Recommendations:MANAGEMENT WITH CATHETER VALVES
47.

In people for whom it is appropriate a catheter valve may be used as an alternative to a drainage bag.

[This recommendation is from ‘Infection: prevention and control of healthcare-associated infections in primary and community care’ (NICE clinical guideline 139).]

48.

To ensure that a catheter valve is appropriate, take into consideration the person’s preference, family member and carer support, manual dexterity, cognitive ability, and lower urinary tract function when offering a catheter valve as an alternative to continuous drainage into a bag.

49.

Consider the need for continuing upper urinary tract surveillance in people who have impaired bladder storage (for example, due to reduced bladder compliance).

Relative value placed on the outcomes consideredThe GDG recognised the high value placed on quality of life.
Economic considerationsThe clinical review will inform which one should be used in which group of patients, and this is likely to lead to cost savings as clinicians will avoid recommending the wrong equipment for use and later switching to the other option. Using both options at the same time will also be avoided.
Based on a simple cost analysis based on unit costs and GDG assumptions on the quantity of resources needed, catheter valves and urinary drainage bags have similar costs.
As the clinical review has revealed that there is no difference in incontinence, the main issue to consider in terms of cost effectiveness is the risk of urinary tract infections and adherence (patient comfort). If one intervention is shown to be associated with fewer infections, then this will probably be cost effective, due to a reduction in longer term costs. The greater the comfort of the patient also will lead to better adherence and greater effectiveness of the treatment A fairly simple analysis of cost allows us to see that while there is very little difference between catheter valve and bag usage, using drainage bags rather than non drainable bags is cheaper. Whether they are more cost effective is dependent on the prevalence of infection and patient comfort.
Quality of evidenceThere was no evidence of harm or benefit available to the GDG as no relevant studies were identified in the literature review. Recommendations on the use of catheter valves were made on the basis of the clinical experience of the GDG members.
Trade-off between clinical benefits and harmsIn selected patients there may be significant quality of life benefits from the use of intermittent bladder drainage using a catheter valve rather than continuous drainage of urine into a bag but there is a risk of harm (in the form of incontinence, infection and renal damage) if catheter valves are used in patients whose bladders are not capable of storing urine at safe pressures.

The GDG agreed that the recommendation from the Infection control guideline be incorporated.
Other considerationsThe GDG noted that the use of catheter valves was dependent on the patient’s cognitive ability, dexterity, or the availability of a carer to assist and these factors need to be considered when drawing up an individuals support plan. A valve may not be suitable for all patients, however the group agreed that a valve was often the option preferred by patients, because of convenience, the feeling of increased control over their bladder management and the relatively discreet nature of a valve as opposed to a leg bag.

From: 11, Management with catheter valves

Cover of Urinary Incontinence in Neurological Disease
Urinary Incontinence in Neurological Disease: Management of Lower Urinary Tract Dysfunction in Neurological Disease.
NICE Clinical Guidelines, No. 148.
National Clinical Guideline Centre (UK).
Copyright © 2012, National Clinical Guideline Centre.

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