 General Election campaign, he referred to a 65-year-old woman who asked him about immigration as a ‘bigoted woman’, was more compromising, because TV journalists recorded his outburst. Unlike Clegg, Brown couldn’t say ‘it wasn’t me!’.
Politicians’ promiscuous use of terms like bigot and racist to describe members of the public is not simply an affectation. Many of them sincerely believe that a significant section of the population – especially members of the white working classes and the elderly – are irredeemably prejudiced. Brown and Clegg’s throwaway remarks speak to a belief that people who refuse to accept the political class’s social etiquette and cultural assumptions about Europe, multiculturalism and family life are morally inferior. Today’s elite views ‘those people’, sometimes called ‘tabloid readers’ or ‘white van men’, as a kind of cultural enemy within.
The terms bigot and racist are frequently coupled with the word ‘extremist’. Why? Because, as a think-tank report published last week claimed, ordinary people have a natural disposition towards extremist ideology and causes.
Thankfully, unlike many parts of Europe, Britain has been more or less an extremist-free zone for a very long time. Now, however, a report published by the Extremis Project, an advocacy monitoring group devoted to discovering the extremist under your bed, warns against complacency on this issue. It asserts that, in fact, British people have a natural inclination towards supporting right-wing extremist parties. Its survey of 1,750 people ‘discovered’ that 41 per cent would be more likely to support a party that promised to end all immigration. Only 28 per cent indicated that they would be less likely to support such a party.
Matthew Goodwin, spokesman for the Extremis Project, says the research shows that there is a strong disposition on the part of the British public to support right-wing extremists. To substantiate this claim, he says: ‘Consider this: 66 per cent of respondents in our survey would be more likely to support a party that promised to stand up to political and business elites; 55 per cent would be more likely to back a party that pledged to prioritise British values over other cultures; 41 per cent would be more likely to support a party that pledged to halt all immigration into the UK; and a striking 37 per cent – or almost two-fifths of our sample – would be more likely to endorse a party that promised to reduce the number of Muslims in British society.’
What is interesting about these comments is that Goodwin clearly believes that any rejection of the cultural values of the political and cultural establishment can be described as a ‘far right’ attitude. His implicit definition of an extremist is anyone who is uninhibited about expressing their disdain for such values.
That is why he exclaims: ‘Consider this – 66 per cent of respondents in our survey would be more likely to support a party that promised to stand up to political and business elites.’ So, people who wish to prioritise their own cultural values over those of others, especially the elite, are perceived as suffering from some kind of moral deficit. For Goodwin, it seems that any kind of populist rejection of the establishment and its values represents a dangerous kind of political malady. It is striking that the Extremis Project assumes that populism is intrinsically a marker for right-wing extremism; perhaps it has never encountered radical, left-wing or plain old conservative populism.
Goodwin can barely suppress his outrage that so many of his fellow citizens would support a party that stood up to the political and business elites. Of course, he is fully entitled to his pro-establishment opinions. But it is worth noting that, historically, standing up to the political elite was an act associated with radical forces, from trade unionists to the Suffragettes all the way to radical movements of both the left and the right. What the Extremis Project’s report does is construct a new definition of the words ‘extremist’ and ‘far right’ that flatters the sensibilities of the current political establishment.
The main target of the report’s enmity is the elderly. Goodwin argues that Britain’s older generations ‘appear relatively clear and resolute in their desire for a party that adopts a tough, populist stance toward elites [and] immigration’, whereas ‘younger Britons are significantly less favourable toward this narrative’. No doubt there is a significant generational divide between the elderly and the young on a variety of political issues. However, from a sociological point of view, it seems pretty clear that these divergent attitudes spring from differences in generational experiences and from very different uses of language. Clearly, the elderly experience change differently to young people and are likely to find adapting to new circumstances more difficult than their children find it.
