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Infection Prevention and Control

Changing a suprapubic catheter

1 of 8 - Infection Prevention and Control Care Changing a suprapubic catheter

Infection Prevention and Control Changing a suprapubic catheter Purpose To ensure all relevant staff are aware of the principles of changing a suprapubic 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 changing of suprapubic catheters.

Guidance •

A suprapubic cystostomy or suprapubic catheter is a surgically created connection between the urinary bladder and the skin which is used to drain urine from the bladder in individuals with obstruction of normal urinary flow

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The insertion of the first suprapubic catheter is usually performed in hospital by a urology specialist. In some areas the first change is also performed by the specialist; thereafter the catheter is usually changed by a person who has received specific training in this procedure and is competent to carry it out

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Only trained and competent staff can change a supra pubic catheter using an aseptic non touch technique

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Frequency of change of a supra pubic catheter will depend on the make of the catheter. Follow manufacturer’s recommendations

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Never remove a suprapubic catheter unless it is going to be changed immediately or removed permanently (Rigby, 2009)

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Prior to changing the suprapubic catheter ensure you are aware of how to contact other healthcare professionals should any difficulties arise during the procedure

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The size of catheter used should be no smaller than 16Ch in adults with a 10ml balloon, unless otherwise specified (and documented) by an appropriate specialist.

A larger Charriere size may be used if the catheter persistently blocks. Check care plan and service user notes for record of persistent blocking or ongoing problems

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Gain consent from the service user to carry out procedure and document this in service users’ notes

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2 of 8 - Infection Prevention and Control Care Changing a suprapubic catheter

Infection Prevention and Control Changing a suprapubic catheter •

Review latex allergy risk assessment. If an allergy is suspected then use 100% silicone catheter. All risk assessments should be documented in care notes

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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)

Equipment Catheterisation pack or dressing pack containing sterile receiver Two pairs of sterile single use gloves Hand sanitizer Disposable plastic apron Single use sachet of cleaning solution i.e. 0.9% sodium chloride Sterile gauze swabs for cleaning catheter site Catheter of appropriate size/length and type of material Drainage bag / leg bag Leg bag straps or means of holding catheter 10 ml sterile syringe to deflate existing catheter balloon 10ml ampoule of sterile water 10 ml sterile syringe with water for injection prefilled for inflating balloon Sterile drape/field Clinical waste bag Sterile single use lubrication/anaesthetic gel (eg; Instillagel) Protection for the bed (inco pad) A sterile non-adherent adhesive dressing Urine specimen container for specimen if required

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3 of 8 - Infection Prevention and Control Care Changing a suprapubic catheter

Infection Prevention and Control Changing a suprapubic 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 known allergies • Check valid consent

Assist the service user to get into the To ensure the catheter site is easily supine position, exposing the catheter accessible site only once ready to proceed Maintain service user’s privacy and dignity with covers at this stage and ensure service users comfort Ensure that visibility is adequate using additional light sources if required

To ensure that the catheter site is accessible and visible

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

To reduce the risk of infection

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

Clean and prepare a dressing trolley / To ensure a clean working dressing tray or prepare a clean working environment surface Perform effective hand hygiene by washing hands with soap and water or using hand sanitizer if hands are visibly clean

To reduce the risk of infection

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4 of 8 - Infection Prevention and Control Care Changing a suprapubic catheter

Infection Prevention and Control Changing a suprapubic catheter Using aseptic technique open all packs

To maintain an aseptic procedure and reduce the risk of introducing infection into the urinary tract

Clean neck of ampoule with sodium chloride prior to drawing up sterile water

To reduce cross infection

Place a small amount of sterile anaesthetic gel in sterile receiver to lubricate the new catheter

For use to reduce trauma and discomfort

Perform hand hygiene by washing hands or use hand sanitizer; Put on non-sterile gloves; Clean around suprapubic site with normal saline using one wipe per swab cleaning from centre outwards

To reduce the risk of cross-infection and the introduction of skin flora into the suprapubic site and bladder

With a sterile 10ml syringe gently attach To deflate balloon to allow catheter to the valve on the inflation channel removal and allow the balloon to deflate Holding a gauze swab with one hand, remove the catheter with the other hand, noting the direction and length of catheter that was inserted; Place the gauze swab over the site to absorb any leakage; Observe removed catheter for encrustation; Aseptically clean the site prior to insertion of the new catheter and administer appropriate lubrication or anaesthetic gel

To facilitate comfortable removal and replacement of catheter

Take off the non-sterile gloves; Clean hands with hand sanitizer

To reduce the risk of introducing infection to the service user during re-catheterisation

To minimise trauma and discomfort

To reduce the risk of introducing infection to the service user during catheterisation

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5 of 8 - Infection Prevention and Control Care Changing a suprapubic catheter

Infection Prevention and Control Changing a suprapubic catheter Put on sterile single use gloves

To reduce the risk of introducing infection to the service user during catheterisation

Place sterile sheet(s) across the abdomen of the service user

To provide a sterile working area

Place the sterile urinary catheter, in the sterile receiver on the sterile field

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

Insert new catheter through the To ensure the catheter is in the correct abdominal wall ensuring an equivalent position length of catheter (to the previous catheter) is introduced into the bladder; Pass the catheter a further 2-3cms into the bladder before inflation Inflate the balloon according to the manufacturer’s directions, having ensured that the catheter is draining adequately

Inadvertent inflation of the balloon in the surgical tunnel will cause trauma

If not using a pre-connect system, connect a catheter valve or an appropriate drainage bag; once urine starts to flow, ensure 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 leg, using straps, night bag or a catheter valve.

To prevent catheter “drag” which can result in trauma to suprapubic site and bladder

A small sterile keyhole dressing can be applied around the supra-­‐pubic opening

To absorb any exudate

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6 of 8 - Infection Prevention and Control Care Changing a suprapubic catheter

Infection Prevention and Control Changing a suprapubic catheter Make the service user comfortable and ensure the area is dry

To promote comfort for the service user; if the area is left wet or moist, particularly with bodily fluids, secondary infection and skin irritation may occur

Dispose of used equipment into correct To prevent environmental waste stream and clean trolley or tray contamination and ensure appropriate disposal Perform effective hand hygiene by To reduce the risk of infection washing hands with soap and water or using hand sanitizer if hands are visibly clean Where required collect and send a urine To detect presence of bacteria sample for investigation Explain to the service user the importance of maintaining cleanliness around the suprapubic site by maintaining a clean dressing and avoiding touching or pulling the catheter or dressing

To reduce the risk of infection and trauma

Record all information including any untoward events; the catheter size; type; expiry date; batch / lot number; dressing type of any products used and amount of water in the balloon.

To facilitate appropriate management and care Record expiry date of anaesthetic gels To ensure accountability Document the date of the next catheter change 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

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7 of 8 - Infection Prevention and Control Care Changing a suprapubic catheter

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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 Care Changing a suprapubic catheter www.infectionpreventionsolutions.co.uk