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CATHETER MANAGEMENT FORMULARY Reviewed August 2009 by Linda Greenman, Lead Nurse Continence, Calderdale PCT Adapted by Joanne Whiteley, Continence Service Manager, KCHS January 2010 Ratified by NHS KIRKLEES PEC and Medicines Management Committees June 2010 To be reviewed March 2012 by Joanne Whiteley

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CONTENTS

Page Catheter Related Equipment (RCN Guidance)

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Equipment Selection and Catheter Formulary

3-6

Indications for Catheterisation

7

Catheter Selection for Patient

7

Suprapubic Catheters

8

Appliances

9

Patient Information

9

Troubleshooting

10

Ordering Prescriptions and Supplies

10

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CATHETER RELATED EQUIPMENT Materials and equipment It is essential for clinicians to understand :The types of catheters, urinary drainage bags, link systems and catheter valves that can be used and why you should select the appropriate catheter How to obtain, store to maintain sterility and dispose of catheter care equipment The types of support methods, including garments, straps and stands, used in conjunction with urinary drainage systems (RCN 2007) National Occupational Standards The following provides further clarity to support the broad statements contained in the NOS;

* Nurses should ensure that all catheter equipment is used according to manufacturers guidelines and only be used for the purpose it was designed for.

* A medical devise can be defined as an instrument, apparatus, appliance, material or health care product, excluding drugs (MDA, 2000) * Be aware of the importance of the work undertaken by the Medicines and Healthcare products Regulatory Agency (MHRA) in safeguarding the use of medical equipment for and by patients * To appreciate the value of research and audit in equipment evaluation, selection and usage. All equipment and its use needs, where possible, to be evidence based. * The NHS in England needs to make the best use of available resources and work to ensure best possible value for money when purchasing catheter equipment, that is the work undertaken by the NHS Purchasing and Supply Agency (PASA) * Continence product Evaluation Network – one of four centres in England which evaluates equipment for the MHRA. Multi centre evaluations are undertaken, which provide current, impartial and comprehensive data for purchasers and providers

* Health professional have the task of familiarising themselves with the vast array of equipment available, which ensures service users receive informed choice of product availability * Nurses need to know what type of catheter equipment is available including types the catheter, indwelling urethral (short and long term), intermittent or suprapubic, leg bags, night bags, link systems, catheter valves, support garments and stands. Nurses need to have an understanding of the benefits and disadvantages of catheter equipment used. * Nurses need to select appropriate patients for self catheterisation or use of a catheter valve. * To make an appropriate choice for an individual patient, nurses should be able to identify the different features of Foley catheters and urinary drainage systems.

* All catheter products require a CE mark. This is a declaration by the manufacturer that the equipment meets all the appropriate provisions of the relevant legislation implementing certain European Directives.

* Patient assessment would ensure the appropriate need for the use of a catheter. Further assessment of competence would be required if the patient was to self manage the use of a catheter. Product selection will be made on an individual basis and reviewed periodically, thus ensuring userâ€&#x;s needs are met and that the catheter is still required. * Patients who manage their own care will require appropriate individually planned education.

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EQUIPMENT SELECTION Pricing Data (Drug Tariff August 2009) C - £1-2 D - £2-4; E - £4-7; F - £7-10; G - £10-15; H - £15-20; I - £20+

FREQUENCY OF CHANGE

AVERAGE QUANTITY PER MONTH

TYPE

CODE

PIP CODE

FOLEY CATHETERS st

SIZE/ QUANTITY

PRICE CAT

Ch

FIRST LINE PRESCRIBING Sympacath Aquaflate Hydrogel Coated Latex Catheter Long term use (up to 12 weeks) Suitable for Urethral or Supra pubic Application

DH310112 DH310114 DH310116 DH210112 DH210114 DH210116

285-6029 285-6060 285-6078 285-6151 285-6177 285-6169

12 standard length 14 standard length 16 standard length 12 female length 14 female length 16 female length

