Female Urethral Catheterisation Education Package

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1 Female Urethral Catheterisation Education Package ACCOUNTABILITY It is essential that you can demonstrate an understanding of the following RUH NHS Trust Policies using The Royal Marsden Hospital Manual of Clinical Nursing Procedures Eighth Edition (2011): Procedure for female catheterisation Catheter Specimen of Urine (CSU collection) Setting up a dressing trolley and aseptic technique (ANTT). Disposal of clinical waste-see Infection Control Policy Infection risks associated with female catheterisation Procedure for requesting and sending laboratory specimens. It is essential that you can demonstrate an awareness of the legal, ethical and professional responsibilities before commencing female catheterisation. Accountability statement RUH NHS Trust Nursing Policies and Practice manual. Code of Professional Conduct NMC (2008) Scope of Professional Practice NMC (2008) Consent Department of Health Guide to Consent for Examination or Treatment (2001) DOH Saving Lives: High Impact Intervention No5: Urinary Catheter Care Bundle (2006) Catheter Care. RCN Guidance for Nurses (2008) RUH NHS Trust Infection Control Manual Mental Capacity Act (2005) Date of publication: September 2015 Ref. RUH URO/024 Royal United Hospitals Bath NHS Foundation Trust Produced by Caroline Kelly, Urology Nurse Specialist Updated May 2015

2 INTRODUCTION By definition, a urethral catheter is a flexible hollow tube inserted into the bladder via the urethra to drain urine or instill fluids as part of medical treatment. It may be intermittent, for periodic insertion or retaining for continuous drainage. Catheterisation should form part of a holistic assessment based on the patient s diagnosis and clinical need. The decision to catheterise a patient is a joint decision involving the patient and clinician/nurse (and family/carers where appropriate) made by the nurse/doctor and the patient. Indications for urethral catheterisation: Drainage: Lower urinary tract symptoms (LUTS) including enlarged prostates Acute or chronic retention Hypotonic bladder Pre and post pelvic surgery Measure urine output To empty bladder during labour Management of intractable incontinence (last resort) Where it is viewed as better for the patient to have a catheter, such as end of life care, disability, unfit for surgery. Investigations: To obtain an uncontaminated urine specimen In urodynamic (bladder studies) investigations X-ray investigation Instillation: To irrigate the bladder Chemotherapy/Immunotherapy

3 TYPES OF CATHETERS There is a wide range of catheters to choose from, appropriate selection ensures complications are minimized. They should be used in line with manufacturers guidelines. Catheter selection should be determined by: Assessment of why the catheter is needed Assessment of length of time the catheter is insitu (will help determine material of choice) Diameter size and length to facilitate adequate drainage and promote patient comfort Catheter tip design (Urology Department only). Materials: Short term catheters usually last up to four weeks (28 days) but it is important to check before insertion. They can be made of PVC, latex, PTFE (Polytetrafluroethylene), teflon or silver coated hydrogel (used to minimise UTIs) Long term catheters can remain in situ for up to twelve weeks and can be made of 100% silicone or latex coated with hydrogel. It is important to check patients allergies prior to insertion. Length: FEMALE: 24-26cm MALE: 40-45cm Diameter: Catheter sizes or charriere (Ch) refer to the diameter of the catheter and range from size 8 (paediatric) to 26CH. 1Ch =1/3mm diameter Selection of the correct catheter size should reflect patient comfort and allow adequate drainage. In female catheterisation size 10 or 12 should be the first choice however if urine contains clots, debris or sediment a larger diameter catheter is indicated. Most catheters come with a pre-filled syringe of 10mls of sterile water. Substances such as air, non-sterile water and normal saline should NOT be used to fill the balloon. Any catheter larger than an 18Ch should not be inserted by anyone outside of the Urology Team.

4 PATIENT PREPARATION Informed Consent Informed consent must always be obtained before starting treatment or any physical examination. Catheterisation is an invasive procedure which can cause embarrassment, physical and psychological discomfort and impact on the patient s self image. It is the responsibility of the health care professional to inform the patient of the reasons and necessity of the procedure and obtain their permission. This should then be documented in the patient records. It is important to have knowledge of the Mental Capacity Act EQUIPMENT Catheterisation is an Aseptic Non-Touch Technique (ANTT). Equipment required: 1. Sterile catheterisation pack containing gallipot, receiver, swabs and disposable towel 2. Apron 3. Disposable pad (inco sheet) 4. Sterile gloves (2 pairs) 5. Selection of appropriate catheters 6. Sterile anaesthetic lubricating gel % Sodium chloride solution 8. Sterile water for inflation of balloon (if not provided with catheter) 9. Syringe and needle 10. Leg bag/ night bag or flip flow tap 11. Catheter stand if required

5 THE USE OF INSTILLAGEL Non-registered staff can administer Instillagel into the urethra for the use of male and female catheterisation. Using Instillagel is an integral part of the urethral catheterisation insertion to anaesthetise the urethra, whilst providing broad-spectrum anti-microbial coverage as well as giving essential lubrication. The anaesthetic effect begins after 3-5 minutes. A pre-filled disposable syringe of 6ml for a female and 11 ml for a male should be used prior and in preparation of the catheterisation. A 2 nd pre-filled disposable syringe can be used to enhance the gels actions and effects. A female can have at least one of the 6ml pre-filled syringes. Catheterisation should only be carried out by registered nurses and authorised nonregistered staff that have been assessed as competent in the procedure and successfully completed the workbooks. There is no policy or legal position regarding female practitioners catheterising male patients or male practitioners catheterising female patients. Patients should always be offered a chaperone or be invited to request the presence of a chaperone. As with all procedures the wishes of the patient are paramount, informed consent should always be given and documented prior to the procedure.

