PROCEDURE FOR CATHETER AFTERCARE

Transcription

1 PROCEDURE FOR CATHETER AFTERCARE First Issued May 2010 Issue Version Two Purpose of Issue/Description of Change To promote safe and effective emptying of urinary drainage bags, closed drainage systems and general catheter aftercare Planned Review Date 2013 Named Responsible Officer:- Approved by Date Continence Specialist Nurses Section:- Continence C N O 3 Clinical Policy and Procedures Group Impact Assessment Screening Complete Date: May 2010 August 2010 Full Impact Assessment Required Y/N UNLESS THIS VERSION HAS BEEN TAKEN DIRECTLY FROM NHS WIRRAL WEB SITE THERE IS NO ASSURANCE THIS IS THE CORRECT VERSION

2 CONTENTS LIST CONTENTS PAGE Patient and Carers guide to Catheter Aftercare 3 Equipment needed 3 How to empty a urinary catheter drainage bag 3 How to attach a night drainage bag 4 How to change a leg bag 4 Catheter cleansing 4 Procedure for Catheter Aftercare 5 Introduction 5 Target group 5 Related NHS policies and Procedures 5 Catheter Aftercare 5 Equipment 5 Procedure for emptying a urinary catheter bag 6 Procedure for changing a leg bag 6 Procedure for changing a night drainage bag 7 Obtaining supplies 8 Catheter cleansing 8 Further advice and support 8 References 8 CONSULTATION Continence Service Infection Control Team Clinical Policy and Procedures Group Service improvement Unit 2/9

3 Patient and Informal Carers Guide to Catheter Aftercare Easy step by step guide for patient or carers A urinary catheter is a small, flexible hollow tube which is put in the bladder and held in place by the inflation of a small balloon to drain urine away from the bladder into a drainage bag. The catheter drainage bag will need to be emptied, changed and attached to a night bag for overnight drainage. The patient should be encouraged where possible to care for their own catheter. When this is not possible a family member or carer will be required to perform these tasks. The patient/ family member or carer should feel comfortable and confident to do this following support and guidance from the community nurse. N.B Please note that domiciliary care workers should follow their own procedure from their employer. Equipment Needed Hand washing equipment e.g. soap, water and a towel Clean jug, just used for urine collection Single use night bag (if required) Leg bag (If required) How to empty a urinary catheter drainage bag This will need to be done many times a day as the bag fills up and becomes heavy. The frequency of this will depend on the size of leg bag Always wash your hands with soap and water first and dry hands well Place the jug under the bag outlet tap and open to allow the urine to drain (avoid contact from the tap to the jug to reduce the risk of infection). When empty close bag outlet tap and wipe with a tissue. Make sure the leg bag is placed back in a comfortable position for the patient (The urine will need to drain downwards into the bag and be secured so that it does not pull) Dispose of contents of jug into the toilet Rinse out jug with warm soapy water and allow to dry 3/9

4 Wash hands with soap and water How to attach a night drainage bag Always wash your hands with soap and water first and dry hands well Remove the cap from the night bag and attach to the end of leg bag Open the leg bag outlet tap as you would for emptying and allow urine to drain freely into the night bag Ensure the night bag is hung on an appropriate stand and not left on the floor as this can be a risk for infection Wash hands thoroughly again On removal of the bag always make sure that the leg bag tap is closed first Dispose of the night bag by emptying urine into toilet and putting the bag in household rubbish Wash hands with soap and water How to change a leg bag Always wash your hands with soap and water first and dry hands well Empty the existing leg bag as you usually would, remembering to close outlet tap Remove existing leg bag Remove cap from new leg bag and quickly attach to catheter Ensure that outlet tap is closed Leg drainage bag will need to be changed according to manufacturers instructions, usually every 5-7 days unless there is a problem sooner. Wash hands with soap and water and dry hands well Catheter cleansing Catheters should be washed twice a day with a cloth and mild soap and water and following any bowel actions. Catheters should be cleaned by wiping away from where the catheter enters the body (urethra). This is to reduce the risk of infection. Any discharge from around the catheter should be noted and observed. The frequency of cleansing may need to also be increased. If you feel you need further advice or support please contact your community nursing team 4/9

