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

4.4 Management of Supra Pubic Catheter: Community Based Patient

Alert: If the Supra pubic catheter becomes dislodged it should be replaced within 30 - 45 minutes to prevent the stoma closing over.

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  Following initial insertion, the tract will take 10 days to four weeks to become established. If the catheter becomes blocked or dislodged within this initial phase, expert medical advice should be sought as soon as possible. The patient should return to the treating hospital for management.
  
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  Prior to first change of a suprapubic catheter the ‘Medical Officer’s Orders for Urinary Catheter Management’ clinical record form (form no. 40950) must be completed and signed by the referring medical officer.
  
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  Community nurses may perform the first and subsequent suprapubic catheter changes, where the catheter is a balloon catheter (Foley) and NOT a Bonanno (Pigtail)
  
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  First change of suprapubic catheters can be performed in the ambulatory clinic or in the client’s own home unless otherwise documented by specialist or General Practitioner (GP)
  
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  The size of the catheter should be no smaller than 16Fg in adults with a 10ml balloon
  

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  Ensure patient has had adequate fluid intake prior to procedure
  
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  Catheters should not be clamped prior removal
  
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  Always endeavour to re-insert same size catheter where possible
  
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  If unable to re-insert a catheter, insert a nelaton catheter to keep stoma open and arrange prompt transport to treating hospital for catheter reinsertion
  
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  Urinary Catheters need to be changed at intervals that meet each client’s specific needs and comply with manufacturers’ recommendations (usually 6 to 12 weeks). Careful evaluation of each catheter change will enable the nurse to establish each patient’s individual catheter change routine. Use a ‘Urinary Catheter Management Chart’ to assist with this process
  
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  Stabilising the catheter to the abdomen as well as to the upper thigh with a securement device is vital to reduce adverse events such as dislodgement, tissue trauma, hyper-granulation, inflammation and infection
  
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  SPC stoma sites do not routinely require a dressing after the first 24 hours of initial insertion. If the site is discharging a temporary sterile gauze dressing should be applied
  
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  Ensure the patient is informed of the procedure should the catheter become dislodged and that contact numbers are in place for Community Nursing team leader, the LINK after hours service and the treating hospital
  
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  Where difficulties are experienced or anticipated seek medical assistance
  
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  Where a catheter is required to be removed permanently, medical orders should be obtained from the treating doctor and documented Inpatient’s file
  
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  Medical Officer’s Orders for Urinary Catheter Management should be reviewed every 3 years
  

Patients with spinal lesions above T6 require monitoring for Autonomic Dysreflexia (do not clamp catheter prior to change). The following conditions do not preclude catheterisation but extra care should be taken when:

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  The client is taking high dose anticoagulants as these increases the risk of haemorrhage.
  
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  There is a history of recent surgery, cancer or radiotherapy to the lower urinary tract.
  

Consult with medical officer if in doubt.
Equipment:

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  Sterile catheter pack
  
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  Urinary catheter to meet patient’s specific needs (size 16 or above)
  
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  Sterile Normal Saline (cleansing solution)
  
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  Sterile gloves
  
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  Non-sterile gloves
  
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  Water soluble lubricating gel. (Lignocaine 2% gel for patient with SCI and/ or bladder spasms)
  
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  10 ml syringe
  
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  Drainage equipment to meet patient’s specific needs
  
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  Safety goggles
  
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  Disposable Gown
  
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  Antimicrobial hand gel
  
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  Small sterile dry dressing may be required
  

Procedure:

1. 
   Read medical order, identify correct client for catheter removal and re-insertion, explain procedure and obtain consent from patient
   
2. 
   Position patient appropriately for their comfort, condition and delivery of care: clinic/home
   
3. 
   Don safety eyewear and gown.
   
4. 
   Deflate balloon, do not remove catheter (allow balloon to deflate without drawing back on syringe to prevent balloon distortion)
   
5. 
   Hand hygiene and don sterile gloves. Drape with sterile towel.
   
6. 
   Lubricate tip of catheter. (Lignocaine 2% gel for patient with SCI and/ or history of bladder spasms)
   
7. 
   Clean around catheter insitu with normal saline
   
8. 
   Place sterile fenestrated drape over area
   
9. 
   Grasp the catheter with non dominant hand under the drape and remove catheter from bladder.
   

Note: position, angle and length of the catheter from the stoma exit to the catheter hub

10. 
    Insert new catheter immediately using your dominant hand at the angle and length of catheter previously removed
    
11. 
    Advance the catheter into the tract a further 3 cm (not more) to prevent the catheter tip irritating the bladder wall and to ensure the catheter passes into the urethra. If no urine drains gently apply pressure over the symphysis pubis area
    
12. 
    Once urine drains, insert the catheter approximately 3 cm further to ensure the catheter is in the bladder and not the suprapubic tract
    
13. 
    Slowly inflate balloon with required volume of sterile water (according to manufacturer’s instructions), check patient for any ongoing discomfort or pain
    
14. 
    Withdraw the catheter slightly and attach sterile drainage bag
    
15. 
    Secure catheter to patient’s abdomen and the top of the thigh with securement device then secure the drainage bag to the leg with leg straps. Discard equipment and attend hand hygiene
    
16. 
    Document the procedure in the client’s clinical and on Urinary Catheter Management Form
    

Care of the Suprapubic Catheter:

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  See Suprapubic Trouble shooting guide (Attachment D)
  
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  The suprapubic catheter emerges at a right angle to the abdomen and needs to be supported in this position
  
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  It is not necessary to rotate the catheter at the insertion site between catheter changes
  
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  Observe the SPC site for signs of infection and/ or over granulation
  
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  Dressings should not be routinely used. If a dressing is required it must be sterile and applied using an aseptic technique
  
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  Hygiene is important and once healed the site should be washed with warm soapy water, preferably twice daily. Cleaning should be directed away from the insertion site
  
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  Talcum powder, creams and strongly perfumed soaps should be avoided.
  
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  Patients should be made aware of the importance of hand washing both before and after handling the catheter drainage system
  

Supply of catheter equipment:

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  The treating nurse will educate the client on how to access the necessary supplies. (See Urinary Drainage System Management for Community Based Patient)
  

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Section 5 – Catheterisation Intermittent in the adult Inpatient