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Infection Prevention and Control

Insertion of a Male Urethral Catheter

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Infection Prevention and Control Inser&on of a Male Urethral Catheter Purpose To ensure all relevant staff are aware of the principles of insertion of a male urethral catheter and understand the rationale that informs the principle, to prevent cross infection between service users, staff and visitors and prevent Health Care Associated Infections.

Target Group This procedure is relevant to healthcare or care staff that have received specific training in the insertion of male urethral catheters.

Introduction Urinary tract infection (UTI) is the most common infection acquired as a result of health care, accounting for 19% of Health Care Associated Infections, with between 43% and 56% of UTI’s associated with a urethral catheter.

This guidance has been formulated to give healthcare and care staff a step by step approach to the insertion of a urethral catheter with a rationale for each stage, based on the current national research and guidance.

This guidance should be used in conjunction with other associated infection prevention and control policies and procedures such as Hand Hygiene, Waste Management, Use of Personal Protective Equipment (PPE), Aseptic Non-Touch Technique (ANTT) Only appropriately trained and competent healthcare or care staff should carry out male urethral catheterisation using an aseptic non touch technique

Equipment • • • • • • • • • • • • • •

2 pairs of sterile single use gloves Hand sanitiser Disposable plastic apron Alcohol wipes or hard surface disinfectant wipes 10mls sterile water for catheter balloon Sterile syringe and needle or sterile filler Sterile dressing/catheterisation pack containing sterile receiver Sodium Chloride 0.9% Single use sterile lubricant/anaesthetic gel Catheter of appropriate size/length and type of material Appropriate drainage bag Leg bag straps or means of holding catheter Urine specimen container for specimen if required Clinical waste bag

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Infection Prevention and Control Inser&on of a Male Urethral Catheter Action

Rationale

Explain and discuss the procedure with the service user verbally and obtain consent

To ensure that the service user understands the procedure • Check service users identity • Check any allergies • Check valid consent

Assist the service user to get into the To enable genital area to be viewed and accessible supine posi0on with legs extended

Maintain service user’s privacy with covers at this stage and ensure service users comfort

To maintain dignity and comfort while equipment preparation takes place.

Ensure that visibility is adequate using additional light sources if required

To ensure that the genital area is visible

Perform effective hand hygiene by washing hands with soap and water or using alcohol gel if hands are visible clean

To reduce the risk of infection

Put on a disposable plastic apron

To reduce the risk of cross contamination through contact with healthcare staffs’ clothing

Prepare equipment and ensure packaging is intact and products are within the expiry date

To ensure equipment is single use, sterile and within the expiry date

Using alcohol wipes or similar, clean To facilitate optimum clean working and prepare a dressing trolley / dressing conditions and minimise the risk of tray or prepare a clean working surface contamination

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Infection Prevention and Control Inser&on of a Male Urethral Catheter Clean neck of ampoule with Sodium Chloride prior to drawing up sterile water

To reduce cross infection

Using an aseptic technique, open supplementary packs

To reduce cross infection

Remove privacy covers maintaining service user’s privacy and position disposable pad under service user’s buttocks/thigh area

To provide access to the area;

Perform effective hand hygiene by washing hands with soap and water or using alcohol gel if hands are visibly clean

To reduce the risk of infection, hands may have been contaminated by handling outer packaging

Put on 1st pair of sterile single use gloves

To reduce cross infection

Place sterile towel from pack under service users buttocks

To create a sterile working area

Take the sterile towel, place across the service user’s thighs

To provide a sterile working area

To ensure bodily fluids do not leak onto service users bed clothes

Wrap a sterile swab around the penis, To reduce the risk of cross-infection and below the glans penis, retract the the introduction of skin flora into the foreskin if necessary and clean the glans urethra and bladder; penis with 0.9% sodium chloride Inadequate preparation of the urethral orifice is a major cause of infection following catheterisation Insert the sterile nozzle of the anaesthetic lubrication gel into the urethra.

