online version Understanding Indwelling Urinary Catheters and Drainage Systems Useful information When to call for help

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1 When to call for help This will depend on the individual situation, but usually help should be sought if any of the following occurs: 1. The catheter does not start to drain, despite trying the problem solving advice. 2. There is no urine in the bag after 4-5 hours, or you become uncomfortable. 3. The catheter falls out. 4. Urine keeps leaking around the catheter, despite trying the problem solving advice. 5. The urine is cloudy, smelly or feels as if it is burning, and does not improve after drinking more fluids 6. Any sudden or persistent lower abdominal pain is experienced. 7. If heavy, thick or clotted blood appears in the drainage bag. Light blood stained urine is very common and is not considered to be a medical problem. Always keep a spare catheter at home in case of an emergency. If you need to speak to anyone, please use the contact numbers below. Useful information If you require further information on catheter care you can contact: During Office Hours: Your District Nursing Team The continence Team on The Hospital based Continence nurse Specialist on or ask for operator and ask them to bleep 2170 Out of Office hours Your on call GP GHPI0138_05_07 Author: Continence Review due: May 2010 Patient Information for the Gloucestershire Health Community Understanding Indwelling Urinary Catheters and Drainage Systems

2 Individual Care Plan Personal Details Name Address Post Code Contacts Hospital Nurse Contact Number Community Nurse Contact Number GP Contact Number Catheterisation / Catheter Details Reason for catheterisation Ease of procedure Catheter type, make and order code Charrier size Urine drainage system (type, make and order codes) Recommended frequency of catheter change Details of any prescribed catheter maintenance solutions Details of any catheter related drug therapy Notes Problem solving common catheter related problems If no urine is draining into your bag: 1. Check the catheter tubing is not kinked or blocked. 2. Check the drainage bag is below bladder level. 3. Check the drainage bag is connected correctly and does not need emptying. 4. Make sure you are drinking enough liquid. 5. Make sure you are not constipated. Try to avoid constipation, by eating the correct foods and drinking an adequate amount of fluid. 6. Ask your nurse to check the tip and inside of the catheter tube when it is next changed, for signs of catheter encrustation. This can be treated but needs to be confirmed first. If your catheter is painful: 1. Check that your catheter and drainage system are adequately secured. 2. Check that the catheter and tubing is not kinked or that you are not sitting on the tubing. 3. For men, check that the foreskin is in the correct position. 4. Make sure you are not constipated. Try to avoid constipation, by eating the correct foods and drinking an adequate amount of fluid. 5. Check the drainage bag is connected correctly and does not need emptying. 6. Ask your doctor/nurse if anti spasmodic medication maybe appropriate. 1 10

3 Can I have sex with an indwelling urethral catheter? Intercourse is usually possible with a urethral catheter for both men and women. In some special situations the catheter can be removed and you or your partner taught how to reinsert it, however the catheter should never be removed unless you have been specifically taught to do so. Alternatively the catheter can be taped out of the way. Men can tape the catheter along the shaft of the penis and secure it in place with a condom. Women can tape the catheter up onto the abdomen. The drainage bag should always be emptied before sexual activity and both partners should wash their genital thoroughly. It helps to use plenty of water- based lubrication, such as K-Y jelly (but not Vaseline). A supra- pubic catheter may make sexual intercourse easier. Going on holiday If you are going on holiday, make sure that you have a spare catheter and plenty of catheter valves and/or drainage bags to take with you. Pack these in your bag for the plane as well as in your suitcase, in case your suitcase gets lost. Where to get the catheter supplies from? The products are prescribed by your Doctor and the prescription can be obtained from either a pharmacy or delivered direct to you through a home delivery service. Catheter supplies Store any catheters, catheter valves or drainage bags in their original packaging; in a dry safe place away from direct heat and sunlight. Why people need a urinary catheter Many people need to be catheterised at some stage in their lives. It may be that your bladder muscle has lost the ability to contract enough to completely empty your bladder. Alternatively, you may need an indwelling catheter following an operation, or because of a medical condition. Catheterisation is, therefore, a technique, which helps people who cannot control, or have difficulties emptying their bladder to get on with their lives. Catheters can be for either indwelling or intermittent use. This leaflet provides information on indwelling catheters only. How your bladder and kidneys work The kidneys filter waste products from the blood to produce urine. This is passed to the bladder via two tubes called ureters. When the bladder is full, urine is passed through the urethra (water pipe) and out of the body. If the bladder does not work properly, sometimes urine can be left behind. If this urine is not removed it can become stale and may cause infection and discomfort. It may also cause some back pressure on the kidneys. Using a catheter, will allow the bladder to be emptied. 9 2

