CATHETER MANAGEMENT

A catheter may be inserted due to urinary retention, post-operatively, for treatment and as a last resort for urinary incontinence.

Getliffe (1997) states that the main aims of catheter management are:

• To relieve and manage urinary problems
• To recognise and minimise risk of secondary complications
• To promote patient dignity and comfort and assist patients to reach their own potential in terms of self-care and independence
• To provide a cost-effective service

TYPES OF CATHETER

Male
Female
Suprapubic

CATHETER CARE

• HYGIENE - Always wash and dry hands thoroughly before and after emptying/connecting urinary bags.
• Carers should wear gloves
• Daily bathing/showering/washing is important; paying particular attention to the site the catheter enters the body, with mild soap and water and dried thoroughly.
• Men should ensure that beneath their foreskin is cleaned daily.
• Ensure catheter and leg bag is secured to prevent accidental pulling of the catheter
  Leg bags/flip flo valves must be changed every 7 days
• Flip flo valves should be attached to a drainage bag overnight
• Disposable night bags to be emptied and then thrown away
• Drainable night bags to be rinsed each morning with water, blue cap replaced and left for that nights use, but they must not be used for more than 7 days.
• Use a stand/bowl or bucket to place the night bag in and not directly onto the floor.
• Empty leg bag regularly, do not let it get above two-thirds full
• DRINKING – important to drink about 1.5litres of mixed fluids a day to help prevent infection and to ensure drainage
• CONSTIPATION –It isimportant to prevent constipation by eating a healthy diet as a full bowel can push on the catheter tube and cause drainage problems.

PROBLEM SOLVING

If urine does not drain or is draining slowly:-

• Check that the drainage bag is below the level of the bladder
• Check that there is no tension on the catheter
• Check that the catheter tubing is not kinked
• Check that the urine bag is not over full
• Check patient is not constipated – ask patient
• Check urine for infection – smell, colour
• Refer to District Nurse if catheter still does not drain urine

If there is bypassing of urine:-

• Check all the above
• It may be due to bladder irritation – increase fluid intake
• Refer to District Nurse who may check for infection
• Arrange anticholinergics for bladder
• Spasm
• Replace catheter with a smaller size

Haematuria (blood in urine):-

Trauma or infection may cause small amounts of blood. Look at preventative measures, such as ensuring leg bag/catheter secured to leg to prevent trauma and adequate fluid intake.
If severe, seek medical help immediately

Infection:-

PREVENTION by maintaining a closed link system, daily cleaning with unperfumed soap and water (ensuring dried thoroughly) and a good fluid intake of 1-1.5litres a day of mixed fluids.
Antibiotics are only used when clinical symptoms are present e.g. pyrexia (high temperature), confusion and/or generally not well

If there is a discharge around the catheter, please inform the District Nurse as this can indicate infection. PLEASE NOTE there is often a discharge from a supra-pubic site, but inform the District Nurse if there is an increased amount of discharge, redness and/or the discharge smells.

LEG BAGS/NIGHT DRAINAGE BAGS

• Sterile leg bags must be used with indwelling catheters and should be changed every 7 days to maintain the closed link system.
• Type to be worn depends on preference of individual
• Types available – long tube (worn on calf)
• Short tube (worn on thigh)
• Outlet tap – slide or lever action
• Capacity – 350mls, 500mls and 750mls
• Securing leg bags by straps or leg bag holders. If latter used then the patients’ leg must be measured to ensure correct fit as they come in various sizes.
• Night bags are attached to the leg bag for overnight use.
• Non-drainable night bags are used in hospitals, nursing and residential homes, but can also be used in a patients’ own home
• Drainable night bags can be used in patients’ own home, but non-drainable bags should be used if there is a history of infection. These bags must be rinsed through with water each morning and must be changed every 7 days.
• G-straps are used to secure the catheter to avoid any undue trauma.
• Patients’ manual dexterity, cognitive function and the ability to self to the toilet are important consideration on deciding if they are able to have a flip flo valve. This is a tap placed directly onto the catheter (so no leg bag is worn) and must be changed every 7 days.

Prescriptions for catheters and accessories are through your GP or District Nurse. You will be able to order your own supplies as needed from dispensary. Please allow 48 hours for repeat prescriptions.