Trust

All Sites
Guideline

Catheter Care in the Community

Guidelines

All healthcare professionals must exercise their own professional judgement when using
guidelines. However any decision to vary from the guideline should be documented in the
patient records to include the reason for variance and the subsequent action taken.

Lead Clinician(s) Anne Skinner Continence Nurse Specialist

Lisa Hatch Continence Nurse Specialist

Lead Director(s) Sandra Rote Director of Clinical Development and Lead

Executive Nurse

Ratified by Worcestershire PCT Quality and June 2007

Safety Group
This Policy should not be used after end of: June 2009

Links into Healthcare Standard:

Impact Analysis (Race Equality)

Impact Analysis (Mental Capacity Act)

Page 1 of 35
CONTRIBUTION LIST

Key individuals involved in developing the document

Name Designation
Anne Skinner Continence Nurse Specialist
Elaine Sutcliffe Continence Nurse Specialist
Lisa Hatch Continence Nurse Specialist
Tracey Harrison Continence Nurse Specialist

Circulated to the following individuals for comments

Name Designation
Joyce Wild District Nurse Team Leader
Sally Alexander District Nurse Team Leader
Yvonne Fortey District Nurse Team Leader
June Patel Director of Clinical Services and
Nursing
Dr Guy Busher GP
Dr Tony DeCothi GP
Dr B Borestero GP
Vicky Preece Associate Director of Nursing
Jill Doyle IV Therapy Team Leader (sent in her
previous role as Professional Lead for
District Nursing, SWPCT)

Catheter Care Guidelines WPCT Page 2 of 35

Contents
Introduction 4
Scope of the Guideline 4
Competencies required 4
Patients covered 5
Consent to treatment 5
The Guidelines 6
Choice of Catheter 6
Charriere Size 6
Balloon Size 6
Silver coated catheter 6
Self-retaining catheters 7
Supra-pubic catheters 7
Closed drainage system: principles of management 8
Changing of urine drainage bags - Day/Night 8
Catheter Change 8
Urine Samples 8
Catheter Strap 8
Bathing the catheterised patient 9
Clamping 9
Use of spigots 9
Catheter valves 9
Bladder irrigation in the home 9
Removal of a self-retaining catheter 9
Collection of mid stream specimen of urine 10
Monitoring Tool 10
References 11
Appendix 1: Catheterisation Procedure: requirements 14
Appendix 2: Male Catheterisation 15
Appendix 3: Acute Painful Retention in Adult Males Care Pathway 17
Appendix 4: Trial without Catheter 19
Appendix 5: Female Catheterisation 22
Appendix 6: Supra-pubic Catheterisation 24
Appendix 7: Intermittent Self-Catheterisation (Female) 26
Appendix 8: Intermittent Self-Catheterisation (Male) 27
Appendix 9: Emptying the Urine Drainage Bag 29
Appendix 10: Changing A Urine Drainage Bag 30
Appendix 11: Obtaining a Catheter Drainage Specimen of Urine 31
Appendix 12: Removal of a Self-retaining Catheter 32
Appendix 13: Bladder Irrigation 33
Appendix 14: Collection of a Mid Stream Specimen of Urine: Male/Female 35
Please also see separate appendices:

Guidelines for the correct choice of urinary appliances in Worcestershire

Abridged Guidelines for the correct choice of urinary appliances in Worcestershire

Catheter Care Guidelines WPCT Page 3 of 35

Introduction
Catheterisation is a common procedure performed in the community. These guidelines have
been developed to standardise practice according to current research and evidence based
practice.

Scope of the Guideline

This guideline applies to all registered nurses employed within the Trust or working on behalf
of the Trust who are required to undertake catheterisation as part of their role.

Competencies required
These guidelines apply to all registered nurses. Nurses have an individual responsibility to
ensure they feel confident and competent in the knowledge and skills of practice in line with
their Scope of Professional Practice (NMC, 1992). They should inform their immediate line
manager if they feel they are not competent and discuss their training needs. The line
manager is responsible for ensuring that any training required is identified as appropriate, and
measures taken to ensure that the nurse is able to obtain competencies in this area of
practice.

