Surely, not another article on catheterisation?
Frank Booth, RGN
Urinary catheterisation is as old as the hills, affects thousands of people a year and costs millions of pounds. And yet patients continue to suffer catheter associated urinary infections (CAUTI) or experience discomfort during the procedure or while the catheter is in situ. Add to this the fact that primary care workloads never get lighter, and it would seem obvious that this most basic of all procedures should be simple. So, refreshing one’s knowledge base can only help.
10-Points to consider
There are ten points to consider before undertaking catheterisation. This article pertains to in-dwelling urinary catheterisation, but some of the points are pertinent to other methods such as intermittent or supra-pubic catherisation. Use this as a briefing profile, an aide-memoir or teaching aid, and simply fill in any blanks as they relate to your Trust. All Trusts are different; each has a slightly different angle according to perceived priority. However, using local guidelines in conjunction with national guidelines, such as those provided by the Royal College of Nursing or the Association for Continence Advice [1,2] will facilitate safe and effective care.
1. Golden Rule - Catheterisation is an invasive procedure, therefore valid and timely consent must be given. Check your local policy.
2. Patient gender - Given the anatomical differences between males and females and the availability of catheters in varying sizes (female length [20-26cm], standard length [40-45cm] and paediatric [30-31cm]), it is surprising that mistakes are made; female catheters have been used on male patients . Therefore, ensure that you are using the correct length for your patient. Practitioners must also ensure that all lengths are available in stock . Foley catheters are the most commonly used, and the points to consider relate to their use.
3. Charrière size - Charrière size (Ch) size, previously French Gauge, refers to the width or bore of the catheter; adult sizes range from 10Ch to 16Ch, and are rarely smaller or larger (unless specialist).
4. Balloon size - Foley catheters have a balloon securing device to stop it falling out; if there is no balloon, it’s not a Foley catheter. The infill volume for both male and female catheters is 10 millilitres of sterile water (nothing else!).
5. Reasons for catheterisation - Unfortunately, catheterisation is often undertaken inappropriately [4,5], perhaps as the easy option, or where time to provide continence training is limited. Briefly, the indications for catheterisation are :
- acute or chronic urine retention
- hypotonic bladder
- pre and post abdominal/pelvic surgery
- measurement of urine output
- to obtain an uncontaminated specimen
- urodynamic or x-ray investigations
- bladder irrigation
- instillation of chemotherapy
- Management of intractable incontinence - only when all other methods have been tried
6. Planned length of catheterisation - The length of time the catheter is left in situ depends upon the clinical indication and patient condition, but a rule of thumb is:
- short term up to 7 (seven) days
- medium term up to 28 days
- long term up to 12 weeks
7. Catheter coating/silver coating - Choice of coating may depend upon the length of time the catheter will be in situ.
- short term: plastic or more commonly, latex rubber (NB: a plastic catheter has a latex balloon)
- medium term: often made from latex with a specialist coating of Teflon. Relatively soft and pliable but be aware that the undercoat of the product is latex
- long term: often made from silicone/elastomer; there is no latex in ‘pure silicone’ but most silicone/elastomer units are latex based. The coating is harder, and is thought to be more resistant to biofilms
- silver-coated: There is some evidence that this prevents catheter associated urinary tract infections, but other evidence suggests that it is expensive in use and does little to prove a reduction in infection risks or cures
8. Anaesthetic gels - Catheterisation is painful; Lignocaine gel (or similar) is both an anaesthetic and a lubricant. Products that also contain Chlorhexidine (an antiseptic) can be used, but are not essential in terms of anaesthesia. Leave the gel in place 3 – 5 minutes as per manufacturer’s instructions.
9. Maintenance solutions - Some years ago such solutions were used routinely, albeit without a sound evidence-base. However, act in accordance with organisation guidelines and clinical judgement.
10. Catheter bag
- daytime/leg bags - fit below the knee and have a 500ml capacity (350ml [short tube for above knee] and 750ml sizes available for specific indications). They are left in situ for 5 – 7 days, draining as necessary. Writing the date on the bag can remind people when to change it.
- night-time bags – used generally as an extension to the day bag; it has a two litre capacity, but is non-drainable.
- 2 Litre bag for use with a tap – generally used for bed or chair bound where simple managed capacity is needed. It starts its life as sterile, is a single use product and like its brother the leg bag, can last for up to 7 days
Catheter insertion, changes and care should be documented
Follow-up training and on-going support of patients and carers should be available for the duration of long-term catheterisation
...patients continue to suffer catheter associated urinary infections (CAUTI) or experience discomfort during the procedure or while the catheter is in situ.