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

Section 8 – Indwelling Urinary Catheter Management: Inpatient and Community

Alert: In patients with an Indwelling Urinary Catheter, it is important to remove any obvious signs of encrustations from around the urethral meatus. To achieve this, the catheter must be washed gently with warm soapy water at the start of the procedure and during the patient’s daily wash/shower. Avoid back and forth movement of the catheter at the urethral meatus as this may cause unnecessary trauma or irritation and may increase the risk of infection or pressure injury. Observe for any signs of pressure areas or trauma at the urethral meatus. Document findings in appropriate patient records
The purpose of this section is to provide clinical care so as to:

• 
  Maintain a patent urinary drainage system
  
• 
  Prevent urinary tract infections
  
• 
  Promote patient comfort
  
• 
  Provide education for self management of urinary drainage systems
  

Perineal/ penile care: Inpatient specific procedure:

1. 
   Explain procedure to patient and ensure privacy
   
2. 
   Ensure catheter is securely anchored at all times (See Attachment A)
   
3. 
   Routine daily perineal/ penile care is performed Drainage bag must be kept below the patient’s waist to prevent reflux of urine back up the IDC
   
4. 
   Encourage a two to three litre fluid intake unless contraindicated
   
5. 
   Record output, clarity, colour and odour
   
6. 
   Perform and record urinalysis where indicated
   
7. 
   Observe for Haematuria
   
8. 
   Watch for Haematuria and diuresis in patients with chronic urinary retention
   
9. 
   Adjust the Patient Accountability and Care Plan to indicate IDC insitu and associated peri-toilets required for hygiene needs
   

8.1 Emptying a Urinary Drainage Bag: Inpatient specific

A closed urinary drainage system should be maintained. The catheter and tubing should not be disconnected unless absolutely necessary. This applies to:

• 
  Urinary Drainage Systems
  
• 
  Closed Drainage Systems
  
• 
  Catheter Valve Drainage Systems
  

During urinary drainage bag changes, strict aseptic technique is essential to prevent infection. Ensure that there are no dependent loops in the tubing, where possible, to prevent stasis of the urine in the tubing.

Urinary Drainage Bag Change: Inpatient specific:

• 
  To change a urinary drainage bag in order to maintain a patent urinary drainage system
  
• 
  To prevent contamination of the urinary drainage system
  
• 
  Promote patient comfort
  

Equipment:

• 
  Sterile urinary drainage bag
  
• 
  Alcohol swab
  
• 
  Clamp
  
• 
  Foleys Statlock device
  
• 
  Safety glasses or goggles
  
• 
  Clean gown and gloves
  

Procedure:

1. 
   Explain procedure to patient and ensure privacy is maintained
   
2. 
   Prepare equipment and the patient
   
3. 
   Don safety glasses
   
4. 
   Attend hand hygiene before touching patient by either hand washing or using ABHR
   
5. 
   Don gloves
   
6. 
   Ensure the drainage system is closed, clamp off all clamps
   
7. 
   Remove the protective cap from the drainage tube
   
8. 
   Clamp the catheter above the tubing connector, and clean the catheter tubing junction with an alcohol swab
   
9. 
   Disconnect the catheter from the old tubing, being careful not to contaminate the end of the catheter, and connect the catheter to the new tubing
   
10. 
    Unclamp the catheter, and establish drainage by securing the tube and drainage bag to the bed at the appropriate level
    
11. 
    Leave patient comfortable and dispose of equipment
    
12. 
    Remove gloves and perform hand hygiene after a procedure or body fluid exposure risk as per the five moments of hand hygiene
    
13. 
    Document the urinary bag change in the patient’s clinical record, FBC and Patient Accountability and Care Plan
    

8.2 Urinary Drainage Bag Management: Community Specific

Procedure:

Types:

• 
  Leg bags are available in a range of capacities: 350ml, 500ml, and 750mI.
  
• 
  Tubing on leg bags is available in different lengths, (5cm to 40cm) and can be tailored to individual patient's requirements (adjustments can be made with extension tubing and connecting pieces).
  

Management:

• 
  Urinary drainage bags should be positioned below the level of the bladder to prevent harmful reflux of urine.
  
• 
  Leg bags can be placed on the thigh or calf and secured to the leg using straps
  provided, to prevent urethral trauma and damage to the bladder wall.
  
• 
  Aseptic technique should be used when attaching urine drainage bags directly to the catheter.
  
• 
  Urinary drainage bags should be emptied when half to two thirds full.
  
• 
  Urinary drainage bags should be replaced as per manufacturer's recommendations; every seven days for regular bags or at the time of catheter change for long life leg bags
  

Closed Drainage System

Types:

• 
  Closed link system is used to facilitate overnight drainage and is appropriate for use with indwelling urethral and supra-pubic catheter drainage systems.
  
• 
  Closed drainage systems are available in drainage bags with a two litre capacity and drainage bottles with a four litre capacity.
  
• 
  Closed drainage systems are supplemented by the linking of a larger two litre capacity bag or urinary drainage bottle with a four litre capacity to the outlet of the sterile leg
  
• 
  The linked overnight drainage system need not be sterile but must be cleaned daily to minimise the bacterial growth and extend the life of the bag. Manufacturer's instructions for cleaning should be observed (outlined below)
  

Catheter Valve System

A catheter valve may be used in place of a urinary drainage bag, allowing bladder filling and intermittent drainage. Catheter valves are recommended as single use only items and should not be reused. Manufacturer's instruction regarding frequency of change should be observed. Bard catheter valves are changed weekly, Coloplast Simpla catheter valves are changed at the time of catheter change. For clients/ carers to use this system, they need to have:

• 
  The cognitive ability to learn strategies to prevent infection and/or urinary complications
  
• 
  An understanding of the principles associated with catheter management
  
• 
  The ability to independently manage their catheter care, or a carer who is willing to ensure safe management
  
• 
  The awareness of bladder sensation and recognition of bladder fullness, and manual dexterity to manipulate the outlet tap
  

Alert: Catheter valves are inappropriate for clients with detrusor instability, lack of bladder sensation or clients who are confused.

Instructions for patient/ carer regarding changing of drainage bags/valves:

• 
  Wash hands
  
• 
  Disconnect bag/valve from catheter
  
• 
  Connect new bag/valve to catheter - avoid touching clean/sterile connections
  
• 
  Wiping connection with alcohol wipe is not necessary
  

Instructions for patient/ carer regarding cleaning of overnight drainage:

• 
  Rinse with cold water to prevent agglutination of urinary proteins
  
• 
  Wash with warm soapy water (dishwashing liquid)
  
• 
  Rinse with clean water
  
• 
  Allow to drain and dry (by hooking bags onto a wire coat hanger from a bathroom rail)
  
• 
  Night drainage bottles may be left to dry in an upturned position on a clean towel
  
• 
  ‘Urosol’, a deodorant and detergent cleansing agent, may be used to dissolve urinary crystals. Vinegar or bicarbonate of soda may be used as a substitute
  
• 
  Use of bleach should be avoided as it may damage rubber and plastic