UTMDACC INSTITUTIONAL POLICY # CLN0976

CARE OF NON-VASCULAR
PERCUTANEOUS CATHETER POLICY

PURPOSE

The purpose of this policy is to:

 To protect and secure the non-vascular percutaneous catheter.

 To reduce the risk of catheter-related infection and maintain skin integrity at the tube insertion
site.

 To maintain patency of the non-vascular percutaneous catheter.

POLICY STATEMENT

It is the policy of The University of Texas MD Anderson Cancer Center (MD Anderson) to establish and
follow guidelines for the management and care of non-vascular percutaneous catheters.

SCOPE

This policy covers all employees engaged in the management and care of the following non-vascular
percutaneous catheters: biliary, nephrostomy, venting intraperitoneal, nutritional/venting
endoscopically/fluoroscopically placed gastrostomy and/or jejunostomy, cholecystostomy, abscess and
seroma drains, and suprapubic catheters.

STRATEGIC VISION

Strategic Goal 1: Patient Care

Enhance the quality and value of our patient care throughout the cancer care cycle.

DEFINITIONS

Abscess Drains: A catheter inserted to drain an abnormal collection of fluid within the body.

Biliary Catheter for External Drainage: A catheter inserted into the biliary duct with an exit site on the
abdominal wall for the purpose of externally draining bile.

Cholecystostomy Catheter: A catheter inserted into the gallbladder for the purpose of external
drainage of the gallbladder.

CTU-30 Tubing: A vinyl, connecting tube.

Flushing: Instillation (without aspiration) of a solution into a percutaneous catheter to promote patency;
requires a physician/designee order.
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 UTMDACC INSTITUTIONAL POLICY # CLN0976

Gastrojejunostomy/Percutaneous Endoscopic Jejunostomy (PEJ): A technique for the endoscopic

insertion of a feeding tube through a PEG tube and into the jejunum, for the purpose of providing enteral
feeding.

Gastrostomy Catheter: A catheter inserted through the abdominal wall into the stomach for the purpose
of draining gastric secretions (decompression) and/or enteral feeding.

Intraperitoneal Catheter (IP): A catheter inserted into the peritoneal cavity for the purpose of externally
draining peritoneal (ascitic) fluid.

Jejunostomy Catheter: A catheter inserted through the abdominal wall into the jejunum for the purpose
of enteral feeding.

Luer-lock Injection Cap: A cap utilized to stop flow from a catheter; “capping the catheter.”

Medication Administration Record (MAR): Medication administration report.

Nephrostomy Catheter (Cope Catheter): A catheter through the flank into the renal pelvis to alleviate
renal obstruction by diverting urine to an external drainage collection system.

Percutaneous Endoscopic Gastrostomy (PEG): A percutaneous gastrostomy catheter placed with

endoscopic guidance, for the purpose of providing enteral feeding.

Percutaneous Fluoroscopic Gastrostomy (PFG): A percutaneous gastrostomy catheter placed with

fluoroscopic guidance, for the purpose of providing enteral feeding.

Percutaneous Fluoroscopic Jejunostomy (PFJ): A percutaneous jejunostomy catheter placed with

fluoroscopic guidance, for the purpose of providing enteral feeding.

Seroma Drains: A catheter inserted to externally drain a serous fluid collection.

Suprapubic Catheter: A catheter through the lower abdominal wall above the symphysis pubis into the
urinary bladder for the purpose of externally draining urine.

WOCN: Wound, Ostomy, Continence Nurse.

PROCEDURE

1.0 General Information

Catheter dressings will be changed every other day utilizing clean technique, exceptions:

1.1 Catheters with drainage noted on the dressing will be changed daily and as needed to prevent
skin irritation.

1.2 Catheters with signs of infection (e.g., erythema, tenderness to touch, warmth, swelling,
drainage, or foul order) will be changed daily.

2.0 Responsibilities

2.1 Physician or designee: Order/request catheter placement, obtain and document informed
consent for catheter placement, and provide orders regarding catheter flushing (if required).

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 UTMDACC INSTITUTIONAL POLICY # CLN0976

2.2 Registered Nurse (RN): Initial assessment of the catheter insertion site, initial patient/caregiver
teaching, dressing change, drainage bag/tubing change, and catheter flushing; with
documentation of initial site assessment and teaching.

2.3 Licensed Vocation Nurse (LVN): Routine assessment of the catheter site, reinforcement of
patient/caregiver teaching, and drainage bag/tubing change; with documentation of
assessment and response to teaching.

3.0 Dressing Change Supplies

3.1 Liquid soap (optional Hibiclens 4%).

3.2 Normal saline (NS) or water (may use tap water).

3.3 4x4 gauze (4 packages).

3.4 2x2 gauze (1 package) – optional.

3.5 4” Medipore tape.