4 Urinary catheters A Foley catheter is a hollow flexible tube, which drains urine from your bladder. The catheter reaches the bladder either by passing through the urethra, or through a channel made in the abdominal wall, just above the pubic bone. This is called a supra-pubic catheterisation. Once the catheter is in place a small balloon at the catheter tip is inflated inside the bladder to prevent the catheter from falling out. As urine fills the bladder it drains down the catheter into a drainage bag or catheter valve. You should not need to pass urine in the usual way when you have a catheter in place. Types of foley catheters There are different types of Foley catheters which are made out of different materials and coatings. Short term catheters These are only left in the body for up to 2-4 weeks, and are made of latex coated in PTFE. There are anti-infective Foley catheters made with Bacti-Guard Silver Alloy coating, used for up to 28 days. Long term catheters These can be used for up to 12 weeks; they are made from materials such as hydrogel and All Silicone that better resist the build up of encrustations, which may block the drainage of the catheter. 3 Living with a catheter When you start using your catheter you will probably have the feeling that you need to pass urine, or may experience a bladder spasm or cramp from time to time. This usually stops within hours and is nothing to worry about. You may experience a slight urine leak around the outside of the catheter as a result of a bladder spasm. This is not an emergency, provided the catheter is draining. However you should notify your nurse when you next see them, or on one of the telephone numbers at the back of this leaflet. Personal hygiene Wash the area where the catheter enters your body with mild soap and warm water at least once a day. Dry thoroughly and never use talcum powder or ointments around the catheter, as some ointments can actually damage the catheter. Always wash your hands before and after draining, or changing, a bag. Diet and fluid intake People with catheters need to take care to keep their bladders and bowels healthy. Following a healthy diet and eating five fruit or vegetable portions daily, as recommended by the Department of Health, is important to avoid constipation. Constipation can cause drainage problems with the catheter. Drinking approximately eight teacups or five mugs (1.5 2 litres) of fluid is strongly recommended to ensure the catheter drains well and helps keep the urine clear. Does a supra-pubic catheter need special care? The usual advice for caring for any catheter applies with a supra-pubic catheter. The area around the insertion site should be washed with plain soap and water daily. Again, avoid using any creams or powders around the entry site. 8

5 As the leg bag fills it becomes heavier. Do not allow the bag to become too full. About three quarters full is about right to empty. How to empty the drainage bag: Wash your hands thoroughly Open the tap at the bottom of the bag and drain it into a toilet or a suitable container Close the tap after you have drained the bag Wash your hands again What happens at night? At night, connect the bed bag to the bottom of the leg bag and open the tap of the leg bag to allow urine to drain freely into the bed bag. Support the bed bag on a stand, or hanger and always keep the bed bag down lower than your bladder, because urine cannot drain up hill. Do not allow the bed bag to lie on the floor. Remember to check that the bed bag tap is closed, otherwise you may find you will have a wet floor! The following morning, close the tap on the leg bag and remove the bed bag. The bed bag should then be emptied, rinsed through with water and left to dry ready for the following night. If you are a patient in a hospital, the bed bag should be only used once and thrown away in the yellow clinical waste bin. How often should the leg bag be changed? The leg bag should be changed every 5-7 days, or earlier if damaged. How should the drainage bags be disposed of? Both the leg and bed bags should be emptied and disposed of in a plastic bag and put in the household rubbish. 7 Types of catheter drainage system There are different types of drainage systems to use with the indwelling catheter; these include catheter valves and drainage bags. Catheter valves The catheter valve is a tap like device, which fits into the end of the catheter (urethral of supra-pubic); it can be used whether the catheter is a temporary or permanent arrangement. The bladder continues to store urine and can be emptied intermittently by releasing the valve, thus helping to maintain normal function of the bladder. The catheter valve is more discreet and comfortable than a leg bag and may reduce the risk of infection and blockages by intermittently flushing the catheter with urine. A catheter valve increases the options available to you for the drainage of urine. If the catheter is to be used for a short period of time a catheter valve is more likely to help maintain the bladders normal function. How to use the catheter valve The catheter valve should be opened to release urine when the bladder feels comfortably full or approximately four hourly in the daytime and during the night if necessary, as well as before a bowel action. If the volume of urine emptied each time is below 200mls, 4

6 then reduce the number of times the valve is opened in the day, in order, to encourage a higher volume to be emptied. If the volume that is emptied each time is over 500mls then increase the amount of times in the day to empty the bladder. The average volume should be between 350mls 500mls. How to wear the catheter valve The catheter valve will tuck nicely into underwear; alternatively the valve can be supported on to the upper thigh with a catheter retainer strap which can be supplied by the district nurse or GP. How often should the catheter valve be changed? The catheter valve should be changed every 5-7 days, or earlier if damaged. You should seek advice, support and training by a health care professional, such as your district nurse, before you attempt to change the catheter valve. If this procedure is not performed correctly then the risk of an infection could be introduced. The catheter valve can also be used with a bed bag at night, or with a leg bag in the day if toilet access is likely to be a problem. Disposing of the catheter valve Always wash your hands before handling the catheter valve. Empty the bladder first, then remove the old catheter valve and replace it immediately with a new one. Avoid handling the section of the valve which is inserted into the catheter to prevent introduction of an infection. Rinse the old catheter valve and place into a plastic bag before disposing of it into the household rubbish. 5 Drainage bags There are two types of drainage bags to use with a catheter. 1 A LEG BAG which is worn under normal clothing in the day 2 A BED BAG or OVERNIGHT BAG which is used at night. The bed bag is larger than the leg bag and is connected to the bottom of the leg bag to collect the urine, which drains from the bladder overnight. Closed system Night Drainage bag This catheter and leg bag forms a closed drainage system, which prevents bacteria getting into the system and reduces the risk of infection. The leg bag should only be disconnected from the catheter when the leg bag needs replacing which is every 5-7 days. How to wear the leg bag Leg Bag Connector The bag can be attached to the thigh or calf with a pair of leg bag straps, or worn inside a special leg bag holder against the leg. Leg bags come in different sizes with different tube lengths. The health care professional/district nurse will help you to choose the one that suits you best. 6