Catheterisation and Catheter Care

Learning outcomes
By the end of the session students will be able to: Identify reasons for urinary catheterisation Discuss choice of catheter Understand the significance of maintaining asepsis Demonstrate an aseptic technique in urinary catheterisation Demonstrate care to prevent infection

Catheterisation

Indications for catheterisation

Retention of urine Monitor urine output / acutely ill patient Pre/peri/post-operatively Assessment and investigations Treatment (e.g. to instil chemotherapy) Irrigation of bladder Bypass an obstruction Management of incontinence (as a last resort)

Reasons for Female Urinary Retention

Large fibroids Pregnancy Post partum- epidural/spinal Urine infection Post pelvic surgery Post bladder surgery-TVT, anterior and
posterior repair, colposuspension

Reasons for Female Urinary Retention

Constipation Medication- anticholinergics,

antihistamines, morphine, anaesthetic agents (atropine), botox, alcohol Genital herpes infection

Mode of catheterisation
Choices to be made:
Clean intermittent self catheterisation Suprapubic catheterisation Urethral catheterisation

Catheter Selection
Points to consider;
Size Balloon size 10ml for routine drainage, 30 ml for some urology procedures only Length Female = 27cm, paediatric = 30 cm, standard length = 40cm Charriere size (1Ch = 0.3mm) Material (consider latex allergy) Drainage system (closed / link system)

Catheter Materials
Short-term materials May stay in up to 3/52
Latex PTFE coated latex Siliconised latex PVC

Long-term materials May stay in up to 3/12

Silicone elastomer (silastic) Hydrogel coated latex Silver coated latex 100% silicone 100% silicone + hydrogel coating

Drainage System: closed system

Overnight drainage bag /

2 litre bed bag For patients who are bedbound or bed to chair only The bag attaches directly to the catheter and stays there for 7 days Dont break/open the system!

Link drainage system

Link system
Used for ambulant patients Leg bag stays attached to catheter for 7 days

and dont open this connection Attach overnight 2 litre bag to end of leg bag and open tap at night Remove overnight bag in the morning, empty and dispose of Overnight bags are never to be re-used the following night!

Catheter valves
No bag attached to catheter Bladder fills and stores urine, lifting
bladder tissue off catheter tip Discrete But:

Patient needs good manual dexterity Patient needs good cognitive ability to remember to empty the bladder

Procedure
Patient preparation - information - consent
Aseptic technique - to prevent the transmission of microorganisms either directly or indirectly, thus reducing risk of infection

Equipment
Catheter pack Two pairs sterile gloves Sachet of normasol (to clean round urethral

meatus) 10ml syringe Ampoule of sterile water for injections (if not in pack with catheter) Lubricant e.g. instillagel
6ml for females and 11ml for males

An appropriate catheter Drainage system

Documentation
Date inserted & date

due to be changed Rationale for catheterisation Any problems encountered Size inserted

Batch / lot number Expiry date Fluid used in balloon

Type & volume

Volume of urine

drained Drainage system used

Risk of infection : CAUTI

Extraluminal contamination
on insertion, opportunistic Intraluminal contamination reflux
Bacteria > biofilm > alkaline urine > crystallization > encrustation

Care
Meatal hygiene Minimise handling Maintain asepsis Do not allow bag to become too full Keep drainage bag below level of bladder

Reading
Bissett L (2005) Reducing the risk of catheter-related

urinary tract infection. Nursing Times 101 : 12 64-65 Doherty W (2006) Male urinary catheterisation. Nursing Standard. 20: 35 57-63 NICE (2003) Infection control: prevention of healthcareassociated infection in primary and community care. Clinical guideline 2. NICE, London Pellowe CM, Pratt RJ, Loveday HP, Harper P, Robinson N, Jones SRLJ (2004) The EPIC project- updating the evidence base for National Evidence-based Guidelines for preventing healthcare-associated infections in NHS hospitals in England: a report with recommendations. Available from www.epic.tvu.ac.uk