Urology – Catheter Insertion and Management, Bladder Irrigation, Nephrectomy and Trans Urethral Prostatectomy (turp)

CHHS16/008

Canberra Hospital and Health Services

Clinical Procedure

Urology – Catheter Insertion and Management, Bladder Irrigation, Nephrectomy and Trans Urethral Prostatectomy (TURP)

Contents

Contents 1

Purpose 2

Alerts 2

Scope 2

Section 1 – Catheter Management for Adults (Inpatients and Community Based Patients) 2

Section 2 – Insertion of Female Indwelling Catheter (IDC) 6

Section 3 – Insertion of Male Indwelling Catheter (IDC) 8

Section 4 – Suprapubic Catheter (SPC) Procedures for Inpatients and Community Based Patients 10

4.1 Insertion of Suprapubic Catheter 11

4.2 Changing Suprapubic Catheter: Inpatient 15

4.3 Removal Suprapubic Catheter 17

4.4 Management of Supra Pubic Catheter: Community Based Patient 18

19

Section 5 – Catheterisation Intermittent in the adult Inpatient 20

Section 6 – Catheter Intermittent: Patient Education 22

Section 6 – Catheter Flushing for Adult Community based patient 26

Section 7 – Trial of Void: Community based patient 27

Section 8 – Indwelling Urinary Catheter Management: Inpatient and Community 29

8.1 Emptying a Urinary Drainage Bag: Inpatient specific 30

8.2 Urinary Drainage Bag Management: Community Specific 31

8.3 Removal of Indwelling Urinary Catheter 33

Section 9 – Trans Urethral Prostatectomy (TURP) 34

Section 10 – Bladder Irrigation 38

10.1 Continuous Bladder Irrigation 38

10.2 Manual Bladder Irrigation 40

Section 11 – Pre and Post Operative Management of patients undergoing a Nephrectomy 42

Section 12 – Management of patients undergoing a Percutaneous Nephrolithotomy 48

Section 13 – Management of patients admitted with Pre-Existing Continent Urinary Reservoirs/Neobladder during routine hospital admissions 53

Implementation 54

Related Policies, Procedures, Guidelines and Legislation 55

Search Terms 55

References 55

Attachments 57

Attachment A: Stat Lock – Foley Stabilisation Device 59

Attachment B: Insertion of Urinary Catheter Sticker 61

Attachment C: How to care for your Urinary Catheter 63

Attachment D: Troubleshooting guide for urinary catheters 67

Attachment E: Source of information and/or suppliers for urinary catheter equipment 79

Attachment F: Catheter selection 81

Purpose

The Urology Assessment and Management Procedures describe practice which will be performed by registered nurses, medical staff and allied health. New nursing or medical staff, or students (within their defined scope of practice) will be required to perform these skills under the direct supervision of a competent practitioner.

Clinicians providing assessment, education and clinical procedures must have current theoretical and clinical knowledge in continence management.
To provide best practice in managing, educating and supporting patients requiring short/ long term management of urinary catheters.
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Alerts

Strict hand hygiene should be adhered to at all times when performing all clinical procedures as per Healthcare Associated Infections Procedure-Section 2 Infection Prevention & Control Strategies

Consent must be gained for all interactions with patients and care provided consistent with Intimate Body Care and Examinations by Health Care workers Standard Operating Procedure
All staff to adhere to Patient Identification and Procedure Matching Clinical Policy

Scope

This document applies to:

• 
  Medical Officers (MO)
  
• 
  Nurses and Midwives who are working within their scope of practice
  
• 
  Students under direct supervision of a registered nurse.
  

Note: A medical officer/ nurse/ midwife is assessed as competent when they have:

• 
  Observed the procedure
  
• 
  Performed the procedure at least once under the supervision of a competent medical officer/ registered nurse/ midwife
  
• 
  Been assessed as competent by another competent registered nurse/midwife, medical officer nominated by the Clinical Nurse Consultant (CNC) or CDN.
  

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Section 1 – Catheter Management for Adults (Inpatients and Community Based Patients)

General Information:

• 
  It is recommended that nursing staff who are inserting urinary catheters and/or caring for and/or removing urinary catheters from patients complete the eLearning course Indwelling Urinary Catheter and the competency assessment form, accessible via Capabiliti.
  