5 INTRODUCTION NHS Wirral is committed to providing high quality nursing services to all patients. This procedure outlines the standards of safe and timely healthcare for patients in the community setting who are catheterised and require emptying of urinary drainage leg bags and to maintain a closed urinary drainage system. There are a wide variety of urinary catheter drainage systems available. Selecting a system involves consideration of the reasons for catheterisation, the intended duration, the wishes of the patient, and infection control issues. TARGET GROUP This procedure applies to all clinical staff directly employed by NHS Wirral who are required to carry out this role. RELATED NHS WIRRAL POLICIES AND PROCEDURES Please refer to related policies and procedures on NHS Wirral web site CATHETER AFTERCARE Best practice suggests that the connection between the catheter and the urinary drainage bags should not be broken except for good clinical reasons e.g. only be changed when clinically indicated and/or in line with the manufacturer s recommendations. (DOH, 2001) (EPIC, 2001) Reflux of urine is associated with infection and, consequently, drainage bags should be positioned in a way that prevents back-flow of urine. There are a variety of supports available for use with leg bags such as leg straps and holsters. It is also best practice to recommend that urinary drainage night bags should be hung on an appropriate stand that prevents contact with the floor. Do not add antiseptic or antimicrobial solutions into drainage bags. (Pratt et al, 2001) (Pellowe et al, 2001) Patients should be encouraged to empty their own drainage bag whenever possible, directly into the toilet or into a suitable receptacle/container or jug solely for that purpose. When the patient is unable to empty their own bag, the nurse or carer should complete the task following the guidelines below. Carers will be advised by the community staff nurse on the practicalities of following the procedure, and endeavour to ensure that the carer feels confident and supported in performing the task. 5/9

6 EQUIPMENT Single use leg bag or night bag (if required depending on which procedure is being followed) single use disposable apron Clean jug / receptacle Single use disposable non sterile gloves PROCEDURE FOR EMPTYING A URINARY CATHETER BAG PROCEDURE Confirm identity of patient, by asking for full name and date of birth. Clarify identity with carers if patient not able to do so Explain procedure to the patient, obtain valid consent and document in the patients health record Decontaminate hands prior to procedure Apply single use disposable apron Apply single use disposable non-sterile gloves Loosen leg bag, or other accessories Place receptacle/container or suitable jug under bag outlet tap and open, allowing urine to drain. Avoid contact between the drainage tap and container at all times When empty close bag outlet tap and wipe with a tissue. Re-position leg bag in an acceptable position for the patient, being aware of the possibility of bag reflux. Dispose of the jug contents into the toilet. Clean the jug after use with detergent and warm water, dry thoroughly. On completion of procedure remove and dispose of Personal Protective Equipment (PPE) to comply with waste management policy Decontaminate hands following removal of PPE Record volume and nature of urine, if required. RATIONALE To confirm correct identity of patient To enable patient to make an informed decision about their own health care To reduce the risk of transfer of transient microorganisms on the health care workers hands To protect clothing or uniform from contamination and potential transfer of micro-organisms To protect hands from contamination with organic matter and transfer of micro-organisms Aid access Avoid spillage and cross infection To ensure patient comfort and minimise the risk of infection. To reduce risk of environmental contamination. To prevent cross infection and environmental contamination To remove any accumulation of transient and resident skin flora that may have built up under gloves and possible contamination following removal of gloves and apron To meet individualised health needs as per care plan 6/9

7 PROCEDURE FOR CHANGING A LEG DRAINAGE BAG (CLOSED DRAINAGE SYSTEM) Maintaining a sterile, continuously closed urinary drainage system is central to the prevention of catheter associated infection (EPIC, 2001). Breaches in the closed system, such as unnecessary emptying of the urinary drainage bag or taking a urine sample, will increase the risk of catheter related infection and should be avoided. PROCEDURE RATIONALE Confirm identity of patient, by asking for full To confirm correct identity of patient name and date of birth. Clarify identity with carers if patient not able to do so Explain procedure to the patient, obtain valid To ensure that the patient understands the consent and document in the patients health procedure and gives their valid consent record Decontaminate hands prior to procedure To reduce the risk of transfer of transient microorganisms on the health care workers hands Apply single use disposable apron To protect clothing or uniform from contamination and potential transfer of micro-organisms Apply single use disposable non-sterile To protect hands from contamination with organic gloves matter and transfer of micro-organisms Loosen leg bag, or other accessories Aid access Place receptacle/container or suitable jug Avoid spillage and cross infection under bag outlet tap and open, allowing urine to drain. When empty close bag outlet tap and To ensure patient comfort and minimise the risk of wipe with a tissue. infection. Remove existing leg bag and dispose as per To comply with waste management procedures clinical waste procedure Remove cap from new leg bag and using a non To reduce the risk of cross infection touch technique attach to catheter, ensure that the outlet tap is closed. Leg drainage bag will need to be changed according to manufacture s instructions usually 5-7 days Re-position leg bag in an acceptable position for To ensure patient comfort and prevent back flow of the patient, being aware of the possibility of bag urine. Reflux of urine is associated with infection reflux. On completion of procedure remove and dispose of Personal Protective Equipment (PPE) to comply with waste management policy. To prevent cross infection and environmental contamination Decontaminate hands following removal of PPE To remove any accumulation of transient and resident skin flora that may have built up under gloves and possible contamination following removal of gloves and apron 7/9