However, a generational divide on specific policies should not be taken as evidence that older and younger people have fundamentally different attitudes towards political life. Old-aged pensioners who are uncomfortable with change, but who have voted for mainstream parties all their lives, are unlikely to constitute the shock troops for a new extremist paramilitary force. Similarly, young people who are more attuned to what can be said to pollsters are more likely to express opinions that they think the interviewer wants to hear; like Nick Clegg, they know the virtues of censoring your real views.
Cosmos vs the plebs
What is most interesting about the Extremis report is what it reveals about its authors. It speaks to a profound dissonance between two different worlds: that of the establishment and that of the plebs. This is especially vivid in another report published on the Extremis Project’s website, titled Parochial and Cosmopolitan Britain: Examining the Social Divide in Reactions to Immigration. Written by Robert Ford and published in June 2012, the report makes a crude distinction between backward-looking elderly people and the apparently more open-minded younger generations. The ‘younger, more cosmopolitan voters’ are represented as being more morally with-it than ‘the more parochial older generation’. Throughout the report, the term parochial is used to describe the elderly, whereas the young are categorised as ‘cosmopolitan’.
However, on closer inspection it becomes clear that the generational difference flagged up by the Extremis Project is really about class. So the elderly who are hostile to immigration are not simply old – they are also ‘less-educated’ and ‘parochial’. And in contrast, the ‘tolerant’ young cosmopolitans are ‘highly educated, economically secure, and used to effortless travel across borders and regular mixing with people of different ethnic and racial backgrounds’.
The report concludes that: ‘Many of the factors that predict attitudes on immigration – age, education, migrant heritage and financial security – tend to overlap with each other. The result is a strong social division between the “cosmopolitan young” – highly educated, ethnically diverse and relatively comfortable with immigration – and the “parochial pensioners”: older, homogeneously white respondents who are deeply alarmed by the settlement of migrants.’
Here, the Extremis Project is drawing attention to the different moral outlooks of those who have benefitted from socio-economic changes and education and those who have lost out. And like Gordon Brown’s ‘bigoted’ pensioner, the people who have lost out serve as uncomfortable reminder of communities that are best written off as parochial fodder for extremist parties.
Don’t act ‘too gay’ if you want to become a doctor, senior British GP tells trainees… and if you’re Asian, try to sound Welsh or Scottish
I knew a doctor once who took over a busy practice but who proclaimed his homosexuality. His practice soon dwindled to nothing — so the advice below is good advice for all its “incorrectness”
A senior GP is under investigation for telling gay junior doctors to avoid acting effeminately around patients.
Dr Una Coales said if they deepened their voices and changed the way they walked they would stand a better chance of impressing their examiners.
In a guidebook written for medics sitting clinical skills tests, she advised doctors from Africa and Asia to try speaking in ‘lyrical’ Scottish or Welsh accents if they wanted jobs in those countries.
And she told women doctors not to wear overly-feminine, flowery dresses – in case patients mistake them for nurses. Bizarrely, she even advised overweight medical students to project an ‘image of Santa Claus’ by interlocking their fingers over their bellies.
Dr Coales is a senior member of the Royal College of General Practitioners’ Council and earlier this year narrowly missed out on being elected its president.
She made her comments in a guidebook for junior doctors sitting their ‘Clinical Skills Assessments’, which are exams taken in their final year. In one passage, she wrote: ‘One candidate was facing a third sitting and yet no one had told him that his mannerisms, gait and speech were too overtly gay.
‘So I advised him to lower and deepen his high-pitched voice and neutralise his body movements.
‘He went back to his surgery, practised his speech until his voice went hoarse and modified his body language. Not only did he pass his exam, but he informed me he noticed a huge difference in the way patients interacted with him.’
She also told women not to wear flowery dresses because ‘if you dress like a nurse they [patients] have difficulty believing they are seeing “the doctor”.’
The Royal College of GPs has now launched an inquiry into her comments, which have provoked outrage on the social networking site Twitter. Dr Coales, who trained in America before becoming a GP in South London, could now be ordered to leave the College.