8 catheter problem solving final

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Infection Prevention and Control

Strategy for the management of catheter related problems

1 of 7 - Infection Prevention and Control Strategy for the management of catheter related problems

Infection Prevention and Control Strategy for the management of catheter related problems Purpose To ensure all relevant staff are aware of the principles for managing catheter related problems 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 managing catheter related problems for a service user.

Introduction The management of catheter related problems occurring when a short term catheter is required for a service user is part of general catheter maintenance and care and as such, all of the principles set out in the Epic 3 (2013) guidance should be adhered to.

These include: • Maintaining a sterile closed urinary drainage system with a sampling port • Preventing breaks in the connection between the urinary catheter and the drainage system unless clinically indicated • Changing short term catheters only when clinically indicated and in line with manufacturer’s instructions • Adhering to the principles of hand decontamination before and after each service user intervention • Wearing clean non-sterile gloves for any manipulation of the service users catheter • Using the sampling port and an aseptic technique to obtain catheter sample of urine • Positioning the urinary drainage bag below the level of the bladder on a stand that prevents contact with the floor • Not allowing the urinary drainage bag to fill to more than ¾ full • Using a separate clean container for each service user and avoiding contact between the tap and container when emptying the drainage bag • Not adding antiseptic or antimicrobial solutions to urinary drainage bags • Enabling (and assisting where necessary) the service user to undertake daily personal hygiene for meatal cleansing 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) and Aseptic Non Touch Technique (ANTT)

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2 of 7 - Infection Prevention and Control Strategy for the management of catheter related problems

Infection Prevention and Control Strategy for the management of catheter related problems Urine Twisted tubing “bypassing” (urine passing around the Balloon/catheter gauge outside of the too big catheter) Infection

Change position; if used with a leg bag consider shorter length tube Select 10ml balloon or smaller gauge catheter Obtain a catheter specimen of urine using the sampling port and discuss treatment options with the responsible medical practitioner

Catheter blocked by debris Remove and re-catheterise; Inspect tip for signs of debris or encrustation – record in service user notes; Maintain record of catheter changes and note any emerging pattern; Consider a programme of catheter maintenance solution

Bladder spasm / instability (common 24-48 hrs after catheterisation)

May need a smaller catheter; Consider anticholinergic medication

Constipation

Increase fluid intake; dietary fibre advice; prescribe laxatives if needed; consider diet

Bladder calculi

Can occur in service users with longer term catheters – may require confirmation by x-ray

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3 of 7 - Infection Prevention and Control Strategy for the management of catheter related problems

Infection Prevention and Control Strategy for the management of catheter related problems Urine does not drain

Blocked catheter

Remove and re-­‐catheterise; Inspect 7p for signs of debris or encrusta7on -­‐ this may require cu>ng the removed device in half – record in service user notes; Assess suitability for a programme of catheter maintenance solu7on

Kinked or twisted drainage tubing

Inspect the system and straighten any kinks; Change posi7on; if used with a leg bag consider shorter length tube

Leg bag above the level of Reposi7on catheter bag the bladder Catheter not in urethra

Remove catheter and re-­‐ catheterise

Catheter not the correct Remove and re-­‐catheterise with length (obese female suitable length catheter service users may require a standard length catheter as a female length may be too short) Dehydra7on or service user in renal failure

Catheter is encrusted

Treat accordingly aIer consulta7on with medical prac77oner

Micro-­‐organisms s7cking Consider catheter maintenance to catheter surface solu7ons

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4 of 7 - Infection Prevention and Control Strategy for the management of catheter related problems

Infection Prevention and Control Strategy for the management of catheter related problems Non-­‐defla3ng Valve port and balloon balloon infla7on channel may be compressed Faulty valve mechanism

Infec3on

Check no external compression problems Remove the syringe and try another one; always aspirate slowly or the valve mechanism may collapse; A few millilitres of sterile water can be added to the valve to clear any obstruc7on but do not over inflate the balloon; Do not cut the catheter during removal; Seek medical help if unable to remove catheter;

Poor catheter care – symptoms include cloudy, offensive smelling urine; burning pain, raised temperature; haematuria; confusion

Test a urine sample using a urine test strip: if posi7ve to nitrates, leucocytes, protein or blood obtain a catheter specimen of urine using the sampling port and send for microscopy, culture and sensi7vity; discuss treatment op7ons with the service user’s medical prac77oner

Contamina7on

Ensure all staff are competent in correct catheter care and promote service users personal hygiene

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5 of 7 - Infection Prevention and Control Strategy for the management of catheter related problems

Infection Prevention and Control 
 Strategy for the management of catheter related problems Haematuria

Trauma or infection: Can be due to traction on catheter, trauma during insertion or renal/bladder pathology

Observe output, encourage fluids; Ensure the catheter is properly supported; Treat infection if symptomatic; If severe haematuria, medical referral should be made immediately and the service user monitored for clot formation and catheter blockage; may require further investigation such as cystoscopy

Tension on catheter due to Ensure catheter and drainage bag is inadequate support appropriately secured and supported Persistent haematuria

Seek medical advice

Distention of the urethra by a catheter which is too large; Occlusion of the paraurethral glands (in women) leading to infection, urethritis and oensive discharge around the catheter

Consider removing catheter; Consider changing to a smaller size catheter

Inability to tolerate catheter

Psychological trauma, overactive bladder or radiation cystitis

Consider alternatives to catheterisation

Paraphimosis (in males)

The foreskin becomes trapped behind the glans penis causing the foreskin to become oedematous

Refer to medical practitioner for treatment and advice

Urethral discomfort

Refer to medical practitioner if there is oensive discharge

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6 of 7 - Infection Prevention and Control Strategy for the management of catheter related problems

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Infection Prevention and Control Gordon House, Station Road
 Mill Hill, London NW2 2JU

7 of 7 - Infection Prevention and Control Strategy

Telephone 020 8906 2777 Fax: 020 8906 2233
 for the management of catheter related problems www.infectionpreventionsolutions.co.uk