8 PROCEDURE FOR CHANGING A NIGHT DRAINAGE BAG (CLOSED DRAINAGE SYSTEM) The chart below outlines the procedure for the use of closed drainage systems (connecting a night bag). It is best practice to use a disposable night bag. PROCEDURE Explain and discuss the procedure with the patient Decontaminate hands prior to procedure Apply single use disposable apron Apply single use disposable non-sterile gloves Remove the cap from the night bag Insert night bag connector using a non touch technique into the leg bag connector Support night bag on a catheter bag stand RATIONALE To ensure that the patient understands the procedure and gives their valid consent To reduce the risk of transfer of transient microorganisms on the health care workers hands To protect clothing or uniform from contamination and potential transfer of micro-organisms To protect hands from contamination with organic matter and transfer of micro-organisms To reveal the entry port for connection To enable the passage of urine from one bag to another To keep bag off the floor and prevent back flow of urine. Reflux of urine is associated with infection To allow free flow of urine drainage overnight To prevent cross infection and environmental contamination Open the leg bag drainage tap On completion of procedure remove and dispose of PPE to comply with waste management policy. Decontaminate hands following removal of PPE To remove any accumulation of transient and resident skin flora that may have built up under gloves and possible contamination following removal of gloves and apron To remove the night bag follow the same procedure with regard to infection control, remembering to close the leg bag tap prior to removing the night bag. Night bags are single use only and should be disposed of in general household waste after emptying urine into the toilet. OBTAINING SUPPLIES It is the responsibility of the community staff nurse to check that further supplies of catheter bag equipment are readily available in the patients home for subsequent emptying or changing of the catheter bag. If the task is to be performed by formal or informal carers in between the community staff nurse visits then adequate supplies should be left to enable them to do this. Supplies will be obtained by the route in which the patient has already established. e.g. General Practitioner, continence service, prescription express service etc. CATHETER CLEANSING Catheters should be washed twice a day with a cloth and mild soap and water and following any bowel actions. Catheters should be cleaned by wiping away from the urethral opening. This is to reduce the risk of ascending infection. Any discharge from around the catheter should be noted and observed. The frequency of cleansing may need to also be increased. 8/9

9 FURTHER ADVICE AND SUPPORT Further advice for nurses can be sought from the Continence Specialist Nurses in the Continence Service. Daytime and out of hours contact numbers should be written clearly at the front of patient health records for patients or carers to seek further advice as required. CLINICAL INCIDENTS Any related incidents arising from carrying out this procedure which may involve a clinical error or near miss must be reported following the Incident Reporting Policy. REFERENCES DH (2001) Essence of Care Patient-focused Benchmarking for Health Care Practitioners. Department of Health, London. DH (2001) The epic project: Developing national evidence-based guidelines for preventing healthcare associated infections. Department of Health, London. NICE (2003) Full guidelines. Prevention of Healthcare Associated Infection in Primary and community care. Section 3. Urinary catheterisation. National Institute for Health and Clinical Excellence, London. Pellowe C, Loveday H, Harper P, Robinson N, Pratt R. (2001) Preventing infections from short-term indwelling catheters. Nursing Times 97(14): Pratt, R.J. et al. (2001) Guidelines for Preventing Healthcare associated Infections. Journal of Hospital Infection 47(Supplement): S3-S4. 9/9