Catheter Care – Problem

Solving

Presented by Cheryl Hammond

Clinical Nurse Specialist

Objective

To maintain urinary drainage and reduce the

risk of trauma and infection.

Educate the patient

Discuss catheter care

- hygiene

- securing catheter

- supporting drainage bag

- catheter not kinked or twisted

- drainage bag emptied regularly

- advise on fluid intake and prevention of constipation

- importance of a closed system

Catheter by-passing

Check tubing is not twisted or kinked

Catheter secured

Check patient not constipated

Check size of catheter is correct

Check balloon inflated correctly

Check if bag needs emptying Check for infection

Check catheter not blocked

Consider possibility of bladder spasm or irritation

Catheter blocked

Check catheter in correct position

Check drainage bag, below bladder level and empty if full

Check tubing not kinked or blocked

Catheter by-passing due to bladder spasm Decrease known bladder irritants i.e. caffeine and

alcohol.

Decrease size of catheter

Check balloon size

Check bag is secured and empty bag.

Possible infection Maintain closed system

Follow hand hygiene guidelines

Position bag below bladder level

Drainage bag should be off the floor

Catheter secured correctly

Risk factors

Patient been in hospital last 12 months Patient taken antibiotics in last 6 months Over 65 years of age Diabetes Chemotherapy Taking steroids Chronic wounds

Possible encrustation

Inspect for encrustation in the catheter lumen and on outer surfaces of the tip and the balloon.

Monitor PH of urine, urine is normally acidic.

Monitor time of catheter life and when blockage

Unable to deflate the balloon

Check for kinked tubing Relieve in constipation Try a different syringe and leave in place. Try and dislodge debris blocking the deflation

channel by milking the catheter along its length. Never cut the catheter or inflation valve Never attempt to burst the balloon by over inflating

it.

.

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Freeman C (2009) Why more attention must be given to catheter fixation , Nursing Times, 105 (29)

Fraczyk L Godfrey H (2004) Current practice of antibiotic prophyalaxis for catheter procedures, British Journal of Nursing , 13 (10) 610-617.

Getliffe K and Dolman M (2007) Catheters and containment products, 10, 259- 307; Promoting Continence A Clinical and Research Resource.

Holtam B (2004) Blocked indwelling urethral catheters ; Evaluating the evidence, Journal of Community Nursing, 18, 3.

Howell AB, Foxman B (2002) Cranberry juice and adherence of antibiotic resistant uropathogens, Journal of the American Medical Association, 287, 3082-3

Madeo M and Roohouse AJ (2001) Reducing the risks associated with urinary catheters, Nursing Standard , Supplement, 3-13.

Promfret I (2007) Urinary catheter problems 2, Journal of Community Nursing, 21, (7) 23-25.

Robinson J (2006) Selecting a urinary catheter and drainage system, British Journal of Nursing, 15 (19), 1045-1050.

Royal College of Nursing (2012) Catheter Care, RCN guidance for nurses.

Turner B and Dickens N (2011) Long term urethral catheterisation, Nursing Standard, 25 (24) 49-56