3.6 Re-sealable plastic bag.

3.7 Gloves – clean examination.

3.8 CTU-30 connecting tubing – if applicable.

3.9 Bedside drainage bag.

3.10 Leg bag.

3.11 Biliary Drainage bag (item # 881).

3.12 Luer-lock injection cap.

4.0 General Dressing Change Procedure

4.1 Wash hands with soap and water; refer to the Hand Hygiene Policy (UTMDACC
Institutional Policy # CLN0452).

4.2 Explain procedure to patient and caregiver.

4.3 Gather supplies and place on a clean dry surface.

4.4 Apply a pair of clean gloves.

4.5 Remove the old dressing while supporting the tubing. Place the old dressing and gloves in a
re-sealable plastic bag.

4.6 If sutures are present, note if they are intact. Inspect the catheter insertion site and
surrounding areas for erythema, tenderness to touch, warmth, swelling, drainage, or foul odor.
If the sutures are not intact or if any of the listed symptoms are present notify the physician or
designee.

4.7 If present, ensure that the Luer-lock cap on the stopcock is tight.

4.8 Remove examination gloves and replace with a clean, new pair.
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 UTMDACC INSTITUTIONAL POLICY # CLN0976

4.9 Pour NS or water over 2 gauze pads in a 4x4 package. Pour liquid soap or 4% Hibiclens over
2 gauze pads in a 4x4 package. Lift out a gauze pad covered with the Hibiclens, and clean the
catheter insertion site cleaning in a circular motion moving from the insertion site outward.
Repeat this one more time. Then lift out a 4x4gauze covered with the NS or water. Cleanse
the catheter site in the same circular motion, moving from in to out, and repeat this one more
time. Place all used pads in the re-sealable plastic bag.

4.10 After cleansing the site with the soap and water, pat the area dry with a clean 4x4 gauze pad.
When done drying the area, place this 4x4 gauze pad in the re-sealable plastic bag.

4.11 Place clean 2x2 or 4x4 gauze over the catheter insertion site. If using a 4x4 gauze pad to
cover the site, fold one 4x4 gauze pad in half and place under the tube with folded edge up;
place the other 4x4 gauze pad in the same manner, placing over the tube with folded edge
down.

4.12 Cover the gauze with a piece of Medipore tape.

4.13 Tape the catheter to the skin approximately 2½” below the dressing edge.

4.14 Check the visible tubing for kinks and patency – remove kinks if present.

4.15 Remove gloves and place in the re-sealable plastic bag. Discard the bag in the proper
receptacle.

4.16 Date, time, and initial the dressing.

4.17 Wash hands.

4.18 Reinforce patient education, document dressing change and education provided; refer to the
Nursing Documentation of Patient Care Policy (UTMDACC Institutional Policy #
CLN0647) and Interdisciplinary Plan of Care and Patient Teaching Policy (UTMDACC
Institutional Policy # CLN0473).

5.0 Catheter Flushing for Nephrostomy and Biliary Catheters

5.1 A physician/designee’s order is required before catheter flushing.

5.2 There is to be no aspiration of instilled solution.

5.3 Explain the procedure to the patient and provide privacy.

5.4 Obtain supplies.

5.5 Wash hands and apply gloves.

5.6 Sterile Normal Saline (NS) flushes:

A. Obtain a pre-filled 10 mL NS Syringe – remove 5 mL’s, unless otherwise ordered per

physician/designee.

B. Open a package of sterile 2x2 gauze.

C. If a stopcock is present on the outflow tubing turn it to a closed position or bend the
catheter slightly to stop the flow of output if present.

D. Carefully remove the CTU-30 tubing from the end of the catheter. Set the tubing on the
sterile 2x2 gauze.
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 UTMDACC INSTITUTIONAL POLICY # CLN0976

E. Keeping stopcock turned or the catheter slightly bent, attach the pre-filled NS syringe.

F. Attach the syringe to the end of the catheter, unbend the tubing or move the stopcock to
an open position, and slowly instill the NS; do not force the NS into the catheter. If the
patient complains of discomfort during catheter flushing, stop and notify the physician or
designee.

G. After instillation is complete, turn the stopcock to a closed position or slightly bend the
catheter and remove the syringe; remembering to return the stopcock to an open
position if the catheter is to continuous drainage.

H. Reconnect the CTU-30 tubing to the catheter.

I. Observe drainage flow into the CTU-30 tubing and drainage device. Notify the physician
or designee if no irrigant returns.

J. Properly dispose of supplies and used gloves.

6.0 Care of Drainage Devices

6.1 Supplies:

A. Leg bag, bed side drainage (BSD) bag.

B. Non-perfumed liquid bleach containing 5.25% sodium hypochlorite.

C. Large slip-tip syringe (optional).

6.2 Procedure:

A. Wash hands and apply gloves.

B. Explain the procedure to the patient and caregiver.

C. After emptying all urine from the leg bag or BSD bag, wash the outside of the bag and
tubing with warm, soapy water.

D. Add approximately 2 cups of cold water into the bag utilizing a syringe or the water
faucet. Instruct patient and/or caregiver that they may use any clean large slip-tip device
at home.

