CATHETER MANAGEMENT FORMULARY

Transcription

1 CATHTR MANAGMNT ORMULARY Reviewed August 2009 by Linda Greenman, Lead Nurse Continence, Calderdale PCT Adapted by Joanne Whiteley, Continence Service Manager, KCHS January 2010 Ratified by NHS KIRKLS PC and Medicines Management Committees June 2010 To be reviewed March 2012 by Joanne Whiteley 1

2 CONTNTS Page Catheter Related quipment (RCN Guidance) 2 quipment Selection and Catheter ormulary 3-6 Indications for Catheterisation 7 Catheter Selection for Patient 7 Suprapubic Catheters 8 Appliances 9 Patient Information 9 Troubleshooting 10 Ordering Prescriptions and Supplies 10 1

3 CATHTR RLATD QUIPMNT Materials and equipment It is essential for clinicians to understand :- The types of catheters, urinary drainage bags, link systems and catheter valves that can be used and why you should select the appropriate catheter How to obtain, store to maintain sterility and dispose of catheter care equipment The types of support methods, including garments, straps and stands, used in conjunction with urinary drainage systems (RCN 2007) National Occupational Standards The following provides further clarity to support the broad statements contained in the NOS; * A medical devise can be defined as an instrument, apparatus, appliance, material or health care product, excluding drugs (MDA, 2000) * Be aware of the importance of the work undertaken by the Medicines and Healthcare products Regulatory Agency (MHRA) in safeguarding the use of medical equipment for and by patients * To appreciate the value of research and audit in equipment evaluation, selection and usage. All equipment and its use needs, where possible, to be evidence based. * The NHS in ngland needs to make the best use of available resources and work to ensure best possible value for money when purchasing catheter equipment, that is the work undertaken by the NHS Purchasing and Supply Agency (PASA) * Continence product valuation Network one of four centres in ngland which evaluates equipment for the MHRA. Multi centre evaluations are undertaken, which provide current, impartial and comprehensive data for purchasers and providers * All catheter products require a C mark. This is a declaration by the manufacturer that the equipment meets all the appropriate provisions of the relevant legislation implementing certain uropean Directives. * Nurses should ensure that all catheter equipment is used according to manufacturers guidelines and only be used for the purpose it was designed for. * Health professional have the task of familiarising themselves with the vast array of equipment available, which ensures service users receive informed choice of product availability * Nurses need to know what type of catheter equipment is available including types the catheter, indwelling urethral (short and long term), intermittent or suprapubic, leg bags, night bags, link systems, catheter valves, support garments and stands. Nurses need to have an understanding of the benefits and disadvantages of catheter equipment used. * Nurses need to select appropriate patients for self catheterisation or use of a catheter valve. * To make an appropriate choice for an individual patient, nurses should be able to identify the different features of oley catheters and urinary drainage systems. * Patient assessment would ensure the appropriate need for the use of a catheter. urther assessment of competence would be required if the patient was to self manage the use of a catheter. Product selection will be made on an individual basis and reviewed periodically, thus ensuring user s needs are met and that the catheter is still required. * Patients who manage their own care will require appropriate individually planned education. 2

4 QUIPMNT SLCTION Pricing Data (Drug Tariff August 2009) C D - 2-4; - 4-7; ; G ; H ; I RQUNCY O CHANG AVRAG PR MONTH TYP COD PIP COD SIZ/ OLY CATHTRS Ch PRIC CAT 12 weeks 3 on 1 st script then 1 2 per script IRST LIN PRSCRIBING Sympacath Aquaflate Hydrogel Coated Latex Catheter Long term use (up to 12 weeks) Suitable for Urethral or Supra pubic Application DH DH DH DH DH DH standard length 14 standard length 16 standard length 12 female length 14 female length 16 female length 12 weeks 3 on 1 st script then 1 2 per script IRST LIN PRSCRIBING Brilliant Aquaflate All-silicone LATX R Long term use (up to 12 weeks) Suitable for Urethral or Suprapubic Application DA DA DA DA DA DA standard length 14 standard length 16 standard length 12 female length 14 female length 16 female length 12 weeks 3 on 1 st script then 1 2 per script Ultramer Hydromer coated,(covidien Commercial UK) latex based Long term use Suitable for urethral or supra pubic use M M M standard length 14 standard length 16 standard length 12 female length 14 female length 16 female length 12 weeks 3 on 1 st script then 1 2 per script Biocath Hydrogel Coated catheter Long term use. Suitable for urethral or supra pubic use D D D D D D No PIP codes needed for Bard products 12 standard length 14 standard length 16 standard length 12 female length 14 female length 16 female length 3

