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

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saline is su itable. Observations should be recorded routinely 6indicated.monthly or as clinically4.11 Changing the CatheterThe principles of asepsis should apply to th e procedure of urinary catheterisation, bothurethral and suprapubic (Appendix 3).For recatheterisation procedures, the existing catheter should be re moved, examined forencrustations and disca rded at the start of the procedure. Extreme care should be takenwith supra-pubic cathe ters changes for those patients who are receiving anticoagulanttherapy or who have blood clotting disorders.The first ch ange for both routes of entry into the bladder can be don e in the co mmunity,either in the patient’s home, community clinic or hospital by a competent HCP. Unless thereis a need for recatheterisation in a controlled environment, there is no rationale fo r it to beonly done in a hospital setting. Urethral and supra-pubic lo ng-term catheters can be left inplace for up to 12 w eeks, but recatheterisations may need to be carried ou t soonerdepending on individual needs. Some patients and inf ormal carers can be taug ht how tochange their own urethral or supra-pubic catheter.Conversion to suprap ubic catheterisation from urethral catheterisation is no t alwayssuccessful for female patients, as there is a considerable risk of coincidental urethralleakage, and patients should be warned of this risk.4.12 Patient EducationPatients (and carers) need to be involved in their care, which includes b eing aware of thecomplications of cath eterisation and correct information on general catheter car e. It isimportant that patients (and carers) know how t o identify a potential problem (Appendix 4)and whom to contact f or help. A programme of learning should include appr opriateliterature, i.e. leaflets; Catheter Passport. It is r ecommended that HCPs document that thishas been done.Advice on c are options regarding sexual activity and cathe ters should be offered. Theseoptions may include teaching the patient how to remove and reinsert the catheter before andafter intercourse.4.13 Urine SamplingRoutine collection of urine specimens for cultur e is not useful and is unnecessary unless thepatient is symptomatic (Nicolle 200 1). When a specimen collection is justified, a clinicallyclean technique should be used, with disinfection of the needle-free sample port with alcohol70% and chlorhexidine 2% and allowed to dry t horoughly (Clinical Microbiology March 2012(BSOP 41)). It is important to include systemic symptoms on the clinical microbiology form.4.14 Care of the Suprapubic SiteIf dressings are clinically required, t hey must be sterile an d applied using an ase ptic nontouchtechnique. In most ca ses, a dressing will not be required and patients sh ould beencouraged to clean the site daily.4.15 TraumaCatheter tubing and the drainage bag should be secured to the leg so that it avoids kinks inthe tubing, t raction on t he bladder neck, trauma to the urethra, occlu sion of the catheter8 of 16
lumen, or causing excessive constriction to the limb. There are different choices of fixationmethod, such as strap s or sleeves, which needs to be based on individual need. It isimportant to allow enough slack to accommodate penile e rection, thus minimising risk ofurethral meatus injury. Tape should not be used as catheter material could be damaged dueto solvents.4.16 Bag positionDrainage bags need t o be positio ned below t he level of the bladder to avoid h ydrostaticsuction, which can cause damage to the bladd er mucosa. Higher rates of bacter iuria havebeen linked to in correct positioning. Drainage bags should be atta ched to a stand thatprevents contact with the floor. To avoid skin irritation and damage, alternating the leg onwhich the drainage bag is secured will minimise this risk.4.17 Bag emptyingWhenever possible, patients should be encouraged to empty their own drainage bag. If thisis not possible, the HCP or carer should wear non-sterile g loves, apron and goggles wherethe risk of splash injury is anticipated. Patients should have their own containers, w hich areeither disposable or heat-disinfected to prevent cross-infection.For patients in hospital, a single-use pulp product should be used to empty urine into andthen macerated. Where this is not available, a single-use sterile jug should be used for eachepisode of bag emptying or a sterile jug that can be retu rned to CSSD. Additionally, it isimportant to avoid conta mination of the tap or the environment by spillage. When dr ainagebags are three-quarters full, they should be emptied to avoid traction on the bladder.However, the closed system should not be broken more than is necessary. It is reportedthat decontamination of outlet spouts with an alcohol wipe is ineffective. Clean tissue shouldbe used to clean the outlet spouts.4.18 ValvesThese can be used as an alternative to a conventional drainage bag . As well as beingdiscreet, they allow the bladder to resume/continue its storage function. The use of a valveduring the day and continuous drain age at night has been found to be an ideal solution formany catheterised patients. There are man y different valves available and it is theresponsibility of the prescriber to be aware o f the strengths and limitations to enableappropriate product selection. The re is no evidence to su pport clamping of cathet er as away of assessing bladder tone prior to the removal of a catheter.4.19 BathingThe patient may take either a bath or shower. The build up of secretions at the urethralmeatus should be minimised by daily routine personal hygiene. Perineal care should also beincluded to facilitate reduction in extraluminal contamination.4.20 Drainage bag changeThe manufacturer’s recommendations should be followed for leg drainage bags; forexample, 5 – 7 da ys or earlier if the ba g is dama ged, which could then becomecontaminated with bacteria that ascend the system. For night time dra inage, a single useproduct should be used.9 of 16
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