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

Attachments

Attachment A: Stat Lock – Foley Stabilisation Device

Attachment B: Insertion of Urinary Catheter Sticker

Attachment C: How to care for your Urinary Catheter

Attachment D: Troubleshooting guide for urinary catheters

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

Attachment F: Catheter selection

Disclaimer: This document has been developed by ACT Health, specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Date Amended	Section Amended	Approved By
Eg: 17 August 2014	Section 1	ED/CHHSPC Chair

Attachment A: Stat Lock – Foley Stabilisation Device

Attachment B: Insertion of Urinary Catheter Sticker

Sticker available on order through Corporate Express

ID 18838521

ACT Hth Ins of Urinary Cath Lbls Roll 500

Attachment C: How to care for your Urinary Catheter

Attachment D: Troubleshooting guide for urinary catheters

TROUBLESHOOTING GUIDE FOR URINARY CATHETERS
PROBLEM	POSSIBLE CAUSE	WHAT TO DO
CATHETER LEAKAGE (Bypassing)	Check Plumbing	Is the catheter or tubing kinking - check bag and/or valve connections, check line and connection of tubing. Use catheter securing device.
	Faecal Impaction / Constipation	Assess, alleviate and prevent by review of bowel management.
	Catheter too large	A urethral catheter that is greater than 18Fg may need to be gradually downsized. Women IDC: 12 -14Fg/10ml balloon Men IDC: 14- 16Fg /10ml balloon SPC: 16 -18
	Balloon too large	A 5-10ml balloon is advised. Authorisation from an Urologist is required for long-term use of a catheter with a 30 ml balloon, given it may contribute to bladder neck erosion.
	Catheter blockage	If a catheter is blocked and has been insitu for >2 weeks it may be replaced and documented on Urinary Catheter Management Chart. Determine the blocking agent and consult with Medical Officer re indications for antibiotic therapy or refer for a urological review.
	Bladder spasm	See BLADDER SPASM
BLADDER PAIN	Bladder spasm	Consider concentrated urine – increase fluids
	Bladder Distension	Assess and action as per NO URINE DRAINING
	Traction on Catheter	Secure with tape or strap
	Bladder infection - Symptomatic	See INFECTION
	Balloon too large or Catheter too large	5-10 ml balloon advised (as per manufacturer’s recommendations IDC – less than 18Fg advised
BLADDER SPASM (Cramps)	Traction on catheter with movement	Ensure catheter is not under tension. Recommend use of catheter strap.
	Faecal Impaction / Constipation	Alleviate and prevent. Review bowel management.
	Bladder infection	See INFECTION
	Overactive bladder	Discuss use of anticholinergic medication with Medical Officer. Consider use of topical oestrogen for urethritis in females
	New Catheter in situ	Spasms should settle within 24-48 hours, Reassure patient they should resolve.
BLEEDING	Trauma	Ensure catheter is not under tension, check securement devices. Some clients may experience a small amount of bleeding following SPC change.
	Infection	See INFECTION
	Persistent Haematuria	Urgent referral to medical officer / Urological consult
NO URINE DRAINING +/- urinary leakage	Kinked tubing	Check for correct lie and connection of tubing
	Low fluid intake	Recommend fluid intake of between 2-3 litres daily unless otherwise stated by Medical Officer.
	Faecal Impaction / Constipation	Assess, alleviate and prevent by review of bowel management.
	Drainage bag above bladder level	Lower bag, ensure bag is below bladder level to assist gravity.
	Catheter is blocked with mucous or debris	If a catheter is blocked and has been insitu for >2 weeks it may be changed. Catheter Flush: may be indicated if a client has a history of blocked catheter is prescribed by a medical practitioner and requires a treatment order is a short term management option only and the cause of the blockage should be investigated. A Urology review must be in place. (See Catheter Flushing SOP)
