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Intermittent self catheterisation. Presented by


Intermittent self catheterisation. Presented by Karen Ayers. Continence Nurse Specialist Overview. Guidance Where and when it all began Why the bladder sometimes ... – PowerPoint PPT presentation

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Title: Intermittent self catheterisation. Presented by

Intermittent self catheterisation.Presented by
  • Karen Ayers.Continence Nurse Specialist

  • Guidance
  • Where and when it all began
  • Why the bladder sometimes doesnt empty properly
  • What to consider when teaching ISC
  • Choosing the right catheter
  • Men and women whats the difference (if you
    dont know perhaps youre in the wrong job!)
  • How to know how often to do it
  • Advantages and disadvantages of ISC

Catheter care RCN guidance for nurses
  • RCN
  • Skills for Health
  • Coloplast
  • Launched March 2008
  • (Currently being revised)

  • You must have the knowledge and skills for safe
    and effective practice when working without
    direct supervision
  • You must recognise and work within the limits of
    your competence
  • You must keep your knowledge and skills up to
    date throughout your working life
  • You must deliver care based on the best available
    evidence or best practice

  • (NMC 2008)

  • The state of being accountable liability to
    be called on to render an account the obligation
    to bear the consequences for failure to perform
    as expected
  • Registered practitioners are accountable to
    regulatory and professional bodies in terms of
    standards of practice and patient care (RCN 2006)
  • We will make the NHS more accountable to patients
    (DH 2010)

RCN guidance 6 competencies
  • Insert and secure urethral catheters
  • Monitor, and help individuals to self monitor
    urethral catheters
  • Manage suprapubic catheters
  • Undertake a trial without catheter (TWOC)
  • Enable individuals to carry out intermittent self
    catheterisation (ISC)
  • Review catheter care

RCN guidance (2008)
  • Equipment
  • Catheter care, review and follow-up
  • Patient education
  • Medication and catheterisation
  • Infection control
  • Environmental considerations
  • Healthcare assistants
  • Legislation, policy and good practice
  • Competence
  • Documentation
  • Anatomy and physiology
  • Consent
  • Reasons for catheterisation
  • Risk assessment

Legislation, policy and good practice
  • CG 2 Infection Control (NICE, 2003)
  • Catheter Care Guidance for Nurses (RCN, 2008)
  • Essential Steps to safe, clean care Urinary
    catheter care (DH, 2006)
  • NHS Quality Improvement Scotland Best Practice
    Statement, Urinary Catheterisation and Catheter
    Care, (2004)
  • EPIC 2 (2007)
  • National Occupational Standards (Skills for
    Health) (2008)
  • Saving Lives reducing infection, delivering
    clean safe care. (DH, 2007)
  • CG40 Urinary incontinence, the management of
    urinary incontinence in women. (NICE 2006)
  • The Mental Capacity Act (DH 2005)

Skills for health
  • All users of all competencies must ensure that
    practice reflects up to date information and
  • Therefore all services and clinicians must have
    easy access to up-to-date policies and guidance

CCO6 Knowledge and Understanding
  • K6. an in-depth understanding of the causative
    factors which determine the need for urinary
    catheter usage
  • K7. an in-depth understanding of why a risk
    assessment prior to the decision to catheterise
    or use an intermittent catheter is important and
    what contributes to this
  • K8. an in-depth understanding of how to advise
    individuals who undertake intermittent
  • K9. an in-depth understanding of the effects of
    intermittent catheterisation and dilatation on
    the individuals comfort and dignity, and ways of
    handling this
  • K10. an in-depth understanding of the adverse
    effects and potential complications during
  • catheterisation/dilatation and appropriate
    actions to take
  • K11. an in-depth understanding of the short and
    long term risks and health implications
    associated with intermittent catheterisation/dilat
    ation and how to resolve or minimise these
  • K12. an in-depth understanding of the clinical
    decisions and method/s required to terminate the
    usage of intermittent catheterisation/dilatation
    in an effective and safe manner
  • K13. an in-depth understanding of how individuals
    should risk assess themselves and how this will
    influence their self care
  • K14. an in-depth understanding of when to not
    proceed or abandon catheterisation for an
    individual and what actions to take

RCN guidance
  • Assess the individual for ISC, not on their
    residual urine alone
  • Renal function, symptom severity and physical and
    psychological ability to perform ISC must also be
  • Cognitive ability should be assessed
  • ISC should be considered when TWOC fails

  • Mental Capacity Act (2005) 5 key principles
  • Documentation of the giving of consent for
    catheter usage and ongoing catheter care is vital
    from a professional, ethical and legal
  • Explain rationale for ISC
  • Explain intended benefits and potential risks
  • Explain frequency of procedure and that it may be
  • Explain the need for follow-up and review

  • (RCN 2008)

Found at Pompei (not available on prescription!)
Where it all began
  • Intermittent catheterisation is far from being a
    modern idea.

