PROCEDURE FOR ADMINISTERING CATHETER MAINTENANCE SOLUTION AND RESOLVING CATHETER PROBLEMS

Transcription

1 PROCEDURE FOR ADMINISTERING CATHETER MAINTENANCE SOLUTION AND RESOLVING CATHETER First Issued Issue Version Purpose of Issue/Description of Change Planned Review Date One Outlines the process for staff to follow in order to safely administer Catheter Maintenance Solution Named Responsible Officer:- Approved by Date Continence Nurse Specialist Risk and Governance Group August 2011 Section: Continence NP CO4 Target Audience Community Nursing and Continence Service UNLESS THIS VERSION HAS BEEN TAKEN DIRECTLY FROM THE TRUST WEB SITE THERE IS NO ASSURANCE THIS IS THE CORRECT VERSION

2 CONTROL RECORD Title Procedure for administering catheter maintenance solution and resolving catheter problems Purpose Outlines the process for staff to follow in order to safely administer Catheter Maintenance Solution Author Continence Service and Quality and Governance Service (QGS) Equality Assessment Integrated into procedure Yes No Subject Experts Document Librarian Groups consulted with :- Norma Hayes. Continence Specialist Nurse Annie Baker. Advanced Practitioner QGS QGS Clinical Policies and Procedures Group Date formally approved by 3 rd August 2011 Risk and Governance Group Infection Control Approved YES Method of distribution Intranet August 2011 Archived Date August 2011 Location S Drive QGS Access Via QGS VERSION CONTROL RECORD Version Number Author Status Changes / Comments Version 1 N Hayes R/TC To comply with best practice for Infection and Prevention Control Standards Status New / Revised / Trust Change 2/9

3 PROCEDURE FOR ADMINISTERING CATHETER MAINTENANCE SOLUTION AND RESOLVING CATHETER INTRODUCTION This procedure outlines the process for registered nurses and assistant practitioners to follow in order to safely administer catheter maintenance solution. This procedure outlines the standards of safe and timely healthcare for patients in the community setting who require administration of catheter maintenance solution. TARGET GROUP This procedure applies to all clinical staff directly employed by the Trust, who are required to carry out this role. TRAINING All relevant health professionals will attend the Trust Continence Training Course, which includes catheterisation and catheter care. Compliance monitoring rate is 80%. The Continence Service provides Continence Training Courses throughout the year, attendance is mandatory if a practitioner has:- The training and the competency may need to be repeated if the practitioner:- has been on long term absence e.g. over 6 months has had this topic identified as a developmental need following a clinical incident investigation or Root Cause Analysis DEFINITION OF ADULT For the purpose of this document an adult is deemed to be a person over the age of 16 years. TRUST POLICIES AND PROCEDURES Please refer to related policies and procedures CATHETER MAINTENANCE SOLUTIONS A full assessment of the client s catheter history must be completed prior to making the decision to use a catheter maintenance solution. It is suggested that the life of at least 3-5 catheters need to be recorded in order to establish an individualised programme of catheter management. This also enables time for full assessment of contributory factors, 3/9

4 which include constipation, fluid intake, bladder spasms, treatment of symptomatic infections. Management of recurrent catheter blockage is best achieved by identifying a pattern of catheter life ; this can vary according to each patient individual s clinical needs (Getliffe 2003) INVESTIGATING CATHETER BLOCKAGE Where there is no evidence of the cause of the blockage the following steps should be taken:- the catheter to be removed examine the tip of the catheter for any encrustation, the catheter may need to be cut open to see if there are any debris present or any crystals record findings in care plan use findings to inform choice of catheter and future management RISK MANAGEMENT Caution should be exercised in the use of any catheter maintenance solution as there is evidence that all solutions increase the shredding of epithelial cells within the bladder. Nurses must read the specific product characteristics produced by the manufacturer (Getliffe 2004). Catheter maintenance solutions (Optiflo) are not bladder washouts; they cleanse the catheter, not the bladder (Yates2007). Studies show that the use of two sequential uses of 50mls Optiflo G was more effective than a single instillation with either 50 or 100 mls at reducing encrustation. It may also be more effective to administer two sequential solutions once a week that one solution twice a week, reducing the number of times the closed system is open. (Getliffe 2003) Prepacked solutions are usually available in 100ml and 50ml volumes. However, even large catheters such as 18 Charriere hold only approximately 4ml, so after allowing for sufficient fluid to bathe the catheter balloon and tip as well as the lumen, a large amount of solution still enters the bladder, where it may cause chemical irritation. Recommended Solutions Sodium chloride 09% Solution G Citric acid 3.23% Solution R Citric acid 6% Product Licence For the removal of debris (blood clots, mucus, pus) from the catheter. Useful for patients who produce thick debrious urine For the dissolution of struvite crystals which form on the catheter tip under alkaline conditions Stronger citric acid solution for more persistent crystallisation Practice Notes/Cautions Will not dissolve crystal formation. Can be used for long-term catheter maintenance for patients with struvite crystals Strongly acidic potential damage to the bladder endothelium Not for long term catheter maintenance 4/9