NO DRAINAGE OF URINE AFTER SEVERAL HOURS	Check as above.	Check for palpable bladder i.e. blocked catheter. Check the catheter position in the bladder by deflating the balloon and slightly rotate and push catheter in. Check for sediment and document characteristics. Replace catheter. If anuria is identified (urinary output of less than 100-250mls in 24 hours), immediately refer client to nearest local hospital emergency department.
INFECTION		Review catheter management; ensure closed link system is being maintained. Clients with symptomatic catheter related infection should be treated as per local prescribing procedure or the latest version of the Therapeutic Guidelines: Antibiotic if not available Concerns regarding persistent infective symptoms should be referred to a Medical Officer.
PAIN AND DISCOMFORT AROUND THE CATHETER, BLEEDING, ITCHING AND SORENESS	Bladder and/or urethral irritation	Alleviate urethral traction trauma and potential for pressure necrosis; secure catheter with catheter retaining strap. Liaise with Medical Officer. See INFECTION Discuss with medical officer possible use of topical oestrogen for urethritis (in post-menopausal women) with Medical Officer.
	Allergy to catheter material	Change catheter type
	Hyper granulation of supra pubic site due to pulling or tension.	Prevent catheter traction and alternate the side the catheter is taped to on a weekly basis. Keep stoma clean and dry. Silver nitrate treatment may be required (See Wound Care Manual).
	Infection of stoma	Arrange for wound swab, treat as required (See Wound Care Manual)
CATHETER FALLS OUT	Catheter balloon deflates prematurely Balloon faulty Balloon intact	Insert new catheter. Nelaton catheter to keep site open until Foleys available Check balloon of dislodged catheter for faults. Anchor inadequate, or trauma at transfer
URINE IS CLOUDY, OFFENSIVE SMELLING	Infection	See INFECTION
	Low fluid intake	Recommend fluid intake: 2-3 litres daily unless otherwise stated by Medical Officer.
Difficult removal	Ridging of deflated balloon or hysteresis’	Allow balloon to spontaneous deflate Select appropriate catheter materials: all- silicone catheters have a tendency to cuff, consider all-silicone catheter with integrated balloon (Releen In-Line Foley catheter or hydrogel coated catheter (Bard Biocath). Consider latex allergy status of clients. Where cuffing is suspected, consider instilling 1ml of sterile water back into the balloon (after complete deflation). Consider the use of anaesthetic gel prior to the removal of the catheter.
Difficult removal	Bladder Spasm Anxiety	Apply lubricate to stoma site. A fair degree of pull may be required, holding the catheter close to stoma, apply consistent firm pressure whilst supporting the abdomen with the non-dominant hand until the catheter releases. Encourage relaxation, allay anxiety
UNABLE TO INSERT SPC	Spasm of tract/bladder	Apply anaesthetic gel (Lignocaine 2%) to stoma site. Place catheter in stoma, apply firm constant pressure to catheter whilst waiting release of spasm. Insert Nelaton intermittent catheter to maintain tract, then remove and quickly insert usual catheter, or try smaller size Foley catheter. Report to medical practitioner, antispasmodic/muscle relaxant therapy may be required. Where unsuccessful, send patient to hospital within 30 to 45 minutes for management.
	Not following tract	Re-attempt at correct angle. Always observe the angle of tract during catheter removal.
NO DRAINAGE AFTER CATHETER INSERTION	Catheter /balloon not in bladder	Advance catheter a little further. Once in the bladder SPC should not be advanced more than 10 cm in total. Check/consider the tip of catheter is not located in the urethra.
No urine in bladder	Dehydration	Give extra fluids. Ensure drainage before inflating balloon. Advise increased fluids prior to planned catheterisation.

