edited by rachel leaver, lecturer ... - clinical skills

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6 5 4 3 2 11011121314151617181920 9 8 7 Inch

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CatheterisationAdults

Female indwelling urethral catheterisationEdited by Rachel Leaver, Lecturer Practitioner—Urological Nursing,

University College London Hospital NHS Foundation Trust ©2019 Clinical Skills Limited. All rights reserved

Do not undertake or attempt any procedure unless you are, or have supervision from, a properly trained, experienced and competent person.Always first explain the procedure to the patient and obtain their consent, in line with the policies of your employer or educational institution.

Catheter selection (Note: colours of catheter materials vary between manufacturers)

Catheter length. The healthcare professional should always offer female adult patients who are slim and mobile, but require urethral catheterisation, the choice of a short-length catheter or a standard-length catheter. Note that colours of catheters vary according to the manufacturer. Duration. It is good practice to check the manufacturer’s information on the catheter packaging to confirm whether it is a long- or short-term catheter. Catheter diameter (Charrière size). For routine urine drainage in adults, select the smallest Charrière size which will effectively drain the bladder. This is usually a size 12 Charrière (12 ch), which is 4.0 mm in diameter, but may be smaller (10 ch) or larger (14 ch) as necessary. Check the patient’s history for problems such as urethral stricture, difficult childbirth or previous complex gynaecological or bladder surgery, which may influence the choice of diameter. Balloon size. It is important to follow the manufacturer’s guidelines. A catheter with a 10-mL balloon is used for routine bladder drainage in adults. Most catheters come with a 10-mL syringe of sterile water in the packaging, although some catheters have a pre-filled reservoir that can be used to inflate the balloon once the catheter has been inserted. Catheters designed for postoperative use following urological procedures have larger balloons with a larger Charrière size. They should not be used for routine bladder drainage as they may irritate the trigone area at the base of the bladder, causing spasm, pain and bypassing. Latex allergy. Check whether the patient is allergic to latex. Only catheters made from polyvinylchloride (PVC) and 100% silicone are free from latex.

Silver-alloy-coated latex (short-term catheter; can be left in place for 4 weeks)

Short-term latex catheter coated with polytetrafluoroethylene (PTFE) (up to 4 weeks)

Silicone-coated long-term catheter (up to 12 weeks)

Hydrogel-coated long-term catheter (up to 12 weeks)

Pure 100% silicone long-term catheter (up to 12 weeks)

Short-length catheters range between20 and 26 centimetres

Female indwelling urethral catheterisation may be used to relieve urinary retention, after urological and gynaecological surgery, during investigations such as urodynamic studies, and for the instillation of intravesical medications; it may also be used during short- and long-term management of urinary incontinence. The National Institute for Health and Care Excellence (NICE) has summarised the indications for catheter use (NICE, 2019).

If the patient has a chronic obstruction she may experience a post-obstructive diuresis following catheter insertion. In some cases, the excessive fluid loss may lead to shock and severe dehydration so the patient may need fluid replacement (Halbgewachs & Domes, 2015). It is important to avoid use of catheters where possible, as around 60 per cent of healthcare-associated urinary tract infections are related to catheter insertion (DH, 2010).

Nurses and other healthcare professionals carrying out catheterisation should ensure that their employers accept this extended role as part of their workload. Competence should be assessed by other healthcare professionals who are deemed competent in this procedure and can provide supervision for those who are striving to achieve competence (Skills for Health, 2010; NMC, 2018).

The type of catheter used, called a Foley catheter, is designed to be retained in the bladder. It has a balloon for inflation with sterile water, which helps to anchor it in the bladder. See below for information on the lengths of time for which the different types of catheter can be left in place. Note that although standard-length catheters may be used in both men and women, short-length catheters should only be used in women. You will also need to select an appropriate drainage appliance for the patient (see “Catheter care”).

Select the catheter, using the criteria described below. Have at least two available, in case one is inserted into the vagina; if this happens, you will have to discard it.

Mono LOT

02/2019

WOUNDCARE PACK BLUELATEX FREE POWDER FREE04/2021

STERILE

Water for

Injections BP

For the 10m

lpreparationof parenteralsSterile

PL03551/0077 POM

2 3 4 5 6 7 8 9 101

I Sterile lubricant local anaesthetic and disinfectant formucosa in disposable syringes for instillation

EXP

02 / 2021760 033

Mono LOT

02/2019

0

1 2 3 4 5 6 7 8 9 10 ml

2014-02LOT 0077100

05 5

Equipment

mLapprox

— 500 —

— 400—

— 300 —

— 200 —

Recommendedweartime 5-7 days

Date bag fitted:� 500

� 400

� 300

� 200

� 100

Approx m

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Select a suitable drainage bag or catheter valve Check packaging is intact; check expiry dates

Before embarking on catheterisation, review the patient’s history and assess the patient’s needs. Consider what type of drainage bag and sampling port would be best for the patient, and for her comfort and dignity (Loveday et al., 2014). (See also the procedure on “Catheter Care”.)