• 
  To introduce a urinary catheter to drain urine from the bladder. If a latex catheter is to be inserted determine the patient’s latex allergy status.
  
• 
  Patient assessment prior to catheterisation should include the exploration of possible patient’s cultural values and beliefs that may influence healthcare practices and consistent with ‘Intimate Body Care and Examinations by Health Care Worker SOP’ . Verbal consent should be obtained especially where catheterisation of males by a female nurse or female catheterisation by a male nurse is required.
  
• 
  For patients with large capacity bladders, indwelling catheters and slow bladder decompression are recommended. No more than 600mls is to be withdrawn from the bladder at any one time unless otherwise indicated by the medical officer as this may induce a syncopic episode.
  

Community Based Patients:

Contraindications for Catheterisation in the Community

• 
  Acute prostatitis.
  
• 
  Suspicion of urethral trauma.
  

1. 
   ‘Medical Officer’s Orders for Urinary Catheter Management’ clinical record form (form no. 40950) must be completed for all urinary management in the community setting. Medical Officers orders for Catheters should be reviewed every three (3) years.
   
2. 
   Catheters should be appropriate, comfortable, easy to insert and remove and must minimize secondary complications such as tissue inflammation, encrustation and colonisation by micro- organisms (See Attachment F)
   
3. 
   The smallest gauge catheter suitable for the patient needs should be used and balloons should generally be 5 to 10ml in size. Patients with a lesion above T6 should use a size 18 to 20Frg to avoid blockage and complications of autonomic dysreflexia.
   
4. 
   Community Nurses will identify patients with spinal lesions at or above T6 and monitor for autonomic dysreflexia during catheterisation. Where applicable first line emergency management should be provided to those patients. Care provided should be consistent with ‘Autonomic Dysreflexia SOP’
   
5. 
   All catheters become colonised with bacteria after a few days. If a catheter specimen of urine (CSU) is required this should only be obtained on change of the catheter not the bag.
   
6. 
   Community nurses will document the management of a patients ‘Urinary Catheter Management Chart’ clinical record form (form no.60535)
   
7. 
   Patients and/ or carers should be educated on how to care for their catheters and also be provided with the pamphlet ‘How to care for your urinary catheter’, which can be found on the Policy Register (see sample at Attachment C)
   
8. 
   Catheter flushing is a prescribed procedure using a small amount of fluid to maintain patency of a catheter
   
9. 
   Manual bladder irrigation or washout involves instilling large amounts of fluid into the bladder withdrawing fluids for the purpose of removing debris and mucus from the bladder. This procedure should be done under medical supervision and is not suitable to be done in the community.
   
10. 
    Patients with long - term catheter requirements are responsible for the provision of ongoing equipment (catheters, leg bags, overnight bags, catheter straps, catheter valves. Consider funding sources such as:
    

• 
  Continence Aids Scheme (CAPS)
  
• 
  ACT Equipment Subsidy Scheme (ACTES)
  
• 
  Rehabilitation Appliances Program (RAP) of Department of Veterans Affairs (DVA)
  

11. 
    If the patient is not eligible for any of these schemes, they may source equipment from supplies either locally or interstate (see Attachment E)
    
12. 
    Where possible, liaison should occur with the medical practitioner or management team who inserted the catheter if there are any concerns regarding catheter management in the community
    
13. 
    Where possible patients should be encouraged to access one of the Community Health Centres ambulatory clinics for their routine catheter change.
    
14. 
    Where difficulties are experienced or anticipated, contact the continence CNC or GP; if the matter is urgent call an ambulance.
    
15. 
    If a catheter requires permanent removal, medical orders should be obtained from the treating doctor and documented in client’s file (refer to Removal of Catheter) attached.
    

Alerts: Seek expert advice for patients with artificial heart values who grow Enterococcus species in the urine prior to the procedure Patients with spinal lesions at or above T6 require monitoring for Autonomic Dysreflexia: refer to ‘Autonomic Dysreflexia SOP’ for management pathway Do not clamp catheter prior to change The following conditions do not preclude catheterisation but extra care should be taken when: The Patient is taking high dose anticoagulants increasing the risk of haemorrhage. If there is a history of recent surgery, cancer or radiotherapy to the lower urinary tract, as there is increased risk of damage Consult with Medical officer or CNC if in doubt