E E E E E E

FIRST LINE PRESCRIBING

DA310112 DA310114 DA310116 DA210112 DA210114 DA 210116

285-6227 285-6235 285-6243 285-5864 285-5872 285-5880

12 standard length 14 standard length 16 standard length 12 female length 14 female length 16 female length

E E E E E E

12 weeks

3 on 1 script then 1 – 2 per script

12 weeks

st

3 on 1 script then 1 – 2 per script

12 weeks

3 on 1st script then 1 – 2 per script

Ultramer Hydromer coated,(Covidien Commercial UK) latex based Long term use Suitable for urethral or supra pubic use

1612-1M 1614-1M 1616-1M 1712-1F 1714-1F 1716-1F

246-5698 246-5706 246-5714 246-5789 246-5797 246-5805

12 standard length 14 standard length 16 standard length 12 female length 14 female length 16 female length

E E E E E E

12 weeks

st

Biocath Hydrogel Coated catheter Long term use. Suitable for urethral or supra pubic use

D226512 D226514 D226516 D226912 D226914 D226916

No PIP codes needed for Bard products

12 standard length 14 standard length 16 standard length 12 female length 14 female length 16 female length

F F F F F F

3 on 1 script then 1 – 2 per script

Brilliant Aquaflate All-silicone – LATEX FREE Long term use (up to 12 weeks) Suitable for Urethral or Suprapubic Application

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FREQUENCY OF CHANGE

AVERAGE QUANTITY PER MONTH

TYPE

CODE

PIP CODE

SIZE/ QUANTITY

PRICE CAT

LM500MD-T LM500LD-T

338-5036 338-5044

10 – short tube 10 – long tube

I I

SLC13

340-6071

10

G

305-4780

10

D

LEG BAGS 5 – 7 days

1 ox every 2 months

L.IN.C Medical 500ml T tap Recommended –Allows free sampling port in obtaining CSU

NIGHT BAGS 5 – 7 days

1 box every 2 months

L.IN.C Medical 2 litre with T tap Recommended for use 5-7 days with patient/carer living at home capable of independently carrying out their activities of daily living, with full hygiene awareness.

NIGHT BAGS FOR NURSING/RES HOMES Daily – single use

3 boxes of 10

L.IN.C Medical 2 litre single use LM2LNS drainage bag Recommended – infection control for use in nursing/res homes or by multiple carers in patient’s own home

SINGLE USE STERILE NIGHT BAGS 305-4806

10

D

3 boxes of 10

L.IN.C Medical 2 litre overnight drainage bag with non return valve Recommended – immuno compromised patients

LM2LS

Daily – single use

FREQUENCY

AVERAGE

TYPE

CODE

PIP CODE

SIZE/

PRICE

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OF CHANGE

QUANTITY PER MONTH

QUANTITY

CAT

5

G

CATHETER VALVES

7 days

1 box of 5

Simpla Catheter Valve

T180

7 days

1 box of 5

Libra lever catheter valve with 180° lever action tap

10540A

342-9487

5

G

783678 783680 783686 783694 783708

No pip codes

Small/yellow 22.33cm Red/standard 3439cm Blue/medium 4046cm Brown/large 4764cm Green/x large 65+ 5

F

2 x 30ml

E

50ml

F

100ml

D

LEG BAG SLEEVES/G Straps Coloplast Aquasleeve 1 – 5 days. Can be washed

1 box every 2 months

7 days

4 per month

Would depend upon clinical assessment

(all sizes are circumference) Boxes of 4

Simpla G Strap adult CATHETER MAINTENANCE SOLUTION

383001

FIRST LINE PRESCRIBING

9746609

305-6652

G

*Uro-tainer Twin Suby G – 3.23% citric acid Two in one unit, one break in system, less volume Optiflow G citric acid 3.23% Need to use 2 Uriflex SP Sodium Chloride 0.90%

