Catheter Care

1. Induction Training Catheter Care Induction Training

2. Next Back Home Welcome… Welcome to this web based information session on Catheter Care. It should take you approximately 15 minutes to complete this material. How to use this pack To go to the next page, please click the button. To go to the previous page, please click the button. To go to the first page, please click the button. To display additional points on a page click the button. Additional information will be displayed in a separate font. Blue bullets indicate how many times to have to click to display all the information. Show Me Induction Training

3. Aims & Objectives… You should complete the Continence & Using the toilet eLearning module before completing this module on Catheter Care. By the end of this session you will have knowledge of: Continence Management What a catheter is Types of urinary catheterisation The choice of catheters Suprapubic catheter care The closed drainage system Changing night and day bags Emptying a catheter bag Catheter valves How to solve common catheter problems Infection Control in catheter care Monitoring and recording in catheter care Induction Training

4. Introduction… • Working in Healthcare you will no doubt be aware that incontinence is an issue that can affect a whole variety of service users. In fact, consider these statistics: • Urinary incontinence affects some 24% of older people and 30 - 60% of people in institutional care. • Faecal incontinence occurs in approximately 1-4% of adults and up to 25% of people in institutional care. • In 2005 the first national audit of incontinence care for older people in the UK revealed widespread failure to diagnose and manage continence problems. Both urinary and faecal incontinence cause much distress and loss of dignity for a person, so good management of it is vital in your role. Remember everyone has a right to dignity! Induction Training

5. Continence Management… A service user may already have continence problems, or they may develop problems whilst in your care. Effective management of continence depends on a thorough assessment of the service user and assessments should be carried out routinely for all service users as part of the care planning process. Any problems must be reported immediately and reviews should be carried on an ongoing basis to monitor the needs of the service users. This is the responsibility of all members of the care team as any one of you might be the first person to identify a need. Induction Training

6. Continence Management… One of the needs that may be identified for a service user is catheterisation. This is undertaken for one or more of the following reasons: Show Me To solve acute /chronic retention of urine To give exact measurement of urinary output To install drugs To control incontinence Induction Training

7. What is a catheter?… A catheter is a thin, clean, flexible hollow tube, usually made of soft plastic or rubber. Urinary catheterization is where a catheter is inserted into the bladder. The catheter is normally inserted through the urethra, but occasionally it may need to be inserted into the bladder through the wall of the abdomen instead, which is called a suprapubic catheter. This procedure is usually carried out in theatre by a surgeon using a general or spinal anaesthetic. Induction Training

8. Types of urinary catheterisation… There are two main types of urinary catheterization. Indwelling catheterisation is where the catheter is left in continuously. Intermittent catheterisation is where the catheter is inserted only until the urine in your bladder has been drained, and then the catheter is removed. Self-catheterisation is a form of intermittent catheterisation where the service user inserts and removes the catheter themselves. Induction Training

9. Choice of Catheters… Choice of catheters will be governed by the length of time the catheter is likely to remain in situ, and taking into account the reason for catheterising. Single use coated In/Out Catheter Used in I.S.C (intermittent self catheterisation ) Silver coated catheter Short/Medium term, Up to 28 days Teflon coated latex Short/Medium term, Up to 28 days Hydrogel coated silicone elastomer Long term, Greater than 28 days Solid silicone No longer than 12 weeks It has been shown that silver coated catheters reduce infection rate in a high proportion of patients. Induction Training

10. Suprapubic catheter care… What do you need to ensure when looking after clients with a superpubic catheter? Show Me You must carry out regular wound care of the insertion site to prevent infection. Avoid movement and traction of the catheter. Catheter supporting straps /garments and catheter stands should be used to prevent any pulling on the catheter. Ensure that drainage bags are always kept below bowel or bladder level as this prevents back flow. Overgrown tissue of the insertion site generally does not need intervention but if you have any concerns you should inform your branch manger or district nurse. Induction Training

11. Closed drainage system… There is a clear correlation between the number of times the drainage system is disconnected and the rate of infection. It is important therefore to keep the drainage system CLOSED at all times. The bag should only be disconnected from the catheter when: The bag needs changing Bladder irrigation is necessary The catheter becomes blocked Somecatheterswill connect to a night drainage bag. Induction Training

12. Changing night and day bags… What do you think the correct procedure is for changing bags? Show Me Protect the client’s bed, chair or other surface. Wash your hands thoroughly before the procedure. Put on aprons and gloves. Loosen the cover from the end of the new tubing. Pinch the catheter 3-5cms from the end and disconnect the old drainage bag, raising the end of the tubing to drain residue urine. Wipe the open end of the catheter with a 70% Isopropyl alcohol swab. Hold the tubing 3-5 cms from the end and connect to the catheter. Remove used bag. Measure and record volume of the output. Dispose of apron and gloves. Wash your hands thoroughly. Record the procedure on the client’s care plan. Induction Training

