5.1.5 Urinary Catheter Management

Urinary Catheter Management

5.1.5

Version 6.1 March 2024

5.1.5 Urinary Catheter Management (Indwelling Urinary Catheter, In-out Catheter, Suprapubic Catheter) Contents Preamble ............................................................................................................................. 3 Normal Bladder Function.................................................................................................. 3 Urinary Catheters ............................................................................................................. 3 Types of Catheters ........................................................................................................... 4 Plan Development ............................................................................................................ 5 Policies and Procedures................................................................................................... 5 Support Worker Training .................................................................................................. 5 Procedure ............................................................................................................................ 7 Urinary Catheter ............................................................................................................... 7 Urine Bags ....................................................................................................................... 7 Potential Problems ........................................................................................................... 8 Summary ............................................................................................................................. 8 Supporting Documents ........................................................................................................ 9 Policies ............................................................................................................................. 9 Forms ............................................................................................................................... 9 Information Sheets ........................................................................................................... 9 NGO Training ................................................................................................................... 9 Legislation ........................................................................................................................ 9 NDIS Practice Standards and Quality Indicators ............................................................... 10 5.1 High Intensity Daily Personal Activities ........................................................................ 10 5.1.5 Urinary Catheter Management .............................................................................. 10 Human Services Quality Standards ................................................................................... 11 3 Responding to Individual Need ................................................................................... 11 6 Human Resources....................................................................................................... 11 Delegation of Authority....................................................................................................... 11 Version Details ................................................................................................................... 12

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Preamble BigDog Support Services Pty Ltd (BigDog) ensures that each client with a catheter receives appropriate catheter management relevant and proportionate to their individual needs.

Normal Bladder Function Being able, voluntarily, to pass urine in a socially acceptable place. The kidneys produce urine, which passes down two small tubes called ureters into the bladder where it collects.

As the bladder fills up, an urge to pass urine is felt. The bladder muscle contracts and then urine is passed from the bladder via the urethra (the channel from the bladder) to the outside of the body.

Urinary Catheters A catheter is a narrow, hollow, flexible tube introduced into the urinary tract and bladder to drain urine. It is held in place by a small balloon at the catheter tip inside the bladder. The balloon is inflated with a few millimetres of water. As urine fills the bladder, it drains down the catheter into the bag. You do not need to pass water while you have a catheter in place.

A health care provider may recommend that the use a catheter if a client has: Blocked flow of urine as a result of bladder stones, blood clots in the urine, or a narrowing of the urethra.

Urinary incontinence (leaking urine or being unable to control when they urinate).

Urinary retention (being unable to empty their bladder when they need to).

Surgery on the prostate or genitals.

Other medical conditions such as multiple sclerosis, spinal cord injury, or dementia.

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Types of Catheters Catheters come in many sizes, materials and types.

Indwelling Urinary Catheter This is one that is left in the bladder. An indwelling catheter collects urine by attaching to a drainage bag. The bag has a valve that can be opened to allow urine to flow out. Some of these bags can be secured to your leg. This allows the client to wear the bag under their clothes. An indwelling catheter may be inserted into the bladder in 2 ways: Most often, the catheter is inserted through the urethra. This is the tube that carries urine from the bladder to the outside of the body Sometimes, it is inserted into a bladder through a small hole in the belly. This is done at a hospital or provider's office.

An indwelling catheter has a small balloon inflated on the end of it. This prevents the catheter from sliding out of your body. When the catheter needs to be removed, the balloon is deflated.

In-Out Catheter One method of emptying the bladder is by doing what is called an intermittent catheterization (IC). An IC is also known as an "in and out" catheterization. This means that the catheter is inserted and left in only long enough to empty the bladder and then is removed. ICs are usually done every 4 or 6 hours depending on the person's emptying needs.

Suprapubic Catheter A trained Urologist will insert this type of catheter into the bladder through a tiny hole in the abdomen. The catheter is changed every 6 to 12 weeks or as required.

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Plan Development Each client is involved in the assessment and development of the plan for the management of their catheter. With their consent, the client's health status is subject to regular and timely review by an appropriately qualified health practitioner.

Health practitioners may include; a Registered Nurse, Dietitian, Speech Pathologist, Pharmacist, Medical Specialist, General Practitioner and Stomal therapist deemed competent by training.

The catheter plan identifies how risks, incidents and emergencies will be managed, including required actions and escalation to ensure client wellbeing.