5 Cautions when administering catheter solutions (Getliffe 2004) Known urological cancer Fistula Recent radiotherapy to the lower urinary tract / pelvis Urological surgery Urinary tract infection Infection to organs related to the urinary tract Spinal Cord injured patients (Autonomic Dysreflexia) PROCEDURE FOR ADMINISTERING CATHETER MAINTENANCE SOLUTION Equipment Sterile dressing pack Sterile drainage Bag Prescribed maintenance solution on a Patient Medication Administration Chart (PMAC) or Patient Group Direction if applicable (PMAC must be reviewed at least six monthly or earlier if the patients clinical needs change) Bed protection Non-sterile gloves and apron PROCEDURE Verbally confirm the identity of the patient by asking for their full name and date of birth. If patient unable to confirm, check identity with family/carer Introduce yourself and any colleagues involved at the contact Explain procedure to patient including risks and benefits and gain informed consent. If patient unable to give consent, act in the patients best interests by following Consent Policy Offer patient a chaperone and document decision in health records Ensure all equipment is gathered before commencing the procedure Decontaminate hands prior to procedure Ask patient to empty urine bag/catheter valve before starting the procedure if able Ask or assist the patient to position themselves into a supine position preferably, and apply bed protection Decontaminate hands prior to procedure RATIONALE To avoid mistaken identity To demonstrate respect To ensure client understands procedure It is the patients choice to have a chaperone if wanted. Discuss with line manager if nurse considers chaperone is needed as part of a risk assessment To prevent contamination of sterile equipment and to ensure the procedure is not commenced without the necessary equipment To reduce the risk of transfer of transient micro-organisms on the health care workers hands To maintain dignity and comfort To ensure effective instillation and for gravity to facilitate drainage To reduce the risk of transfer of transient micro-organisms on the health care workers 5/9

6 Check correct solution to be used against the current Patient Medicines Administration Chart. Prepare maintenance solution as per manufacturer s instructions. Check expiry date Open sterile dressing pack onto a clean field and place all sterile single use equipment including catheter bag required within sterile field Use aseptic principle to ensure that only sterile single use items are used to keep exposure of the susceptible site to a minimum Decontaminate hands prior to procedure Apply single use sterile disposable apron and gloves Remove catheter bag/ valve from catheter using sterile gauze Insert catheter maintenance solution into catheter and administer according to manufacturer s instructions using Aseptic Non Touch Technique If the manufacturer indicates that the solution is to be retained in the bladder, close the clip for the specified period. When the solution is to be removed, ensure the bag is below the level of the bladder, open the clip and allow the solution to drain back Disconnect the solution container and re-connect a new sterile urinary drainage bag/valve. Attach straps, if required, or other suspension accessory. On completion of procedure remove and dispose of PPE to comply with waste management policy Decontaminate hands following removal of Personal Protective Equipment (PPE) Fully document all intervention and any follow up care required in the patients care plan including consent, batch number/expiry date, name of solution used and volume, record results of intervention Record patients/carers comments or any concerns following the procedure hands To ensure correct product is used This is to prevent the bladder going into spasm if the solution is too cold. Check product has not expired To maintain asepsis and prevent contamination of sterile equipment To prevent contamination of a susceptible site by organisms that could cause infection To reduce the risk of transfer of transient micro- organisms on the health care workers hands To prevent cross infection and environmental contamination To maintain asepsis The use of containers that allow gentle agitation may be more effective than instilling the product for a long period of time as agitation appears to dissolve the encrustation A catheter holds little more than 4mls and therefore only very small amounts of solution should be necessary to fill the lumen of the catheter and bathe the tip. For gravity to facilitate drainage To maintain closed circuit system For patient comfort To prevent cross examination and environmental contamination To remove any accumulation of transient skin flora that may have built up under gloves and possible contamination following removal of PPE To comply with Trust record keeping policies To record patients perspective To provide safe and effective continuity of care 6/9

7 PROBLEM SOLVING FOR CATHETERS Catheter Problem Urine not draining into bag Haematuria Possible Reasons Incorrectly sited catheter, it may be in the urethra and not fully into the bladder. Incorrect positioning of the drainage bag above the level of the bladder can prevent good flow of urine. Reduced fluid intake Drainage tube may be kinked. Catheter may be blocked by debris. Constipation Trauma post-catheterisation Infection Prostatic enlargement Calculi Carcinoma Possible Solutions Check tubing and ensure drainage bag is below level of bladder. Offer fluids as urine production may be reduced if not drinking adequate intake Gentle flush of catheter with sterile saline solution. Re-catheterise checking position Bowel assessment and management Observe output and document severity of haematuria. Option1. If heavy/red and has not been catheterised within last 24 hours, please send to Accident and Emergency Department Option 2. If urine is red for 2 hours, following catheterisation visit immediately. If patient on anticoagulant or has pain on urine draining visit within 2hours Option 3. --If urine is rose coloured following catheterisation for more than 12 hours, visit within 2-4 hours If trauma related carry out a telephone review within 2-4hours, and encourage fluids Pain on urine draining - visit within 2hours Patient on anticoagulant therapy telephone review 7/9