Squeeze the gel into the urethra, remove the nozzle and discard the tube; Gently massage the gel along the urethra; Squeeze the penis and wait 5 minutes for it to take effect.

Adequate lubrication helps to prevent urethral trauma.

Use of a local anaesthetic minimizes the service user’s discomfort To ensure distribution along urethra Gently squeezing prevents the gel from escaping from the urethra

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Infection Prevention and Control Inser&on of a Male Urethral Catheter Remove used gloves, perform hand hygiene and put on a 2nd pair of sterile gloves

To reduce contamination following skin contact with 1st pair of gloves

Gently grasp the penis behind the glans, raising it until it is almost totally extended

This action straightens the penile urethra and facilitates the action of catheterisation; maintaining a grasp on the penis prevents contamination and retraction of the penis

Place the sterile urinary catheter, in the sterile receiver, between the service user’s legs

To provide a temporary container to maintain sterility prior to insertion and to catch urine as it drains

• Insert the catheter for 15-25 cms until the urine flows. Do not inflate the balloon until urine flow is visible in tubing • When urine begins to flow advance the catheter almost to the bifurcation • Gently inflate the balloon according to the manufacturer’s directions • Withdraw the catheter slightly and attach it to the drainage system • Support the catheter, ensuring that the catheter does not become taut when service user mobilises or when penis becomes erect • If catheter cannot be advanced – stop procedure and seek further medical advice

Some resistance may be due to spasm of the external sphincter; straining gently helps to relax the external sphincter Advancing the urinary catheter ensures that it is correctly positioned in the bladder Inadvertent inflation of the balloon in the urethra causes pain and trauma to the urethra.

Supporting the catheter maintains service user comfort and reduces risk of bladder or urethral trauma.

Stopping the procedure if it cannot be advanced will prevent further trauma and injury

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Infection Prevention and Control Inser&on of a Male Urethral Catheter Ensure that the glans penis is clean, reduce or reposition the foreskin

Retraction or constriction of the foreskin behind the glans penis (paraphimosis) can occur if this is not done

Make the service user comfortable and ensure the area is dry

If the area is left wet or moist, particularly with bodily fluids, secondary infection and skin irritation may occur

Observe and measure how much residual urine drains and document after procedure

To ensure volume of urine in bladder at time of catheterisation is recorded especially when service user has presented with urinary retention or impaired renal function (During routine re–catheterisation there should be a minimal amount of urine in the bladder)

If not using a pre-connect system, connect an appropriate drainage bag, ensuring this is below the level of the bladder

To ensure unrestricted flow of urine into a closed system

Affix urinary catheter fixation device; attach the drainage bag if using a leg bag to the calf, using straps, night bag or a catheter valve.

To prevent catheter “drag” which can results in trauma to urethra and bladder

If required collect and send a urine sample for investigation

To detect presence of bacteria

Dispose of used equipment into correct To prevent environmental waste stream and clean trolley or tray contamination and ensure appropriate disposal

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Infection Prevention and Control Inser&on of a Male Urethral Catheter Remove gloves and decontaminate hands with either soap and water or hand sanitiser

To reduce the risk of cross infection

Explain to the service user the To reduce the risk of infection and importance of maintaining cleanliness trauma around the penis, by washing with soap and water daily and of avoiding touching or pulling the catheter Assist the service user to dress and return to their usual activity or living area

To enable the service user to continue with their activities of daily living

Give the service user written information leaflet

To support verbal instruction

Record all information including any To ensure effective and accurate record untoward events, the catheter size, keeping is maintained and type, expiry date, batch / lot number of documentation is complete any products used and amount of water in the balloon Record expiry date of anaesthetic gels.

Document the date of the next catheter change

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Infection Prevention and Control Gordon House, Station Road Mill Hill, London NW2 2JU Telephone 020 8906 2777 Fax: 020 8906 2233 8 of 8 - Infection Prevention and Control Insertion of a Male Urethral Catheter www.infectionpreventionsolutions.co.uk