The catheter management plan must also include an Action Plan to address any incident or emergency in relation to the catheter e.g. blockage, dislodgement, leak or infection. The Action Plan must also identify a clear path for the escalation of any incident or emergency in a timely manner.

This catheter management plan will continue to be overseen by a health professional. The regularity of plan reviews is at the discretion of the health professional and will be supported

by BigDog. Any changes in client’s needs, including any incidents or emergencies, will require a plan review.

Policies and Procedures Appropriate policies and procedures are in place, including a training plan for workers, that relate to the support provided to each client with a catheter.

The requirements of this role will be clearly documented in a catheter management plan that has been developed and is overseen by an external health practitioner.

Both the training plan and the management support plan will include the identification of risks including actions and escalations.

Support Worker Training All workers have completed training, relating specifically to each client’s needs, type of catheter and high intensity support skills descriptor for catheter changing and management, delivered by an appropriately qualified health practitioner or a person that meets the high intensity support skills descriptor for urinary catheter changing and management.

Urinary Catheter Management Part 1 Within this course, you will gain an understanding of your obligations when delivering urinary catheter support. You will learn what urinary catheter care is and why people need it. We will discuss what a urinary catheter care plan is and what the requirements are. Lastly, we will explore your role and responsibilities as a disability support professional delivering urinary catheter care to participants.

After this lesson workers will be able to: 1. Explain what urinary catheter care is and the circumstances in which someone would require it.

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2. Have a deeper understanding of urinary anatomy and how to identify healthy and unhealthy systems.

3. Explain what a catheter care plan is and the requirements for creating and managing one.

4. Explain their role and responsibilities as a worker when delivering catheter care support Course duration: 28 minutes Urinary Catheter Management Part 1 Within this course, a worker will further develop their understanding and obligations when delivering urinary catheter care support. They will learn how to safely and effectively support a client with urinary catheter care needs. The range of problems a person with urinary catheter care needs may experience and how to resolve them will be discussed. And lastly, we will identify the sign that constitutes an emergency situation and the process that needs to be followed.

After this lesson, a worker will be able to: 1. Explain the requirements for safely and effectively delivering urinary catheter support to a client.

2. Identify and explain the problems that a client with a catheter care plan may encounter and how to resolve each issue.

3. Identify and explain an emergency situation, including the process to follow to ensure swift and safe care for a client once an emergency has been declared.

Course duration: 33 minutes BigDog will ensure that the worker has the relevant knowledge and has received client specific training in order to safely support the client in the community.

All client specific training will be delivered by an appropriately qualified Registered Training Organisation (RTO).

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Procedure Urinary Catheter

Urine Bags There are two types of bags provided to the client, the leg bag and the night bag.

The leg bag is a sterile bag and should always stay connected unless being changed (weekly). The leg bag is worn under the usual clothing and is usually attached to the leg above the knee with a pair of straps. It should be strapped securely to prevent the bag trailing or dragging on the catheter. It needs to be emptied into the toilet when it is just over 1/2 full or every two hours. Do not let the leg bag become more than 3/4 full.

The night bag is attached directly on to the leg bag for use overnight. It holds more urine so the client doesn’t have to get up and empty it at night.

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Potential Problems Bladder cramps These are not uncommon, particularly when the catheter is first inserted. These will generally settle within a couple of days. Try taking some simple analgesia. If they do not settle or if they accompany any of the following symptoms, contact the continence nurse or local doctor.

Discoloured or strong-smelling urine Dark strong-smelling urine usually means that the client is not drinking enough. Drink at least two litres of water per day.

Urinary tract infections Signs of an infection include: cloudy, bloody or smelly urine feeling unwell, fevers, chills or shaking bladder, pelvic, lower back or flank pain.

If any of these symptoms occur, arrange an appointment to see the doctor as soon as possible.

No drainage from catheter Troubleshooting: Is the tubing bent or kinked?

Is the bag below the bladder level?

Is there sediment in the tubing which is blocking the catheter?

Has the client been drinking enough?

Try moving around, this may dislodge the blockage If no urine has passed in four hours, contact the doctor.

Leaking around the catheter This is not serious, but if it persists, report it to the continence nurse or local doctor.

If the catheter falls out contact the continence nurse or local doctor immediately so that a replacement catheter can be inserted. Take the spare catheter. If unsuccessful, go to the nearest hospital.

Summary When a client has a catheter inserted, personal hygiene becomes extremely important. The most common problem when using a catheter is urinary tract infection due to bacteria entering the bladder via the catheter.