E. Shake the bag vigorously while slowly counting to 10.

F. Empty the water from the bag into the toilet by releasing the clamp.

G. Repeat the last 3 steps one more time so that rinsing is done twice.

H. Fill the bag with 150 mL’s (5 ounces) of water and 5 mL’s of non-perfumed liquid bleach.

I. Swish the cleaning solution around in the bag while slowly counting to 30.

J. Drain the cleaning solution into the toilet.

K. Add 240 mL’s of cold water to the bag.

L. Swish the water around in the bag while counting to 30.

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 UTMDACC INSTITUTIONAL POLICY # CLN0976

M. Drain the water into the toilet.

N. Hang the bag and allow it to dry until time for the next use.

O. Never leave urine in the bag when it is not in use.

6.3 “Care of Your Indwelling Foley Catheter and Urinary Drainage Bag” located in Patient
Education Online in ClinicPortal. Refer to: Urinary Drainage Systems Policy (UTMDACC
Institutional Policy # CLN0444).

7.0 Showering/Bathing

7.1 Cover insertion site with plastic for the first seven to ten days post insert.

7.2 After seven to ten days the site does not need to be covered for showering unless redness or
drainage is noted.

7.3 Never submerge the catheter site in water; to include swimming, hot tubs and/or the bath tub.

8.0 Care of Site Post Catheter Discontinuation

After discontinuation of the percutaneous catheter, site care will be:

8.1 Change the dressing 24 hour post catheter discontinuation.

8.2 Inspect the site for erythema, tenderness to touch, warmth, swelling, drainage, or foul odor.

8.3 Clean the site utilizing clean technique with soap and water; refer to General Dressing
Change Procedure Sections 4.1 – 4.10.

8.4 Cover the site with a band aid.

9.0 Cholecystostomy/ Biliary Catheters

9.1 The biliary drainage bag (item # 881) can be placed on the bed, pinned to patient
clothing, or placed at the bedside to allow for drainage of the catheter.

9.2 Flushing: Refer to catheter flushing for Catheter Flushing for Nephrostomy and Biliary
Catheters Section 5.0.

9.3 Care of Drainage Devices:

A. For gravity drain – attach the Biliary Drainage bag (item # 881); obtained from Material
Management Services (3-5MMS).

B. The biliary drainage bag is not to be removed for cleansing.

10.0 Gastrostomy Jejunostomy PEG/PFG

10.1 Site care and dressing change - refer to General Dressing Change Procedure Section 4.0.

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distributed, or reproduced outside of MD Anderson without written permission from the Institutional Compliance Office.
 UTMDACC INSTITUTIONAL POLICY # CLN0976

10.2 Flushing:

A. Flush with at least 30 mL’s of water before and after feedings or instillation of medication
into the catheter.

B. If the catheter becomes clogged, gently attempt to irrigate it with 30 mL’s of warm water.
If this does not clear the catheter, gently attempt to aspirate any contents, and again
attempt to flush the catheter with warm water.

C. If steps 1 & 2 are not successful at unclogging the catheter check the MAR regarding the
use of Viokase to unclog the catheter.

D. If Viokase if not ordered, notify the physician or designee regarding orders to unclog the
catheter.

10.3 Care of the Drainage Devices:

A. For care of the drainage bags refer to Care of Drainage Devices Section 6.0.

B. For bolus feeding schedules, feeding bags are to be washed after each use with warm
water, air dried, and changed weekly.

C. For continuous feeding schedules, feeding bags are to be changed daily and discarded.

11.0 Intraperitoneal Catheters (IP)

Site care and dressing change – refer to General Dressing Change Procedure Section 4.0.

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This document is the property of The University of Texas MD Anderson Cancer Center and, with few exceptions, may not be used,
distributed, or reproduced outside of MD Anderson without written permission from the Institutional Compliance Office.
 UTMDACC INSTITUTIONAL POLICY # CLN0976

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Interdisciplinary Plan of Care and Patient Teaching Policy (UTMDACC Institutional Policy #
CLN0473).
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Prowant, B.F., Schmidt, L.M., Wardowski, Z.J., Griebel, C.K., Burrows, L.K., Ryan, L.P., and Satalowich,
R.J. (1988) Peritoneal dialysis catheter exit site care. AANA Journal, 15(4), pp. 219-222.
Sau-Yung, F., Chan, W., Chow, N., Tsui, Y., Yung, J. C., and Cheng, Y. (2002). Comparison of exit-site
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Urinary Drainage Systems Policy (UTMDACC Institutional Policy # CLN0444).

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distributed, or reproduced outside of MD Anderson without written permission from the Institutional Compliance Office.
 UTMDACC INSTITUTIONAL POLICY # CLN0976

Approved With Revisions Date: 11/20/2008

Approved Without Revisions Date:
Implementation Date: 11/20/2008

Governors
Summers,Barbara L -VP, Nursing Prac & Chf Nrsg Off
Rodriguez,Maria A -VP, Medical Affairs

Stewards
Cline,Mary K -Advanced Practice Nurse

Content Experts
Cline,Mary K -Advanced Practice Nurse
Gerber,Donna L -Advanced Practice Nurse

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This document is the property of The University of Texas MD Anderson Cancer Center and, with few exceptions, may not be used,
distributed, or reproduced outside of MD Anderson without written permission from the Institutional Compliance Office.