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

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Catheters should be re moved wherever clinically possible, following individual assessment,which takes into accou nt the patie nt’s condition and in co llaboration with the healthcareteam. Removal of the catheter sh ould be considered at each review, unless the patient'scondition requires continued catheterisation for clinical benefit and/or quality of life.Following removal, the patient’s condition should be monitored. A bladder scan ( portable)should be performed in the first few hours to measure for post-void residual urine, becauseurine retention is possible followin g removal of catheter and action should be t aken asnecessary (Appendix 6). Post-ope ratively, the catheter should be removed as soon asclinically possible. Attempts should be made to avoid removal of an in dwelling catheter onthe day of discharge or transfer from hospital.4.28 Adverse EventsConsideration should be given to user sensitisation to lat ex products, especially in thosepatients with spina bifida as they are a t high risk due to repeated exposurewww.asbah.org/libraryAutonomic dysreflexia is a serious life threatening condition that affects people with spinalcord injury at or above t he level of the 6th thoracic vertebrae. Bladder problems are one ofthe most common causes of this condition (Appendix 7).Lidocaine based lubricating gels should not be used during a catheterisation procedure inthe following circumstances:a) If the patient states they have an allergy/hypersensitivity to any of the activeingredients within the product.b) If the patient has noticeable abrasions and lesions on the penis or urethral orifice.Local anaesthetics should not be applied to a traumatised urethra as the drug maybe so rapidly absorbed that a systemic, rather than a local, reaction is produced(BNF 2012). These could include confusion, respiratory depression and convulsions;hypertension; and bradycardia (may lead to cardiac arrest).c) Nursing assessment prior to administration should include identification of patients atincreased risk of systemic effects and checking for possible drug interactions.d) All medical devices and medicinal products containing chlorhexidine have beenidentified as being a risk for anaphylactic reaction. HCP should ensure that anyknown allergies are recorded in the patient notes and report any adverse events tothe MHRA (MDA/2012/075)http://www.mhra.gov.uk/Publications/Safetywarnings/MedicalDeviceAlerts4.29 Bladder & Bowel Specialist ServiceThis is a sp ecialist service, which of fers professional advice, guidance a nd information onthe promotion and management of continen ce; and fa cilitates best practice in continencecare for faecal and urinary incontinence, includ ing enuresis, and related bladder and bowelproblems for children and adults.For any further information or feedcontact via:back on the contents of this guideline, please makeBladder & Bowel Specialist ServiceSt Austell Community HospitalPorthpean RoadSt AustellPL26 6ADTel: 01726 29104212 of 16
Fax: 01726 2912495 Risk Management Strategy Implementation5.1 Implementation & DisseminationLocal organisations will take responsibility to ensure quality of service forindwelling urinary catheterisation.5.2 Training and SupportThrough self-regulation, the HCP who is learning this skill will remain accountablefor his or her competency in urin ary catheterisation, a s in the spir it of theirprofessional code. Informal learning pat hways, such as teaching from a teamcolleague who is co mpetent in the skill, should be documented to provideevidence of the learning experience. The ‘Developing Compet ence inCatheterisation’ study day, which is held at least twice yearly is available for staffto attend. Additionally, completion of ‘Urethra l Catheterisation Skills Training’pack is recommended, which is a vailable to download from the DocumentsLibrary. HCPs should inform their manager if they feel the y are not co mpetentand identify their training needs relating to this area of practice.Continence care will be supported by an educational framework that describesseveral levels of knowledge acquisition. Bef ore undertaking cathet erisation inpatients, all HCPs sho uld possess an understanding of the male an d femaleanatomy and physiology of micturition and reproduction (RCN 2012).All staff undertaking indwelling urinary catheterisation to attend the CPR andAnaphylaxis study days annually. All staff will carry an in date Anaphylaxis shockpack in case of allergic/ anaphylactic reactions. All staff will be trained on how toidentify signs of reactions and treat accordinglyWorkforce competences can be viewed at http://www.skillsforhealth.org.uk/‘Insert & secure urethral catheters’ (CC02)HWB7: Interventions and treatmentsLevel 4: Plan, deliver and evaluate interventions and/or treatments whenthere are complex issues and/or serious illness‘Care for individuals with urethral catheters’ (CC03)‘Manage supra-pubic catheters’ (CC04)HWB5: Provision of care to meet health and wellbeing needsLevel 2: Undertake care activities to meet health and wellbeing needs ofindividuals with a greater degree of dependency‘Review catheter care’ (CC07)HWB2: Assessment and care planning to meet people's health and wellbeingneedsLevel 3: Assess health and wellbeing needs and develop, monitor and reviewcare plans to meet specific needs13 of 16
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