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

Equipment:

• 
  Disposable catheter pack (contains extra gloves)
  

Community specific: sterile gloves x two

Inpatient specific: Betadine (check for Iodine allergy)

• 
  0.9% Sodium Chloride 60ml
  
• 
  10ml Lignocaine gel syringe
  
• 
  Latex (short-term) or Silicone (long-term) catheters x two, usually 14 or 16F Sterile urinary drainage bag
  
• 
  1 x 10ml syringe
  
• 
  Community specific: two x 10ml syringe
  
• 
  1 x 10mls Sterile Water for Injection
  
• 
  Securement devices
  

Inpatient specific: Foleys Statlock device

Community specific: Catheter Retention Strap

• 
  Inpatient specific: Measuring jug
  
• 
  Procedural under pads (one large & one small)
  
• 
  Clean gown
  

Community specific: non sterile gloves

• 
  Sterile gloves
  

Community specific: two x sterile gloves

• 
  Safety glasses or goggles
  
• 
  Sterile specimen jar, if required
  
• 
  Sterile catheter introducer, if required (to be used by Medical Officer only).
  

Alert: A catheter introducer for the introduction of a catheter for male catheterisation is only to be used by a medical officer
Procedure:

1. 
   Inpatient specific: The medical officer must document the order for catheter insertion and removal in clinical record
   

Community specific: Medical Officers Catheter Management

2. 
   Explain procedure to patient and ensure privacy
   
3. 
   Remove the protective cover from the tip of the catheter only. Lubricate, leaving the catheter cover in place
   
4. 
   Place the catheter in the dish
   
5. 
   Drape the genital area around the penis
   
6. 
   Don safety eyewear and gown
   
7. 
   Inpatient specific: Raise bed to appropriate height
   
8. 
   Wash hands and don sterile gloves x two
   
9. 
   Position fenestrated drape to provide sterile field
   
10. 
    Use non dominant hand to hold the penis. Where present retract the foreskin and swab head of the penis paying particular attention to the urethral meatus and glans
    
11. 
    Hold penis at a right angle (90 degree) to the body and gently instil Xylocaine lubricant into the urethra: Gentle pressure underneath the head of the penis will minimise lubricant leaking out. Allow sufficient time for anaesthetic to work (three to five minutes).
    

Note: Do not proceed if patient has an erection, wait until this subsides
After this time you may:

12. 
    Remove outer pair of sterile gloves if contaminated during the procedure
    
13. 
    Holding penis at 90 degree angle, gently insert and advance catheter to the Y hub.
    
14. 
    If resistance is felt at the bladder neck, lower the penis slightly and suggest that the patient breathe slowly whilst pretending to pass urine. The catheter should never be forced
    
15. 
    If resistance continues, withdraw catheter and insert more anaesthetic gel. Re-insert sterile catheter after a further three to five minutes. If further resistance is encountered, seek advice from CNC, Continence CNC or Medical Officer
    
16. 
    When urine begins to flow,(at least 15-20mls ) re-check the position of the catheter to ensure it is still in the bladder, then inflate balloon with required volume of sterile water (according to manufacturer’s instructions)
    

Alert: If resistance is felt at the external sphincter, slightly increase the traction on the penis and apply steady, gentle pressure on the catheter. Ask the patient to attempt to void in order to relax sphincter

17. 
    Attach sterile drainage bag
    
18. 
    Where present, replace foreskin to natural position
    
19. 
    Secure bag to patients requirements
    

Inpatient specific: Attach statlock to the leg to anchor urinary catheter bag (See Attachment A)

Community specific: Attach Catheter Retaining Strap

20. 
    Drain 600ml only then clamp for one hour
    
21. 
    Leave the patient comfortable
    
22. 
    Documentation:
    

Inpatient specific: Record the procedure in the patient's clinical record using the Urinary Catheter Label: (See Attachment B):

1. 
   Date and time of procedure
   
2. 
   Type and catheter size
   
3. 
   Amount of water in the balloon
   
4. 
   Indication and scheduled date for removal or change
   

16. 
    Community specific: Record the procedure using the ‘Urinary Catheter Management Chart’ clinical record form (form no.60535)
    

23. 
    Record output, clarity, colour and odour on the patient's FBC and clinical notes
    
24. 
    Perform urinalysis and document on General Observation Chart and clinical notes
    
25. 
    Inpatient specific: Record if a specimen is sent to pathology
    

Community specific: Contact GP if signs of infection present

26. 
    Observe for haematuria and diuresis in patients with chronic urinary retention.
    

Inpatient specific: Adjust the Patient Accountability and Care Plan to indicate IDC insitu and associated penile toilets required for hygiene needs

27. 
    Perform hand hygiene when leaving the patients environment as per the 5 moments of hand hygiene
    

Alert: Companies who manufacture latex catheters recommend that the catheter be changed every seven days. Silicone catheters as per manufacturers’ recommendations to be changed 6 to 12 weekly
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Section 4 – Suprapubic Catheter (SPC) Procedures for Inpatients and Community Based Patients