094-5816

*Double instillations As the bladder size decreases on long-term catheterisation, it is better to use a smaller volume of 5


maintenance solution. Getliffe et al. (2000) suggests using as little as 15mls to gently bathe the lumen and the tip of the catheter. They also state that: „The small volume within the catheter lumen rapidly becomes saturated with dissolved encrustation components, and the instillation of a second “washout”, after draining the first, provides a fresh medium which promotes further dissolution of encrusting material‟ Reference: Getliffe K.A., Hughes S.C., Le Claire M (2000) The dissolution of urinary catheter encrustation. BJU Int Jan; 85 (1): 60-64. PH Strips, code no. XX-LP from Braun. Telephone 0800 163 007 FREQUENCY OF CHANGE

AVERAGE QUANTITY PER MONTH

TYPE

CODE

PIP CODE

SIZE/ QUANTITY

PRICE CAT

22025 22030 22035 22040

80cm 25mm 30mm 35mm 40mm

£48.90 per box of 30 I

22121 22125 22130 22135

50cm 21mm 25mm 30mm 35mm

£48.90 per box of 30 I

Clear Advantage with Aloe Silicone Sheath (Rochester Medical)

1243 1283 1323 1363 1403

24mm 28mm 32mm 36mm 40mm

I £47 per box

TYPE

CODE

SIZE/ QUANTITY

PRICE CAT

URINARY SHEATHS

1 per 24 hours Initially 2 boxes then 1 box per month

1 per 24 hours Inially 2 boxes then 1 box per month FREQUENCY OF CHANGE

AVERAGE QUANTITY

Conveen Optima latex free sheath (Coloplast)

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PIP CODE


PER MONTH ANTISEPTIC, ANAESTHETIC CATHETER GEL

Need 1 tube at each urethral catheterisation

Initial 5 tubes then as frequency identified

Instillagel gel (Clinimed Ltd)

6mls (females) 11mls (males)

Care of a patient with a Urinary Sheath : Sheath should be changed every 24 hours  Pubic hair should be trimmed prior to application to aid good contact with skin and prevent leakage  Every man should be measured prior to prescription generation. The penis should be measured at the base when the man is sitting INDICATIONS FOR CATHETERISATION RELIEF OF ACUTE/CHRONIC RETENTION  Allows complete drainage of the bladder prior to surgery or investigative procedures.

Instillation of drugs & bladder maintenance solutions INVESTIGATIONS OF RESIDUAL URINE  Bladder function tests

INTRACTABLE URINARY INCONTINENCE  When all other methods of treatment have failed DETERIOATION IN SKIN DUE TO INCONTINENCE CATHETER SELECTION FOR PATIENT (URETHRAL) SIZE (diameter) Measured in Charriere (Ch), 1 Ch = 1/3mm. A 12Ch has a 4mm diameter and can drain over 100litres in 24 hours. The

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average adults‟ output is only 1.5 litres per day! Always use the smallest possible Ch size, 6-10 for paediatrics, 12 for females and 12 for males.

Remember – Larger sizes should only be used under medical supervision. LENGTH Standard/Male catheters are normally 41-43cm long and are suitable for both male and female patients, Female catheters are normally 23-62cm long as the female urethra is much shorter than the male. However, they should not be used on obese patients or where they could compromise the correct positioning of the drainage system. Paediatric catheters are approximately 30cm long. BALLOON 3-5ml - Paediatrics. 10ml - Routine procedures on male and female 30ml + - Used by surgeons in certain urological procedures, such as a prostatectomy (TURP), when traction on a Haematuria (post-operative) balloon can provide haemostasis on the prostatic bed. Remember  Use of a balloon over 10ml capacity in normal routine drainage is more likely to cause bladder spasm  due to the additional weight and size.  Always use sterile water to inflate the balloon. PERIOD OF USE Short/Medium Term Can be left in situ for up to 28 days. Coated on both the inside and outside with PTFE (polytetrafluoroethylene), they are manufactured form a latex base to ensure the catheter is soft, pliable and comfortable. Long Term Can be left in situ for up to 12 weeks. The choice of coatings is either Hydrogel or Silicone Elastomer on a latex base. All-Silicone catheters are also available, made form 100% silicone. Remember  The material determines the length of a catheter’s life, not the colour, as they vary between  manufacturers. SUPRAPUBIC CATHETERS Commonly used for patients with urethral scarring or after severe surgery of pelvic trauma. It is more accurately called a cystostomy and is only contra-indicated when there are bladder tumours or unexplained Haematuria. 8