When assembling equipment, check that the expiry date on the packets has not passed, and that the packets are sealed (IPS, 2017). Decontaminate your hands before patient contact.

Urethral lubricant gel without lidocaine as an alternative, from a sterile single-use container. KY gel or Aquagel are not licensed for urethral use (due to a high uptake within the urethral lining)

Lubricant gel containing 2% lidocaine hydrochloride (6 mL for females) from a sterile single-use container

Syringe and water for non-filled catheters

Alternative prefilled syringe of sterile water

Procedure pad to protect bed or couch

Sterile pack suitable for catheterisation (typical contents: bowl, gauze swabs, forceps, foil or cardboard tray, small gallipot, paper towels and paper sheet, waste bag)

Two pairs of sterile gloves Apron

White blunt fill needle

Sterile water

Cleansing fluid, as in local policy

Explain the procedure to the patient, including provision of written information. If the patient is not socially clean, you should wash the area with soap and water and dry thoroughly before beginning. Offer the patient a chaperone and obtain her consent before beginning the procedure. Ensure privacy by closing curtains and/or the door. Make sure that the area is well lit or that you have a light source. The patient should lie on her back with knees bent and hips flexed, with feet about 60 cm apart. Protect the bed linen with a procedure pad.

If the patient is obese, and not able to flex at the hips/knees, help her to lie on her side with her upper leg crossed over the lower leg. You will need to lift the uppermost buttock and part the labia to access the meatal opening, although it is difficult to visualise the meatus from this position. You may need assistance from a colleague in order to be able to insert the catheter.

The patient: preferred position Alternative position for obese patients

Catheterisation

Adults

Female indwelling urethral catheterisation

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Alternatively, prefilled syringe of sterile water

the female speci�c lubricant gel contain 6mls for females not 11mls - sorry I missed this - so we can change it to (6ml for females) please

Catheterisation

Adults


Page 3 of 5


Use your non-dominant hand to separate the labia to ensure you do not contaminate your dominant hand. Select the cleansing agent according to local policy. Cleanse the labia and urethral meatus with downward strokes using single swabs, to lower the risk of contaminating the urethral meatus with bowel flora. It is important to cleanse the labia thoroughly and/or keep the labia apart during the procedure to ensure that they do not contaminate the meatus (follow local policy).

Cleanse the labia

Change gloves

Urethra

Labia

Vagina

Patients with a prolapse Prepare a sterile field

Arrange equipment and put on sterile gloves

Cover the patient’s thighs

Depending on the setting, you may need to check that the lidocaine local anaesthetic has been prescribed. Following local policy at all times, decontaminate your hands and clean a trolley. Put on an apron and decontaminate your hands again, then prepare a sterile field. Use an aseptic technique throughout (see “Aseptic technique: key principles”).

Place a sterile paper towel under the patient’s buttocks (not shown subsequently). Alternatively, make a hole in a sterile towel to expose the genital area. To help visualise the urethral opening, try placing a pillow under the small of the patient’s back, or ask if she can put her hands under her buttocks to tilt the pelvis up (avoid contaminating your sterile gloves).

If the patient has a prolapse, you will need to gently push this back into the vaginal opening in order to visualise the meatus. Decontaminate your hands, apply non-sterile gloves and use a lubricated, gloved index finger to gently push the prolapse back in. You may need the help of a colleague in order to insert the catheter. Remove and dispose of gloves; wash and dry your hands.

Place the catheter, in the intact sterile inner wrapper, on the sterile field. Retain the batch number (place the outer packet on the trolley’s lower shelf). Add other sterile equipment without contaminating the sterile field, such as additional sterile gloves, sterile gauze and clinical waste bag. If you consider that there is a risk of splashing with body fluids, put on eye/face protection (DH, 2007). Uncover the patient, wash your hands again and dry with a sterile paper towel. Put on sterile gloves (Loveday et al., 2014).