13. Changing night and day bags… Catheter bags normally last for approx. 5 – 7 days. Day and night bags should be changed when there is an accumulation of sediment, leakage, when a new catheter is inserted, or when the bladder has been been irrigated. A leg bag should be in situ for approximately 5-7 days but should be changed more often if infection is present. Always wipe the tap end of the leg bag with a 70% Isopropyl alcohol swab before fitting a night bag. Induction Training

14. Changing night and day bags… A disposal night drainage bag should be used for service users who are bed bound and disposed of each morning. A 2 litre drainage bag may be used only if connected directly to the catheter and left in situ for 5-7 days. Catheters themselves need changing only if they become obstructed or a malfunction occurs. If the catheter is draining normally it can be left alone until the maximum recommended usage time has expired. Using catheter straps will help to keep the catheter in place. Induction Training

15. Emptying a catheter bag… One of the main concerns when emptying a catheter bag is the risk of infection and cross contamination. What do you think the correct procedure is to avoid this risk? Show Me Wash your hands thoroughly before the procedure. Put on aprons and gloves. Place the receptacle under the catheter drainage bags. Drain urine into receptacle. Close the drainage outlet and wipe it with a 70% Isopropyl Alchol swab. Wash and dry the receptacles. Dispose of apron and gloves. Wash your hands thoroughly. Record the procedure on the client’s care plan. Induction Training

16. Emptying a catheter bag… Catheter bags should be emptied between three and four times a day or more often if needed. Never allow the drainage bag to fill to the top as this applies pressure and the weight of the bag will mean that it will pull on the client. If you had to bathe a client with a catheter, would you disconnect the leg drainage bag or just empty it? The correct answer is that you do not need to disconnect the bag but should empty it and then the client can be bathed with the catheter in situ. Induction Training

17. Catheter valves… Using a catheter which continually drains any urine, means that the client’s bladder is always empty. This can actually have a negative effect on the bladder, i.e. it can shrink and lose tone resulting in it not functioning properly any more. A catheter valve can help improve this situation. It is a tap-like device, which is fitted between the catheter and drainage bag. The tap may be switched on to drain urine from the bladder, or switched off to stop drainage. When drainage is stopped, urine gathers in the bladder allowing it to stretch, increasing its tone and capacity so that it can hold gradually increasing volumes of urine. A catheter valve can also be used without a drainage bag, allowing the client to empty their bladder over the toilet or another receptacle. Induction Training

18. Solving catheter problems… One of the main problems you may come across is a catheter not draining properly. What would you do if this was the case? Show Me Ensure that the catheter tubing is not kinked or blocked. Check the drainage bag is below bowel or bladder level. Check the drainage bag is connected correctly and does not need emptying. Make sure the service user is drinking enough liquids. Try and encourage the services user to eat a healthy balanced diet. When it is next changed, ask your nurse to check the tip and inside of the catheter tube for signs of catheter encrustation. Induction Training

19. Solving catheter problems… A service user may complain that their catheter feels painful. What would you do if this was the case? A service user may complain that their catheter feels painful. What would you do if this was the case? Show Me Check that the catheter and the drainage system is secured. Check that the catheter tubing is not twisted and the service user is not sitting on the tubing. For men, make sure the foreskin is in the correct position. Check whether the catheter bag needs emptying. Inform your branch manager or district nurse if the client is in constant pain from the catheter. Induction Training

20. Infection Control… As you can probably imagine it is very important to apply strict infection control measures when dealing with catheters. Please access the Infection Control eLearning module if you need further information on this. But it is not just you that may transmit infections, there are also points on the catheter which can harbour bacteria and cause infections, as indicated by the numbers in the picture on the right. Induction Training

21. Monitoring and Recording… When looking after a service user with a catheter it is important that you monitor the volume and output of urine, as well as when the service user has taken fluids. Recording this in a Fluid Balance chart will allow Nursing Homes to check whether the service user is taking enough fluids. Also in Homecare, the District Nurse may ask to see this information. If you have any concerns about the service user you should contact your Branch Manager or District Nurse and also record your concern in the Care Plan. This may include: If the client has a high temperature. If you notice a change of colour or thickness in the urine. If there is a strong smell of urine while you are emptying the bag and there are segments floating. Or if anything just does not look right. Induction Training

22. Review… This module has covered information on Catheters including what a catheter is, different types of catheters as well as changing catheters and catheter bags. It has also covered how to deal with common catheter problems, the importance of infection control measures as well as the importance of the monitoring and recording procedures you need to follow. Induction Training

23. Well done! You have now completed this web based session on catheter care Please now complete the assessment on Catheter care Click to exit Induction Training