TROUBLESHOOTING GUIDE FOR URINARY CATHETERS
PROBLEM	POSSIBLE CAUSE	WHAT TO DO
CATHETER LEAKAGE (Bypassing)	Check Plumbing	Is the catheter or tubing kinking - check bag and/or valve connections, check line and connection of tubing. Use catheter securing device.
	Faecal Impaction / Constipation	Assess, alleviate and prevent by review of bowel management.
	Catheter too large	A urethral catheter that is greater than 18Fg may need to be gradually downsized. Women IDC: 12 -14Fg/10ml balloon Men IDC: 14- 16Fg /10ml balloon SPC: 16 -18
	Balloon too large	A 5-10ml balloon is advised. Authorisation from an Urologist is required for long-term use of a catheter with a 30 ml balloon, given it may contribute to bladder neck erosion.
	Catheter blockage	If a catheter is blocked and has been insitu for >2 weeks it may be replaced and documented on Urinary Catheter Management Chart. Determine the blocking agent and consult with Medical Officer re indications for antibiotic therapy or refer for a urological review.
	Bladder spasm	See BLADDER SPASM
BLADDER PAIN	Bladder spasm	Consider concentrated urine – increase fluids
	Bladder Distension	Assess and action as per NO URINE DRAINING
	Traction on Catheter	Secure with tape or strap
	Bladder infection - Symptomatic	See INFECTION
	Balloon too large or Catheter too large	5-10 ml balloon advised (as per manufacturer’s recommendations IDC – less than 18Fg advised
BLADDER SPASM (Cramps)	Traction on catheter with movement	Ensure catheter is not under tension. Recommend use of catheter strap.
	Faecal Impaction / Constipation	Alleviate and prevent. Review bowel management.
	Bladder infection	See INFECTION
	Overactive bladder	Discuss use of anticholinergic medication with Medical Officer. Consider use of topical oestrogen for urethritis in females
	New Catheter in situ	Spasms should settle within 24-48 hours, Reassure patient they should resolve.
BLEEDING	Trauma	Ensure catheter is not under tension, check securement devices. Some clients may experience a small amount of bleeding following SPC change.
	Infection	See INFECTION
	Persistent Haematuria	Urgent referral to medical officer / Urological consult
NO URINE DRAINING +/- urinary leakage	Kinked tubing	Check for correct lie and connection of tubing
	Low fluid intake	Recommend fluid intake of between 2-3 litres daily unless otherwise stated by Medical Officer.
	Faecal Impaction / Constipation	Assess, alleviate and prevent by review of bowel management.
	Drainage bag above bladder level	Lower bag, ensure bag is below bladder level to assist gravity.
	Catheter is blocked with mucous or debris	If a catheter is blocked and has been insitu for >2 weeks it may be changed. Determine the blocking agent and consult with Medical Officer re indications for antibiotic therapy or a urological review. Catheter Flush: may be indicated if a client has a history of blocked catheter is prescribed by a medical practitioner and requires a treatment order is a short term management option only and the cause of the blockage should be investigated. A Urology review must be in place. (See Catheter Flushing SOP)
NO DRAINAGE OF URINE AFTER SEVERAL HOURS	Check as above.	Check for palpable bladder i.e. blocked catheter. Check the catheter position in the bladder by deflating the balloon and slightly rotate and push catheter in. Check for sediment and document characteristics. Replace catheter. If anuria is identified (urinary output of less than 100-250mls in 24 hours), immediately refer client to nearest local hospital emergency department.
INFECTION		Review catheter management; ensure closed link system is being maintained. Clients with symptomatic catheter related infection should be treated as per local prescribing procedure or the latest version of the Therapeutic Guidelines: Antibiotic if not available Concerns regarding persistent infective symptoms should be referred to a Medical Officer.
PAIN AND DISCOMFORT AROUND THE CATHETER, BLEEDING, ITCHING AND SORENESS	Bladder and/or urethral irritation	Alleviate urethral traction trauma and potential for pressure necrosis; secure catheter with catheter retaining strap. Liaise with Medical Officer. See INFECTION Discuss with medical officer possible use of topical oestrogen for urethritis (in post-menopausal women) with Medical Officer.
	Allergy to catheter material	Change catheter type
	Hyper granulation of supra pubic site due to pulling or tension.	Prevent catheter traction and alternate the side the catheter is taped to on a weekly basis. Keep stoma clean and dry. Silver nitrate treatment may be required (See Wound Care Manual).
	Infection of stoma	Arrange for wound swab, treat as required (See Wound Care Manual)
CATHETER FALLS OUT	Catheter balloon deflates prematurely Balloon faulty Balloon intact	Insert new catheter. Nelaton catheter to keep site open until Foleys available Check balloon of dislodged catheter for faults. Anchor inadequate, or trauma at transfer
URINE IS CLOUDY, OFFENSIVE SMELLING	Infection	See INFECTION
	Low fluid intake	Recommend fluid intake: 2-3 litres daily unless otherwise stated by Medical Officer.
Difficult removal	Ridging of deflated balloon or hysteresis’	Allow balloon to spontaneous deflate Select appropriate catheter materials: all- silicone catheters have a tendency to cuff, consider all-silicone catheter with integrated balloon (Releen In-Line Foley catheter or hydrogel coated catheter (Bard Biocath). Consider latex allergy status of clients. Where cuffing is suspected, consider instilling 1ml of sterile water back into the balloon (after complete deflation). Consider the use of anaesthetic gel prior to the removal of the catheter.
Difficult removal	Bladder Spasm Anxiety	Apply lubricate to stoma site. A fair degree of pull may be required, holding the catheter close to stoma, apply consistent firm pressure whilst supporting the abdomen with the non-dominant hand until the catheter releases. Encourage relaxation, allay anxiety
UNABLE TO INSERT SPC	Spasm of tract/bladder	Apply anaesthetic gel (Lignocaine 2%) to stoma site. Place catheter in stoma, apply firm constant pressure to catheter whilst waiting release of spasm. Insert Nelaton intermittent catheter to maintain tract, then remove and quickly insert usual catheter, or try smaller size Foley catheter. Report to medical practitioner, antispasmodic/muscle relaxant therapy may be required. Where unsuccessful, send patient to hospital within 30 to 45 minutes for management.
	Not following tract	Re-attempt at correct angle. Always observe the angle of tract during catheter removal.
NO DRAINAGE AFTER CATHETER INSERTION	Catheter /balloon not in bladder	Advance catheter a little further. Once in the bladder SPC should not be advanced more than 10 cm in total. Check/consider the tip of catheter is not located in the urethra.
No urine in bladder	Dehydration	Give extra fluids. Ensure drainage before inflating balloon. Advise increased fluids prior to planned catheterisation.

