Catheterisation in Adults - the Royal Cornwall Hospitals Trust ...
Catheterisation in Adults - the Royal Cornwall Hospitals Trust ...
Catheterisation in Adults - the Royal Cornwall Hospitals Trust ...
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lumen, or caus<strong>in</strong>g excessive constriction to <strong>the</strong> limb. There are different choices of fixationmethod, such as strap s or sleeves, which needs to be based on <strong>in</strong>dividual need. It isimportant to allow enough slack to accommodate penile e rection, thus m<strong>in</strong>imis<strong>in</strong>g risk ofurethral meatus <strong>in</strong>jury. Tape should not be used as ca<strong>the</strong>ter material could be damaged dueto solvents.4.16 Bag positionDra<strong>in</strong>age bags need t o be positio ned below t he level of <strong>the</strong> bladder to avoid h ydrostaticsuction, which can cause damage to <strong>the</strong> bladd er mucosa. Higher rates of bacter iuria havebeen l<strong>in</strong>ked to <strong>in</strong> correct position<strong>in</strong>g. Dra<strong>in</strong>age bags should be atta ched to a stand thatprevents contact with <strong>the</strong> floor. To avoid sk<strong>in</strong> irritation and damage, alternat<strong>in</strong>g <strong>the</strong> leg onwhich <strong>the</strong> dra<strong>in</strong>age bag is secured will m<strong>in</strong>imise this risk.4.17 Bag empty<strong>in</strong>gWhenever possible, patients should be encouraged to empty <strong>the</strong>ir own dra<strong>in</strong>age bag. If thisis not possible, <strong>the</strong> HCP or carer should wear non-sterile g loves, apron and goggles where<strong>the</strong> risk of splash <strong>in</strong>jury is anticipated. Patients should have <strong>the</strong>ir own conta<strong>in</strong>ers, w hich areei<strong>the</strong>r disposable or heat-dis<strong>in</strong>fected to prevent cross-<strong>in</strong>fection.For patients <strong>in</strong> hospital, a s<strong>in</strong>gle-use pulp product should be used to empty ur<strong>in</strong>e <strong>in</strong>to and<strong>the</strong>n macerated. Where this is not available, a s<strong>in</strong>gle-use sterile jug should be used for eachepisode of bag empty<strong>in</strong>g or a sterile jug that can be retu rned to CSSD. Additionally, it isimportant to avoid conta m<strong>in</strong>ation of <strong>the</strong> tap or <strong>the</strong> environment by spillage. When dr a<strong>in</strong>agebags are three-quarters full, <strong>the</strong>y should be emptied to avoid traction on <strong>the</strong> bladder.However, <strong>the</strong> closed system should not be broken more than is necessary. It is reportedthat decontam<strong>in</strong>ation of outlet spouts with an alcohol wipe is <strong>in</strong>effective. Clean tissue shouldbe used to clean <strong>the</strong> outlet spouts.4.18 ValvesThese can be used as an alternative to a conventional dra<strong>in</strong>age bag . As well as be<strong>in</strong>gdiscreet, <strong>the</strong>y allow <strong>the</strong> bladder to resume/cont<strong>in</strong>ue its storage function. The use of a valvedur<strong>in</strong>g <strong>the</strong> day and cont<strong>in</strong>uous dra<strong>in</strong> age at night has been found to be an ideal solution formany ca<strong>the</strong>terised patients. There are man y different valves available and it is <strong>the</strong>responsibility of <strong>the</strong> prescriber to be aware o f <strong>the</strong> strengths and limitations to enableappropriate product selection. The re is no evidence to su pport clamp<strong>in</strong>g of ca<strong>the</strong>t er as away of assess<strong>in</strong>g bladder tone prior to <strong>the</strong> removal of a ca<strong>the</strong>ter.4.19 Bath<strong>in</strong>gThe patient may take ei<strong>the</strong>r a bath or shower. The build up of secretions at <strong>the</strong> urethralmeatus should be m<strong>in</strong>imised by daily rout<strong>in</strong>e personal hygiene. Per<strong>in</strong>eal care should also be<strong>in</strong>cluded to facilitate reduction <strong>in</strong> extralum<strong>in</strong>al contam<strong>in</strong>ation.4.20 Dra<strong>in</strong>age bag changeThe manufacturer’s recommendations should be followed for leg dra<strong>in</strong>age bags; forexample, 5 – 7 da ys or earlier if <strong>the</strong> ba g is dama ged, which could <strong>the</strong>n becomecontam<strong>in</strong>ated with bacteria that ascend <strong>the</strong> system. For night time dra <strong>in</strong>age, a s<strong>in</strong>gle useproduct should be used.9 of 16