5 RQUNCY O CHANG AVRAG PR MONTH TYP COD PIP COD SIZ/ LG BAGS PRIC CAT 5 7 days 1 ox every 2 months L.IN.C Medical 500ml T tap Recommended Allows free sampling port in obtaining CSU NIGHT BAGS LM500MD-T LM500LD-T short tube 10 long tube I I 5 7 days 1 box every 2 months L.IN.C Medical 2 litre with T tap Recommended for use 5-7 days with patient/carer living at home capable of independently carrying out their activities of daily living, with full hygiene awareness. NIGHT BAGS OR NURSING/RS HOMS SLC G Daily single use 3 boxes of 10 L.IN.C Medical 2 litre single use drainage bag Recommended infection control for use in nursing/res homes or by multiple carers in patient s own home LM2LNS D SINGL US STRIL NIGHT BAGS Daily single use 3 boxes of 10 L.IN.C Medical 2 litre overnight drainage bag with non return valve Recommended immuno compromised patients LM2LS D RQUNCY AVRAG TYP COD PIP COD SIZ/ PRIC 4

6 O CHANG PR MONTH CATHTR VALVS CAT 7 days 1 box of 5 Simpla Catheter Valve T180 5 G 7 days 1 box of 5 Libra lever catheter valve with 180 lever action tap 10540A G 1 5 days. Can be washed 1 box every 2 months LG BAG SLVS/G Straps Coloplast Aquasleeve (all sizes are circumference) Boxes of No pip codes Small/yellow 22.33cm Red/standard 34-39cm Blue/medium 40-46cm Brown/large 47-64cm Green/x large days 4 per month Simpla G Strap adult G CATHTR MAINTNANC SOLUTION IRST LIN PRSCRIBING x 30ml Would depend upon clinical assessment *Uro-tainer Twin Suby G 3.23% citric acid Two in one unit, one break in system, less volume Optiflow G citric acid 3.23% Need to use 2 50ml Uriflex SP Sodium Chloride 0.90% ml D *Double instillations As the bladder size decreases on long-term catheterisation, it is better to use a smaller volume of 5

7 maintenance solution. Getliffe et al. (2000) suggests using as little as 15mls to gently bathe the lumen and the tip of the catheter. They also state that: The small volume within the catheter lumen rapidly becomes saturated with dissolved encrustation components, and the instillation of a second washout, after draining the first, provides a fresh medium which promotes further dissolution of encrusting material Reference: Getliffe K.A., Hughes S.C., Le Claire M (2000) The dissolution of urinary catheter encrustation. BJU Int Jan; 85 (1): PH Strips, code no. XX-LP from Braun. Telephone RQUNCY O CHANG AVRAG PR MONTH TYP COD PIP COD SIZ/ URINARY SHATHS PRIC CAT 1 per 24 hours Initially 2 boxes then 1 box per month Conveen Optima latex free sheath (Coloplast) cm 25mm 30mm 35mm 40mm per box of 30 I cm 21mm 25mm 30mm 35mm per box of 30 I 1 per 24 hours Inially 2 boxes then 1 box per month RQUNCY O CHANG AVRAG Clear Advantage with Aloe Silicone Sheath (Rochester Medical) mm 28mm 32mm 36mm 40mm TYP COD PIP COD SIZ/ I 47 per box PRIC CAT

8 PR MONTH ANTISPTIC, ANASTHTIC CATHTR GL Need 1 tube at each urethral catheterisation Initial 5 tubes then as frequency identified Instillagel gel (Clinimed Ltd) 6mls (females) 11mls (males) Care of a patient with a Urinary Sheath :- Sheath should be changed every 24 hours Pubic hair should be trimmed prior to application to aid good contact with skin and prevent leakage very man should be measured prior to prescription generation. The penis should be measured at the base when the man is sitting INDICATIONS OR CATHTRISATION RLI O ACUT/CHRONIC RTNTION Allows complete drainage of the bladder prior to surgery or investigative procedures. Instillation of drugs & bladder maintenance solutions INVSTIGATIONS O RSIDUAL URIN Bladder function tests INTRACTABL URINARY INCONTINNC When all other methods of treatment have failed DTRIOATION IN SKIN DU TO INCONTINNC CATHTR SLCTION OR PATINT (URTHRAL) SIZ (diameter) Measured in Charriere (Ch), 1 Ch = 1/3mm. A 12Ch has a 4mm diameter and can drain over 100litres in 24 hours. The 7