The most commonly used sizes are 14-18Ch.. HAEMATURIA/POST-OPERATIVE These catheters, in their various configurations of materials, tips and eyes, are available in sizes ranging from 16-28Ch. They have a particular use in the removal of blood stained urine (Haematuria), clots and debris from the bladder and are most commonly used following urological surgical procedures such as a prostatectomy. The two types of Haematuria catheter normally used are:  2-way, which have drainage and balloon inflation channels.  3-way, having an additional channel to allow continuous or intermittent fluid irrigation of the bladder to facilitate  removal of blood clots and debris. APPLIANCES CATHETER VALVES It is good practice to use a catheter valve to maintain a patients bladder tone (RCN 2008). They allow the bladder to fill and empty, thereby mimicking the normal function of the bladder. DRAINAGE BAGS A Closed System must be maintained when using continuous drainage, in order to minimise the risk of introducing infection. The type of system will be indicated by the reason for catheterisation, patient choice and compliance/ duration of the catheter. The majority of manufacturers produce leg bags in 350ml, 500ml and 750ml volumes, each with a choice of tubing lengths, and most can be used for up to 5-7 days. To maintain the closed system at night, a larger volume bed bag (usually a non-drainable 2000ml) will be required for connection to the leg bag outlet. In acute medical or surgical situations and non-ambulatory patients, a bed bag will be attached to the catheter and normally left in situ for up to 5-7 days, depending on the patient‟s condition. Remember  The appropriate nursing professional should assess each patient before they are fitted with any drainage  devices. OTHER INFORMATION – For patient information please refer to Kirklees CHS You and Your Urethral Catheter HYGIENE  The area around the catheter should be cleansed twice daily with soap and water.  Men must ensure they wash thoroughly under their foreskin.  A bath or shower can be taken with a catheter. 9


 Maintain a closed drainage system and empty the drainage bag regularly. FLUIDS Patients should be encouraged to drink :1.5 – 2ltrs per 24 hours A glass (200mls) of Cranberry juice daily to prevent infections. Caution Warfarin, GI ulcers and diabetes STORAGE OF EQUIPMENT Careful attention needs to be paid to the care and storage of catheters and drainage bags.  Store in a cool place  Keep in original boxes prior to use, to avoid both physical damage and exposure to light.  Always check the expiry date, size, coating and balloon sizes.  Rotate stock, using oldest product first. TROUBLESHOOTING INFECTION There will always be a certain amount of bacteria around catheters. Antibiotics are advised when a patient exhibits signs of pyrexia, loin pain, offensive smell from urine, or confusion. SEDIMENT This can be produced by bacteria that can make urine alkaline (usually Klebsiella or Pseudomonas) and may require antibiotic treatment. CRAMPS These usually occur when the patient has been catheterised for the first time and usually subside after 24 hours. Monitor and seek advice if the problem persists. BY-PASSING Check sizes of catheter and balloon, a smaller size may be required or the patient might be experiencing bladder spasms and antimuscarinic drugs may be required. 10


ORDERING PRESCRIPTION AND SUPPLIES All patients must be given the choice of a local pharmacist or a home delivery company for supply of catheters and related accessories. GPâ€&#x;s should be informed of all newly catheterised patients and when patients have been assessed for appliances or intermittent catheterisation. Bullen Healthcare is used by the Kirklees Community Healthcare Services Continence Service to order specialist products. Bullen Healthcare is an unbiased home delivery company as they do not manufacture any products.

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/Formularies_and_Guidan  

http://www.kirklees.nhs.uk/fileadmin/documents/New/Public_Information/med_mgt/Formularies_and_Guidance/Catheter_Management_Formulary.pdf

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