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Supporting Documents Policies 1.1 Person-Centred Supports 1.3 Privacy and Dignity 2.3 Quality Management 3.4 Responsive Support 5.0 High Intensity Daily Personal Activities

Forms NGO Course Report NGO User Report Training Attendance Sheet

Information Sheets Catheter Leg Bag Female Urinary System Healthy Bladder Home management of your catheter – Queensland Health Male Urinary System Urinary Catheter Management Fact Booklet

NGO Training Urinary Catheter Care Part 1 Urinary Catheter Care Part 2

Legislation Disability Services and Inclusion Act 2023 (Cwth) Health Act 1937 (QLD) National Disability Insurance Scheme Act 2013 NDIS Quality and Safeguards Commission 2020, NDIS Practice Standards: NDIS Practice Standards and Quality Indicators viewed 11th June 2020.

Queensland Guardianship and Administration Act 2000 (QLD) Queensland Human Rights Act 2019 (QLD)

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NDIS Practice Standards and Quality Indicators BigDog Support Services Pty Ltd (BigDog) is a registered NDIS provider and is required to apply the scheme’s practice standard and quality indicators.

The standards have been developed to create an important benchmark to assess provider performance and ensure that high quality and safe supports and services are provided to NDIS participants.

The four core modules are: 1.0 Rights and Responsibilities; 2.0 Governance and Operational Management; 3.0 The Provision of Supports; and 4.0 The Support Provision Environment.

The supplementary modules cover: 5.0 Specialist Support 5.1 High intensity daily personal activities 5.2 Implementing behaviour support plans.

5.1 High Intensity Daily Personal Activities These NDIS Practice Standards set out the responsibilities of BigDog when providing supports and services to clients that require the following.

5.1.1 Complex Bowel Care 5.1.2 PEG Feeding and Management 5.1.3 Severe Dysphagia Management 5.1.4 Tracheostomy Management 5.1.5 Urinary Catheter Management 5.1.6 Ventilator Management 5.1.7 Subcutaneous Injections 5.1.8 Complex Wound Management

5.1.5 Urinary Catheter Management In-dwelling Urinary Catheter, In-out Catheter, Suprapubic Catheter

Each participant with a catheter receives appropriate catheter management relevant and proportionate to their individual needs.

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Human Services Quality Standards The Standards set a benchmark for the quality of service provision. Each Standard is supported by a set of performance indicators which outline what BigDog is required to demonstrate to meet that standard.

3 Responding to Individual Need The assessed needs of the individual are being appropriately addressed and responded to within resource capacity.

3.3 BigDog ensures that services to the individual/s are delivered, monitored, reviewed and reassessed in a timely manner.

6 Human Resources Effective human resource management systems, including recruitment, induction and supervisory processes, result in quality service provision.

6.3 BigDog provides people working in BigDog with induction, training and development opportunities relevant to their roles.

Delegation of Authority Name

Position

Details

Steven Paull

Director

Authorise review and implementation

Courtney Carroll

Director

Authorise review and implementation

David Burrett

Operations Manager

Ensure information dissemination

Monique Paull

HR Manager Lawyer

Ensure compliance by employees

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Version Details This policy will be reviewed every twelve (12) months unless circumstances deem it necessary to review earlier. The review process will involve an analysis of the usefulness of the policy and to note any changes which are required to improve the policy.

If minor changes are made in wording or to clarify the intent, the version number will indicate this by adding a ‘point’ i.e. Version 1.0 indicates the original version and 1.1 with the first round of minor changes made. A significant change or intent of the policy will be indicated by a whole new number i.e. Version 2.0.

The following rules also apply in interpreting this policy: • Headings are for convenience only and do not affect interpretation.

• A singular word includes the plural and vice versa.

• A word that suggests one gender includes the other genders.

Date

V

June 2020

5.0 New Policy

January 2021

5.1 Updated Responsible Officers details Introduction of NGO Training Portal and modules

January 2022

5.2 Updated Responsible Offices details and NDIS (Provider Registration and Practice Standards) Amendment Rules 2021

January 2023

6.0 Included Human Services Quality Framework (HSQF) and Child Protection Act and the term “Participant” is returned to “Client” to allow for policies to cover NDIS and HSQF.

March 2024

6.1 Disability Services Act 1986 replaced with Disability Services and Inclusion Act 2023 and policy review process included.

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