NHS warned over catheter errors

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The wrong catheters have been used on 114 male patients in the last two years, NHS safety experts warn.

In one case, a man's death was partly linked to a haemorrhage after a female catheter - which is shorter than the catheter needed for men - was inserted.

The National Patient Safety Agency has called for better labelling and a ban on female catheters in all-male wards.

Catheters are thin, flexible plastic tubes inserted in the urethra to drain urine when patients are immobile.

Limit access to female length catheters where appropriate, such as on all-male hospital wards Dr Kevin Cleary, National Patient Safety Agency

Adult catheters are manufactured in two lengths - 20-26cm for women and 40-45cm for men.

Women can use shorter catheters because they have shorter urethras.

The shorter length also means women can hide them under their clothes more easily.

Women can use the longer male catheters without any problems.

But men can suffer a range of complications if too short a tube is used, including pain, swelling, bleeding, urine retention and even renal failure.

Nurses, who insert the majority of catheters, were involved in 57% of the incidents reported to the NPSA.

'Limit access'

NPSA medical director Dr Kevin Cleary said: "Although the 114 incidents that were reported over the last two years represent a very small proportion of catheterisations that occur on a daily basis, they still should not be happening as they can be easily prevented with simple measures.

"We are advising all healthcare organisations that carry out catheterisations to review their current supply systems and limit access to female length catheters where appropriate, such as on all-male hospital wards.

"For healthcare settings that have to store both types in the same area, we have produced warning notices and labels designed to attract the attention of staff so that they are constantly reminded of the potential risk to male patients.

"Organisations can download these from our website at no cost."

Healthcare organisations have until September 2009 to implement these recommendations after which regulatory action may be sanctioned.