6 PROCEDURE ACTION Explain Procedure and gain verbal consent Undertake procedure ideally in a clinical treatment room if not appropriate use screen/ curtains by the patient s bedside Assist the patient to get into position with heels flat on the bed and knees falling outwards Wash hands using soap and water Put on disposable plastic apron Clean and prepare trolley Using Aseptic technique (ANTT), open the required additional equipment and place on sterile field ready for use. Expose the patient s genital area by removing required amount of clothing, but ensure not to over expose the individual. Clean hands using soap and water or alcoholic hand rub. Apply sterile gloves and place a sterile sheet under the patients bottom. Clean the labia and surrounding area with saline solution. Holding the labia apart gently insert the nozzle of the lubricating local anaesthetic gel into the urethra and slowly instil 6mls in the urethra. Wait for 3-5 minutes for the gel to work. Replace gloves with new sterile pair and apply new sterile field around area RATIONALE To ensure patient understands procedure and gives valid consent To promote privacy and dignity To ensure easy accessibility to the area To reduce infection risk To reduce cross infection risk from uniform To ensure top shelf acts as clean working surface To minimise the risk of cross infection To maintain privacy and dignity. To minimise cross infection. To maintain a sterile working area and maintain a degree of dignity. To ensure adequate decontamination of the area and to minimise the risk of introducing bacteria to the urinary tract. This enables visualisation of the urethra. In preparation for catheterisation

7 Place receiver (Sterile pot) onto sterile field and gently insert the catheter. If preferred you can attach the catheter bag or tap at this point. Advance the catheter and wait to visualise urine. If no urine drains apply gentle pressure to the symphysis pubis. Slowly inflate the balloon according to the manufacturer s instructions once the catheter is draining. Withdraw the catheter slightly and attach the appropriate drainage system if not already done. To prevent contamination of the catheter and minimise patient discomfort and trauma. Advancing the catheter ensures that it is correctly inserted in the bladder. Sometimes the anaesthetising gel can block the catheter for a few seconds and gently pressing can encourage the urine flow. If the balloon is inflated in the urethra it can cause damage, pain and trauma. Withdrawing the catheter once the balloon is inflated ensures the balloon sits at the base of the bladder which encourages optimal drainage. Secure the catheter with support straps, ensuring the catheter does not become taut/ stretched when the patient mobilises. Assist the patient into a comfortable position ensuring that the patient and bed are dry Measure the amount of urine drained and document in notes Dispose of equipment as per RUH policy To maintain patient comfort and to reduce the risk or urethral trauma and bladder neck damage. To reduce the risk of pressure sores and maintain healthy skin. This is called the residual urine and is essential for future assessment. It is also necessary to monitor renal function and fluid balance however if this is a routine catheter change then residual is not necessary. To prevent environmental contamination.

8 RECORD INFORMATION IN MEDICAL NOTES (and catheter care plan) Reason for catheterisation Consent Use of local anaesthetic (as per patient group direction) Date and time of insertion Residual volume of urine in bladder Catheter batch and expiry date (including sticker found on catheter packaging) Balloon size Any complications or interventions Planned catheter change date (if necessary) Name and signature of nurse completing procedure. Complete the 1-7 day catheter care plan.

9 COMPETENCIES FOR ROUTINE URETHRAL CATHETER INSERTION IN FEMALES These competences are designed for you to use alongside a colleague already competent in female catheterisation. They are to help ensure that you become a knowledgeable, safe practitioner. These competences are to be used in conjunction with: Nursing and Midwifery Council (2008) Code of Professional Conduct The Royal Marsden Hospital Manual of Clinical Nursing Procedures, 8 th Edition, Urinary Catheterisation. PROFESSIONAL ATTITUDES You sign and date when you feel competent Assessor signs and dates to verify your competency Accept accountability for your own actions. Discuss how the Code of Conduct and Scope of Professional Practice relate to female catheterisation. Recognise own limitations and acknowledge that you may have to seek further advice when necessary. Maintain own competence through awareness of local/national policies and keeping up to date with research. Discuss how you will maintain the rights and values of each individual. KNOWLEDGE State conditions under which female catheterisation may be required. Discuss reasons not to catheterise. Describe the anatomy and physiology of the female urinary tract. Describe relevant catheters and drainage equipment Describe procedure for female catheterisation Discuss problems associated with female catheterisation and discuss appropriate action for blockage, leakage or bypassing, pain/discomfort, urethral trauma, urinary tract infection.

10 SKILLS You sign and date when you feel competent Assessor signs and dates to verify your competency Uses appropriate inter-personal skills to inform and enable the patient, and if appropriate the carer to discuss any anxieties. Facilitates informed consent Selects correct equipment, considering size of catheter, type of drainage equipment etc. Ensures patient has received adequate pain control and anaesthesia. Inserts the catheter competently and safely. Safely disposes of equipment. Completes documentation correctly. Checks and either organises or asks patient to arrange for adequate supplies for future requirements. Advises patient and if appropriate, carer regarding general catheter care and health promotion. Practitioner I confirm that I have self-assessed and been assessed and been deemed competent to undertake female catheterisation. Signature of practitioner... Date... Approved assessor Competence for female catheterisation has been assessed and the practitioner deemed competent. Signature of assessor.. Date...

11 RECORD OF SUPERVISED PRACTICE OF FEMALE CATHETERISATION Practice to be carried out after completion of learning pack, and until nurse feels competent. There must be a minimum of 3 supervised catheterisations Name of nurse: Date Hospital number of patient Assessor s name Comments, nurse or assessor

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