8 Bypassing of urine around the catheter Pain or discomfort Catheter retaining balloon will not deflate Bladder spasm/instability Constipation Incorrect positioning of drainage system Incorrect catheter size Mucous, debris, blood clots in urine May indicate presence of infection if patient has symptoms of infection The eyelets of the catheter may be occluded by urothelium due to hydrostatic suction. May be an indication of infection. Urethral discomfort Catheter Associated Urinary Tract Infection if patient symptomatic Valve port and balloon inflation channel may be compressed Faulty valve mechanism. Report via Medicines and Healthcare Products Regulatory Agency (MHRA) A Trust incident form must be completed and health care records maintained within 2-4hours Review: Assess severity of haematuria Check positioning of catheter Assess for symptoms of Urinary Tract Infection and obtain Catheter Specimen of Urine (if required) If haematuria changes to heavy/ clots, refer to Accident and Emergency Department Consider use of anti-cholinergic medications Increase fluid intake and dietary fibre intake. A bowel management regime may be required Check drainage bag is in correct position, i.e. below the level of the bladder Review catheter size Assess if catheter maintenance solution required Obtain a catheter specimen of urine using the sampling port using Aseptic Non Touch Technique. Please note dipstick urinalysis is of little clinical value in the Long Term Catheterised Patient (Elvy & Colville 2009) Raise the drainage bag above the level of the bladder for seconds only. Obtain catheter specimen of urine. Smaller catheter ( Robinson 2004) Obtain a catheter specimen of urine using the sampling port using Aseptic Non Touch Technique. Please note dipstick urinalysis is of little clinical value in the Long Term Catheterised Patient (Elvy & Colville 2009) Check no external compression problems. Valve port should always be aspirated slowly. If done forcefully, the valve mechanism may collapse. Deflation can sometimes be achieved by injecting an additional small volume of sterile water into balloon and allow it to slowly drain back into the syringe. If attempts fail, medical advice must be sought. Cutting of the valve port is NOT safe practice and may result in retraction of the catheter into the bladder 8/9

9 SPECIALIST ADVICE For further advice, supervision or guidance is available, if necessary, from a member of the Specialist Continence Team VULNERABLE ADULTS In any situation where staff may consider the patient to be a vulnerable adult, they need to follow Trust Vulnerable Adult Policy and discuss with their line manager INCIDENT REPORTING Should any clinical incidents or near misses arise when following this procedure a Trust incident form must be completed. EQUALITY ASSESSMENT During the development of this procedure the Trust has considered the clinical needs of each protected characteristic (age, disability, gender, gender reassignment, pregnancy and maternity, race, religion or belief, sexual orientation). There is no clinical evidence of exclusion of these named groups. If staff become aware of any clinical exclusions that impact on the delivery of care a Trust Incident form would need to be completed and an appropriate action plan put in place. REFERENCES: ACA, (2001) Notes on Good Practice Catheter Maintenance Solutions. (Association for Continence Advice), London Department of Health. (2006). Essential steps to safe, clean care: reducing healthcare associated infections. London: DH. Elvy, J., Colville, A. (2009) Catheter-associated urinary tract infection: what is it? What causes it and how can we prevent it? Journal of Infection Prevention; 10: 2, Getliffe K (2004) The effect of acidic maintenance solutions on catheter longevity. Nursing times. 100(16): 32 Getliffe K (2000) The Dissolution of Urinary Catheter Encrustation. British Journal of Urology 85, Getliffe, K. (2002). Managing recurrent urinary catheter encrustation. BJCN. 11: Getliffe K (2003) Promoting Continence a Clinical research Resource, 2 nd Edition, Bailliar Tindall Edinburgh Kennedy, A.P. et al (1992) British Journal of Urology 70: /9

10 NICE (2003) The infection control clinical guidelines 2. Care of long-term urinary catheters, June. Parkin, J., Keeley, F.X. (2003). Indwelling Catheter Associated Urinary Tract infections. British Journal of Community Nursing. 8(4): Pratt et al. (2001) The EPIC Project: Developing National Evidence-based Guidelines for Preventing Healthcare associated Infections. Journal of Hospital Infection; 47 (Supplement): S3-S4. Robinson J (2004) A Practical approach to catheter associated problems. Nursing standards Vol 18 No 31:38-42 Yates, A. (2007) Managing the Encrustation of Indwelling Catheters. Continence UK. 1(4): /9