Instillagel 6ml

Sterile lubricant local anaesthetic and disinfectant for

mucosa in disposable syringes for instillation

Prepare the anaesthetic gel

Take the syringe of local anaesthetic gel (2% lidocaine hydrochloride), place your finger over the end of the syringe and push the plunger to break the seal. Remove the cap from the syringe.

Catheterisation

Adults


Insert the catheter into the bladder Observe for drainage of urine

While angling the catheter slightly upwards and backwards, pass it into the bladder; insert it by about 5–6 cm. If the patient complains of pain or there is any resistance to passing the catheter, stop and ask for medical advice.

Continue to insert the catheter and discard the wrapper. When urine starts to flow out of the catheter, insert the catheter by a few more centimetres. The purpose of waiting for urine to drain is to ensure that the catheter is in the bladder and not in the vagina or bladder neck before you inflate the balloon.

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Instil the anaesthetic gel

Unwrap the catheter Introduce the catheter

Gently insert the nozzle of the anaesthetic applicator into the urethral meatus. Slowly instil the contents of the 6-mL syringe of 2% lidocaine hydrochloride into the urethra. Keep the syringe in place in the urethral opening or hold a sterile gauze square against the opening to stop the gel oozing out. Wait 3 to 5 minutes, then wipe away excess gel.

Tear along the perforated edge of the sterile inner packaging of the catheter to expose a few centimetres of the catheter. While maintaining a sterile field, place a containing vessel between the patient’s legs to receive urine.

Using the packaging to protect the catheter, pull back the packaging as you insert the catheter. Holding the catheter in your dominant hand, gently feed it into the urethral orifice.

Instillagel 6ml

Sterile lubricant local anaesthetic and disinfectant for

mucosa in disposable syringes for instillation

Dispose of gloves, wash and dry your hands and put on new sterile gloves.

Change gloves

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Catheterisation

Adults


Inflate the balloon

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Having observed drainage of urine, slowly inflate the balloon with 10 mL of sterile water, following the manufacturer’s instructions. The patient should not feel any pain at this point; if she does, the balloon may be in the urethra. Follow local policy and manufacturer’s instructions. You may need to deflate the balloon, remove the catheter and start again with a new catheter. Or you may be able to deflate the balloon, advance the catheter further and reinflate the balloon. Once the balloon is successfully inflated in the bladder, gently pull the catheter out until you meet some resistance; this allows you to check that the balloon was inflated in the bladder and is now in the correct position. Once the catheter is in place, attach an appropriate drainage appliance (see inset) or catheter valve.

REF 165816UK

12Ch 43cm 10ml

LOT 87DO0344 2 2021 04 STERILE EO..........................................

Date

Catheter type

Size

Batch number

Expiry date

Antibiotic given?

Reason for catheter change

Problems

Name

Date of next planned change

REF 165816UK

12Ch 43cm 10ml

LOT 87DO8324 2

2021 04 STERILE EO..........................................

Routine change of catheter. Dry dressing.

Next change due mid November.

DATE PROBLEM/NEED EXPECTED OUTCOMEAND REVIEW DATE

CARE PLAN

6.10.19

08.00

Document the care given Urinary catheter passport

Attach catheter to drainage system Make the patient comfortable

Plan the care of the catheter with the patient. Include a note of the date when the catheter should be changed or removed in the care plan. Short-term indwelling urethral catheters should be changed when clinically indicated and in line with the manufacturer's recommendations (Loveday et al., 2014). In the patient’s notes, record the date, the type and size of catheter, and the amount of water in the balloon. Most catheter packaging comes with sticky labels which contain all the necessary information (catheter material, size, lot number, expiry date and balloon size).

Many organisations will use a urinary catheter passport—a document that the patient receives at the time of insertion of the catheter, which records what type of catheter they have and how long it has been in place (Codd, 2014). Put the second sticky label from the catheter packaging in the catheter passport (if using). The passport allows other healthcare professionals (in the community, for example) to find out these details if the patient’s notes are not available. If the patient is going home, make sure you include all relevant information in the discharge summary.

Depending on whether the patient has had a catheter before, you may need to note the amount of urine draining, and the rate. If more than 1 litre drains, do not clamp the catheter but stay with the patient as rapid decompression may lead to bleeding (Boattcher et al., 2013).

Older patients, particularly those who have had urinary retention, may need to rest for 30 minutes. Ensure the catheter is secured comfortably to minimise patient discomfort (Loveday et al., 2014). (See also the procedure on “Catheter care”.) Dispose of equipment according to local policy. Remove gloves and then apron (Loveday et al., 2014) and wash and dry your hands.

edited by rachel leaver, lecturer ... - clinical skills

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