9 average adults output is only 1.5 litres per day! Always use the smallest possible Ch size, 6-10 for paediatrics, 12 for females and 12 for males. Remember Larger sizes should only be used under medical supervision. LNGTH Standard/Male catheters are normally 41-43cm long and are suitable for both male and female patients, emale catheters are normally 23-62cm long as the female urethra is much shorter than the male. However, they should not be used on obese patients or where they could compromise the correct positioning of the drainage system. Paediatric catheters are approximately 30cm long. BALLOON 3-5ml - Paediatrics. 10ml - Routine procedures on male and female 30ml + - Used by surgeons in certain urological procedures, such as a prostatectomy (TURP), when traction on a Haematuria (post-operative) balloon can provide haemostasis on the prostatic bed. Remember Use of a balloon over 10ml capacity in normal routine drainage is more likely to cause bladder spasm due to the additional weight and size. Always use sterile water to inflate the balloon. PRIOD O US Short/Medium Term Can be left in situ for up to 28 days. Coated on both the inside and outside with PT (polytetrafluoroethylene), they are manufactured form a latex base to ensure the catheter is soft, pliable and comfortable. Long Term Can be left in situ for up to 12 weeks. The choice of coatings is either Hydrogel or Silicone lastomer on a latex base. All-Silicone catheters are also available, made form 100% silicone. Remember The material determines the length of a catheter s life, not the colour, as they vary between manufacturers. SUPRAPUBIC CATHTRS Commonly used for patients with urethral scarring or after severe surgery of pelvic trauma. It is more accurately called a cystostomy and is only contra-indicated when there are bladder tumours or unexplained Haematuria. 8

10 The most commonly used sizes are 14-18Ch.. HAMATURIA/POST-OPRATIV These catheters, in their various configurations of materials, tips and eyes, are available in sizes ranging from 16-28Ch. They have a particular use in the removal of blood stained urine (Haematuria), clots and debris from the bladder and are most commonly used following urological surgical procedures such as a prostatectomy. The two types of Haematuria catheter normally used are: 2-way, which have drainage and balloon inflation channels. 3-way, having an additional channel to allow continuous or intermittent fluid irrigation of the bladder to facilitate removal of blood clots and debris. APPLIANCS CATHTR VALVS It is good practice to use a catheter valve to maintain a patients bladder tone (RCN 2008). They allow the bladder to fill and empty, thereby mimicking the normal function of the bladder. DRAINAG BAGS A Closed System must be maintained when using continuous drainage, in order to minimise the risk of introducing infection. The type of system will be indicated by the reason for catheterisation, patient choice and compliance/ duration of the catheter. The majority of manufacturers produce leg bags in 350ml, 500ml and 750ml volumes, each with a choice of tubing lengths, and most can be used for up to 5-7 days. To maintain the closed system at night, a larger volume bed bag (usually a non-drainable 2000ml) will be required for connection to the leg bag outlet. In acute medical or surgical situations and non-ambulatory patients, a bed bag will be attached to the catheter and normally left in situ for up to 5-7 days, depending on the patient s condition. Remember The appropriate nursing professional should assess each patient before they are fitted with any drainage devices. OTHR INORMATION or patient information please refer to Kirklees CHS You and Your Urethral Catheter HYGIN The area around the catheter should be cleansed twice daily with soap and water. Men must ensure they wash thoroughly under their foreskin. A bath or shower can be taken with a catheter. 9

11 Maintain a closed drainage system and empty the drainage bag regularly. LUIDS Patients should be encouraged to drink : ltrs per 24 hours A glass (200mls) of Cranberry juice daily to prevent infections. Caution Warfarin, GI ulcers and diabetes STORAG O QUIPMNT Careful attention needs to be paid to the care and storage of catheters and drainage bags. Store in a cool place Keep in original boxes prior to use, to avoid both physical damage and exposure to light. Always check the expiry date, size, coating and balloon sizes. Rotate stock, using oldest product first. TROUBLSHOOTING INCTION There will always be a certain amount of bacteria around catheters. Antibiotics are advised when a patient exhibits signs of pyrexia, loin pain, offensive smell from urine, or confusion. SDIMNT This can be produced by bacteria that can make urine alkaline (usually Klebsiella or Pseudomonas) and may require antibiotic treatment. CRAMPS These usually occur when the patient has been catheterised for the first time and usually subside after 24 hours. Monitor and seek advice if the problem persists. BY-PASSING Check sizes of catheter and balloon, a smaller size may be required or the patient might be experiencing bladder spasms and antimuscarinic drugs may be required. 10

12 ORDRING PRSCRIPTION AND SUPPLIS All patients must be given the choice of a local pharmacist or a home delivery company for supply of catheters and related accessories. GP s should be informed of all newly catheterised patients and when patients have been assessed for appliances or intermittent catheterisation. Bullen Healthcare is used by the Kirklees Community Healthcare Services Continence Service to order specialist products. Bullen Healthcare is an unbiased home delivery company as they do not manufacture any products. 11