Catheterisation in Adults - the Royal Cornwall Hospitals Trust ...

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4.21 FluidsUnless restricted for medical reasons, an adequate fluid intake should be encouraged per 24hours, as this maintains a flow of uri ne through the bladder and helps prevent constipation.There is no evidence of long-term benefit or ap propriate dosage of cranberry juice with useof catheters. Furthermore, caution should be exercised for those patients taking warfarin(Suvarna et al 2003). However, citrate-based d rinks are recommended as these have beenfound to positively affect the pH of the urine.4.22 Link drainage systemThe drainage bag sho uld not be disconnected from the catheter, b ut the night bag isconnected to the drainage tap. Patients in Care Homes (both residential and those thatprovide nursing) and in hospital must have a n ew single-use night drainage bag every nightwith disposal of the used bag. T here is minimal research regarding the issues on infectioncontrol for patients in their own homes who reuse their night bags for 5 – 7 nights (they areencouraged to rinse through with f reshly drawn tap water and left to drain). Se lf-caringpatients are more suite d to drainable bags than those who require carers to manage thecatheter system. However, should care needs change and the patient is no longer able toself-manage their catheter system, then switchi ng to single-use night drainage bags will benecessary.4.23 Storage of cathetersExcess quantities of stored catheters can in crease the risk of damage to the product orpassing the expiry date. For exa mple, latex catheters h arden when they are old and ifinserted after the expiry date, the risk of perforating the bladder is increased.It is important that equipment is available withi n the patient’s home, which will ensure thatthe correct catheter is used for individual needs. In the community, it is recommended thatpractitioners document that new stock has been ordered to replace what has been used. Inthe hospital environment, safe storage and stock rotation of the catheters is expected.4.24 Catheter-lifeThere are two distinct groups of patients to describe a catheter-life, that is, those who wear acatheter that blocks an d those tha t don’t (non -blocking). The main cause of a blockedcatheter is encrustation. Non-blocking catheters are those which maintain the patency of thecatheter for the duration of the catheter-life expectancy, such as 12 weeks for a long-termcatheter.Encrustations usually form on the tip of the catheter, the balloon area th at is bathed in urineand the lumen of the catheter. They are not usually found on the side of the balloon that isagainst the bladder mucosa or the surface that is in contact with the urethra.The duration of time that the catheter can be left in place before it becomes blocked, leaks oris pulled o ut by the patient is refe rred to as t he catheter-life. Monit oring this w ill helpeffective planning to reduce the risk of blockage as opposed to crisis intervention.Persistent blockage and other complications such as r ecurrent symptomatic CAUTI orhaematuria, may require investigation and refe rral for investigation. Cystoscopy should beconsidered to rule out t he presence of bladder stones. Th ere is no evidence that sendingcatheter tips to Clinical Microbiology is beneficial.10 of 16
4.25 Catheter Maintenance SolutionsThere is minimal evidence to identify if the use of solutions provides any benefit (Hagen et al2010). However, for catheters tha t block due to encrust ation resulting in a freq uency ofcatheter change that is unacceptab le to the pa tient, then a prescribed regime of an acidi ccatheter maintenance solution may be clinically justif ied for short-t erm use. It is notrecommended to use solutions for unblocking a catheter that is no longer draining.The principle aim of us ing a solution is to wa sh the catheter, not the bladder. The term‘bladder washout’ has been superseded by the more appropriate term of ‘cathetermaintenance solution’. The effectiveness o f acidic cat heter maintenance solutions indissolving encrustations has been demonstrated in laboratory-based studies. However, th einstillation of solutions for either encrustation or debris via an indwelling urinary catheter isnot recommended as a routine measure as th eir efficacy has not be en proven in larg eclinical trials. If prescribed howeve r, they shou ld only be u sed for a s hort period of time ,using the smallest volume (50mls or less) and discontinued if not effective. Frequency ofuse will need to be determined on an individual patient basis.The use of solutions can cause damage to the mucosa, causing irritation and spasm if the yenter the bladder. For further guidance, please see the ‘Treatment Al gorithm for Long-termCatheters’ in Appendix 5. Please consult the Bladder & Bowel Specialist Service (01726291042) or hospital specialist nurse if further advice is needed.4.26 Use of AntibioticsAntibiotic prophylaxis is not recommended for cardiac malfunction/stents/valves according toNICE Guidelines (NICE 2008). For any further information on when antibiotics may berequired, please consult with Clinical Microbiology.For those with sympto matic catheter associated urinary tract infection, t he catheter shouldbe changed at the start of antibiotic therapy.4.27 Decision to Remove CatheterIn secondary care and community hospital settings, daily review of cat heters is essential tominimise length of time in place with the aim to reduce healthcare acquired infections.For community hospitals, we encourage the use of the Stop-Order:On admission all patients with an indwelling urethral urinary catheter will haveremoved within 72 hours.catheterExceptions1. urinary obstruction leading to urinar y retention (where intermittent catheterisation is notviable)2. neurogenic bladder and urinary retention (where intermittent catheterisation is not viable)3. urological surgery4. open sacral wounds (stage 3 or 4) for incontinent patientsAll exceptions should be fully documented and reviewed every 7 daysIf any concerns, please contact the patient’s medical team or the Bladder & Bowel Serviceon 01726 29104211 of 16
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