Indications for catheterisation and catheter selection

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Indications for catheterisation and catheter
selection

• Maria Moor

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Indications for catheterisation

• Bladder drainage (pre, peri, post op)
• Acute ,chronic retention of urine
• Difficulty emptying the bladder ie MS
• Outlet obstruction
• Insillation of prescribed drugs
• Investigations
• Measurement of residual volume
• Chronically incontinent

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Assessment for catheterisation

• Reason for insertion
• Medical history
• Assess cognitive function
• Ability to manage catheter
• Assess fluid intake
• Assess bowel function
• Sexual function
• Which catheter site, catheter material
• Who can catheterise

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CATHETER SITES
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CATHETER SITESSupra pubic

• Initial catheterisation performed under
  General/Local Anaesthetic
• Use 16ch/Standard Length
• First Change after 6-8 weeks again under
  General/Local Anaesthetic
• Care as Uretheral
• Change catheters within 10 mins

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Who can catheterise
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Primary catheterisation

• Competent Registered Nurses with permission from
  employer
• Intermittent catheterisation performed by Nurse
  competent in the procedure
• Supra-pubic insertion usually by a urologist.

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MATERIALS

• Short Term
• (Max 7 days)
• PVC or Plastic
• Uncoated Latex
• ( 28 Days)
• PTFE
• Silver Alloy

• Long Term
• (Max 12 Weeks)
• Hydrogel Latex
• All Silicone
• Hydrogel Silicone

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Catheter selection

• Diameter
• 10-14Ch (clear urine)
• 14-16Ch (debris and small clots)
• 18Ch or above (large clots)
• 6-10Ch (paediatrics)
• 16Ch (supra-pubic)

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Catheter selection

• Length
• Female Length 20-26cm
• Standard length 40-45cm
• Paediatric length 30-31cm

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Warning

• Do not put a female length catheter in a male

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National safety Patient Agency review
1/1/06-17/12/08

• 114 female catheters inserted in males
• Results
• All experienced pain.
• Some retention, swelling, haematuria
• Acute Renal failure in in 2 clients
• Impaired renal function in 2 clients

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BALLOON

• Size
• 10ml - Used for all
• 30ml - Only use following Urology Advice

• What with?
• Sterile H2O
• NOT..

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DRAINAGE SYSTEMS
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Drainage systems

• Leg bags
• Belly bags
• Night drainage bags
• Catheter valves

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Fixation

• Ensure catheter bag is secured by a fixation aid
  i.e G Strap
• Ensure comfortably positioned
• Always use a catheter stand for night bags

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LUBRICATING GELS

• Why Use?
• What does it do?
• What to use?

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Catheter Management
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Catheters can kill
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UTIS HAVE SERIOUS IMPLICATIONS

• On Hospital Resources
• Healthcare associated UTIs cost the NHS an
  estimated 124 million per year
• On average every incidence of Healthcare
  associated UTI incurs an additional cost of
  1,327 per patient and blocks a hospital bed for
  an extra 6 days

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1
1.Plowman et al (1999)
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CATHETER INSERTION

• Aseptic Technique
• Hand-washing
• Meatal Cleansing
• Non latex Sterile Gloves
• Avoid touching any other area of the perineum
  with the catheter

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RISK OF INFECTION

• Breaks between the catheter and drainage bag are
  common (42 of patients)
• 3x more likely to get CAUTI if system is broken
• Entry Points for Pathogens

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PISTON EFFECT

• If catheter is not secured it can cause
• Sphincter Damage
• Irritation to the Urethra
• Allows Bugs to get from the outside in

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Emptying the bag

• Must Use the following
• Gloves, Apron, Clean/Disinfected Container or
  Pulp Receptacle
• Then
• Wipe Bag Tap with Steret
• Use separate Jug for each patient
• Encourage patients to empty their own bag as
  much as possible

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Changing the bag

• Bag changed in line with manufacturers
  recommendations
• i.e. 5-7 days (DOH guidelines)
• Empty bag enough to allow urine flow.
• Use separate container for each patient.

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Monitoring and sampling

• Sample only taken for valid reason
• Take from sampling port according to clinical
  need using aseptic technique
• Clean port with isopropyl 70 swab and allow to
  dry
• Aspirate urine with appropriate syringe

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Meatal cleansing

• No evidence that meatal cleansing with an
  antiseptic solution will reduce catheter
  associated infections. (Classen et al 1991)
• Clean with 0.9 NaCl
• Clean with unperfumed soap and water
• Avoid talcs and creams

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POTENTIAL PROBLEMS

• Urine does not drain
• By-passing
• Pain
• Haematuria
• Non deflating balloon
• Infection

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BY-PASSING

• Consider Reasons
• Catheterised in last 24/48hrs
• Consider the use of anti-cholinergenic medication
• Catheter may be blocked by debris
• Constipation (increase fluid intakeke
• Consider Smaller Ch size catheter
• Consider catheter material, silicone/Latex
• Avoid Use of 30ml Balloons

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Urine not draining

• Catheter may be blocked
• Kinked drainage tube
• Leg bag may be above bladder level
• Bladder spasm
• Dehydration
• Encrustations

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Haematuria and Pain

• Trauma or infection
• Tension on catheter due to inadequate support
• If continues seek medical help

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CATHETER REMOVAL

• Remove with extreme care
• Attach sterile syringe
• Do not apply suction
• Ensure all the water has been removed from the
  balloon
• Can take up to 20 mins to empty

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NON-DEFLATION

• Remove Syringe and attach a new one
• Leave syringe attached for 15-20mins
• Check for kinked catheter or constipation
• DO NOT burst the balloon or cut the catheter
• Gently instill 1-2ml sterile water via the valve
• Use needle and syringe to aspirate the inflation
  arm above the valve
• Check local policy guidelines

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CATHETER BLOCKAGE
PHYSICAL Bladder Spasm Constipation
MECHANICAL Kinked Tubing Drainage bag above
bladder Drainage bag very full
ENCRUSTATION
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WHAT IS CATHETER ENCRUSTATION?

• Major Components are
• Struvite (Magnesium ammonium phosphate)
• Calcium Phosphate
• Ref KA Getliffe BJU (1994).73.696-700

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CYCLE OF ENCRUSTATION
Urine Sterile pH 6-7
Catheterisation
Bacteria producing urease
Contaminated Urine
Ammonia
Urea
Precipitation
Urine Alkaline pH 8-9
ENCRUSTATION (Calcium phosphate and
ammonium magnesium phosphate)
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ENCRUSTATION
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Catheter maintenance solutions

• Solution G (3.23 citric acid) Dissolves crystals
  formed by urease producing bacteria.
• For routine use, most frequently used solution
• Solution R (6 citric acid) Used for severe
  encrustations. Contains magnesium carbonate to
  prevent bladder irritation
• Saline 0.9 Removal of small blood clots, tissue
  and debris

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CATHETER MAINTENANCE SOLUTIONS

• Consider
• Which solution?
• Which delivery method?
• Which volume?
• How often?

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WHICH VOLUME?

• Study carried out
• ..to identify the optimum volume of acidic
  bladder washout solution to dissolve catheter
  encrustation and to compare the effectiveness of
  different bladder washout delivery devices1
• Results
• There was no significant difference between
  washouts with 100mL and washouts with 50 mL Suby
  G

1. K A Getliffe British Journal of urology
(2000).85, 60-64
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HOW OFTEN?

• Individual patient requirements
• According to frequency of blockage
• Ideally administered at leg bag
• change

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• Thankyou
• Any Questions