Clean Intermittent Self Catheterisation
  • Lapides an American urologist first pioneered
    CISC in 1970s
  • Clean as opposed to sterile catheterisation did
    not increase the incidence of renal damage or UTI
    (Lapides et al 1972,1974,1976)

Some causes of incomplete bladder emptying
  • Neurogenic
  • Detrusor areflexia
  • Hyporeflexia
  • Detrusor-sphincter dyssynergia
  • Detrusor hyperreflexia

Other causes of incomplete emptying
  • Enlargement of the prostate
  • Urethral stricture after an infection or trauma.
  • Stenosis following surgery of the bladder neck.
  • Surgical procedures eg. colposuspension or clam
  • Constipation
  • Bladder diverticula and other abnormalities

(No Transcript)
Who may benefit from ISC ?
  • Short term
  • Acute or chronic retention of urine
  • Awaiting TURP/TWOCS
  • Post epidural (labour)
  • Pre/ post pelvic surgery
  • SUI surgery

  • Long term
  • Neurological diseases
  • Botox
  • Detrusor failure
  • Spinal cord injury
  • Urethral stricture
  • Congenital neuropathy
  • Residual 100mls or over (5-90yrs) is no barrier
    to ISC

Other considerations for ISC
  • Residual volume gt10 0f bladder capacity
  • Residual Volume gt1000mls!
  • Good manual dexterity and eyesight
  • Motivation
  • Support from a regular carer/partner for some
  • Appropriate follow up support available
  • (Baron, 2000)

Why ISC/CISC? Lapides Viewpoint
  • To prevent or overcome infection, you need to
    empty the bladder regularly CIC
  • No real increased infection rate using clean
    versus sterile
  • CIC promotes normal filling and emptying stages
    of micturition
  • Upper tract damage limitation
  • Symptomatic improvement

  • Very high infection risk
  • High irritation and trauma risk
  • Professional and extra equipment usually required
    to change
  • Can work well for up to 12 weeks
  • Low level patient skills needed
  • Disliked by some users associations with old
    age and infirmity
  • Sometimes prone to blockages

What professionals need to know
  • A holistic assessment of the patient must be
    carried out before agreeing a management plan.
  • ISC may only be part of an individuals total
    bladder management (ACA, 2003).
  • Know the complicated stuff but dont miss the
  • Consent

Intermittent Self Catheterisation
  • ISC is now much easier and safer because of new
    materials being available and possibly a change
    in our post Victorian social attitudes

Everything you need for self catheterisation!
Achieving success the ACA way
  • Patient selection
  • Patient discussion
  • General discussion
  • Health issues
  • Observations (ACA, 2003)

  • Fairly easy to use for many
  • Fairly low infection risk
  • Large amounts of supplies needed
  • Needs doing regularly
  • Allows easier sexual activity
  • Imitates normal bladder function

ISC Catheter Selection
  • Main factor is patients personal preference
  • Wide range of catheters currently on the market
  • Come in a variety of sizes ranging from 8Ch to
    20Ch and are available in female or male length.
  • The smallest size that will drain the urine at an
    acceptable speed should be used.

  • Three main types
  • Those requiring a water based lubricant prior to
    insertion. Usually reusable.
  • Those needing immersion in water to activate the
    pre-lubricated surface.
  • Those lubricated and sealed ready for use from
    the packet.

Catheter samples
  • Need to carry a wide range to help to inform
    patient choice
  • Demonstrate features eg, lubrication, preparation
  • Use for demonstration only
  • Must only be used for actual catheterisation if
    the company takes vicarious liability

  • Easy to open
  • Easy to handle any special features
  • Low friction low trauma
  • Low support for bacterial growth
  • Well lubricated
  • Good information
  • Smooth drainage eyes
  • Cost

  • Try to pass urine normally
  • Wash hands with soap and water
  • Have a container ready into which you can drain
    the urine. (especially if it needs measuring)
  • Clean urethral meatus with mild soap or plain
    water or wash genital area from front to back
  • Prepare catheter
  • Open packet ready to use
  • Lubricate if required
  • Soak catheter to activate lubricant
  • Wash hands again

  • Choose a comfortable position
  • for men standing, sitting or laying down if this
    is easiest, (penis will need to be held out from
  • For women-squatting, sitting on toilet, standing
    with one foot on toilet seat or lying down with
    knees bent
  • Over toilet if not using container

  • Pull back the foreskin
  • Hold the penis 45 degrees from body
  • Guide the catheter into the urethra, taking care
    not to touch the part of the catheter entering
    your body
  • If you experience a blockage near the bladder
    withdraw a little relax and try again
  • A small cough and push will also often get past
    the bladder neck
  • Wait until urine stops draining and slowly
  • Dispose of safely or store if reusable
  • Wash hands

  • With one hand spread the labia apart and find the
    urethral opening above the vagina.
  • A mirror can be useful initially. With practice
    you should be able to find the urethral opening
    by touch.
  • Slide the catheter slowly and smoothly into the
    urethra until urine starts to flow and drain the
    urine into the toilet or a container.
  • Wait until urine stops draining and withdraw
  • Dispose of safely or store if reusable
  • Wash hands

Frequency of ISC
  • Depends on the patients needs.
  • The urine passed plus residual should not total
    more than 500mls at each catheterisation
  • Residuals over 100mls increase risk of UTIs
  • If patients are wet between catheterisations they
    may need to increase the number of times they

Potential complications of ISC
  • UTI- Asymptomatic bacteriuria is common and is
    generally not treated unless it becomes
  • If the patient experiences recurrent UTIs their
    technique should be reviewed.
  • Blood may be present at first catheterisation -
    usually due to slight trauma during insertion
  • Pain/soreness- most patients can catheterise with
    minimal discomfort. On removal some experience
    pain or resistance, thought to be urethral spasm.
    Relaxing or a gentle cough can help.
  • Give contact details and out of hours numbers

What's all the fuss about ?
  • Assumption to catheterise someone inevitably
    means indwelling?
  • Frequently presented to PTs without other options
  • Doherty (2006) argues that ISC should be the
    first option rather than initiating an Indwelling
  • Despite Evidence, innovation and development
    Indwelling catheterisation has not diminished

  • Old habits die hard
  • There is a need develop strategies to teach the
    teachers to help staff identify not only
    weaknesses in indwelling management but be aware
    of competencies in ISC
  • Employing ISC vs Indwelling empowers pts towards
    self care with less clinical interventions from

  • Thankyou for listening