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

Continence Aids Payment Scheme (eligibility criteria applies)

ACTES ACT Equipment Scheme If client is eligible for CAPS and has used their allowance they may be eligible for assistance

G.P. MEDICAL 30 Colbee Court, Phillip, 2606 ACT Ph. 6282 0059

INDEPENDENT LIVING CENTRE 24 Parkinson St. Weston, 2600, ACT Ph. 6205 1900 Fax [phone] Provides information and advice about products.

INDEPENDENCE SOLUTIONS 6 Holker St. Newington, NSW, 2127 Customer service number: 1300 788 855 Fax: [phone]

BRIGHT SKY ( proceeds support ParaQuad NSW programs) 6 Holker St (corner of Avenue of Africa) Newington NSW 2127 Phone [phone] Fax [phone] Email: [e-mail] Webstore: www.brightsky.com.au

LOCAL PHARMACIES may order relevant equipment for clients

MOBILITY MATTERS PTY LTD 33-35 Townsville St. Fyshwick Ph. 6239 1381

Attachment F: Catheter selection

Catheter Materials	Recommended Usage	Advantages	Disadvantages
Polyvinyl Chloride (PVC) PVC non balloon	Short term use only, maximum 7 days Intermittent catheterisation	Large internal diameter allows good drainage postoperatively	Uncomfortable for long-term use Rigid and inflexible
Polytetrafluoroethylene (PTFE) or Teflon coated with latex core	Short term, up to 28 days	Smoother on external surfaces for insertion – reduces tissue damage More resistant to encrustation	If left in situ for too long Teflon coating may wear thin Unsuitable for clients allergic to latex
Silver-alloy coated	Catheter expected to be in situ for up to 14 days	Protective against bacteriuria when used for 5days	Not so effective at 14 days - not proven for long term effectiveness
Silicone All silicone BARD All silicone CLINY	Long term up to 12 weeks	Wide lumen for drainage. Suitable for clients with latex allergy	‘Cuffing’ of balloon can occur on deflation and can be more difficult to remove suprapubically
Releen 100% Silicone	Long term up to 12 weeks	Reduced urethritis/inflammation of urethra. Wide lumen – reduced encrustation. Integrated balloon – less ridging
Hydrogel coated latex Biocath® Foley Catheter	Long term use up to 12 weeks	More compatible with body tissue, less trauma. May resist colonisation of bacteria and reduce infection	Does contain latex – unsuitable for clients allergic to latex
Silicone elastomer-coated latex (silicone bonding to outer and inner surfaces)	Long term use up to 12 weeks	May help to reduce potential for encrustation	Unsuitable for clients allergic to latex
Hydrogel coated silicone Lubri-sil™ (BARD)	Long term use up to 12 weeks	Suitable for clients with latex allergy	Rigid; may be uncomfortable for clients

Doc Number

Version

Issued

Review Date

Area Responsible

Page

CHHS16/008

1

01/02/2016

01/02/2021

SOH

of

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register