Catheterisation should only be undertaken by staff specifically trained and competent in this
procedure.

Only appropriately trained staff who are competent and confident should change a supra-
pubic catheter.

The trained nurse should acquire knowledge and skills relating to catheterisation to ensure
competency, and adhere to good practice. This is to be conducted in conjunction with R.C.N
recommendations, and ACA Guidelines.

Each trained nurse acquiring knowledge and skills in urethral and supra-pubic catheterisation
should receive classroom tuition, which should include:
1. Consideration to Physical, Social, Sexual and Psychological aspects of catheterisation.
2. An understanding of the anatomy and physiology of micturition and reproduction in
males.
3. Assessment prior to catheterisation.
4. Complications of catheterisation.
5. Legal aspects of care provision.
6. Catheter selection.
7. Catheter maintenance.
8. Aspects of Intermittent Self Catheterisation.
It is not a formal requirement to prove competent practice, but it is suggested that
competency is achieved through observation and supervision.

Catheter Care Guidelines WPCT Page 4 of 35

e.g.

Observed Supervised

Urethral Three Three

Supra-Pubic Three Three

Intermittent One One

Supervised practice may be recorded and countersigned by the Supervisory Nurse or

Continence Advisor and kept for the staff member’s professional portfolio.

Patients covered
These guidelines applies to all adult patients, at home or in one of the community hospitals,
being treated and cared for by staff employed by, or working on behalf of WPCT.

Children are usually seen at the Children’s Hospital or by the Community Paediatrician.

Consent to treatment
Patients should have the procedure explained to them, and consent obtained by the nurse
carrying out the catheterisation, in accordance with the WPCT Consent to Treatment Policy,
and documented in the patient’s notes.

Catheter Care Guidelines WPCT Page 5 of 35

The Guidelines
Catheterisation is undertaken for one or more of the following reasons:

• To solve acute/chronic retention of urine.

• To give exact measurement of urinary output.

• To instil drugs.

• To control urinary incontinence.

Choice of Catheter

The choice of catheter used should be governed by the length of time the catheter is likely to
remain in situ, taking into account the reason for catheterisation.

SINGLE USE COATED: In/out catheter. Used in I.S.C.

SILVER COATED CATHETER Short/Medium term - Up to 28 days

TEFLON COATED LATEX Short/Medium term - Up to 28 days

HYDROGEL COATED: Long term - Greater than 28 days

SILICONE ELASTOMER:

SOLID SILICONE: No longer than 12 weeks

There are a limited number of silicone catheters licenced for supra-pubic use, due to their
potential of cuffing. 1

Charriere Size

The charriere is the outer circumference of the catheter in millimetres and is equivalent to
three times the diameter. To avoid discomfort and leaking choose the smallest sized catheter
possible.

Balloon Size

For the majority of patients 10ml balloons are satisfactory, and are less likely to cause
irritation of the bladder mucosa.

30ml balloons were developed to prevent haemorrhage following prostatectomy, which is their
intended use only

Silver coated catheter

It has been shown to reduce infection rate in a high proportion of patients

Catheterisation procedures are included in Appendices 1,2,3,4,5,6

Catheter Care Guidelines WPCT Page 6 of 35

Self-retaining catheters

For patients with a self-retaining catheter the following principles must be followed to prevent
ascending infection.

• It is imperative to adhere to the procedure guidelines when emptying a urine drainage bag
(see appendix 7) and when changing a urine drainage bag (Appendix 8).

• The genital area should be thoroughly cleansed at least once daily with unscented soap
and water, and repeated after every bowel movement. Particular attention should be paid
to the catheter meatal junction, the folds of the labia and under the foreskin in the male.

• Following defecation, patients should be reminded to use soft toilet tissue, wiping from
front to back. Moist toilet wipes are extremely useful for this purpose.

• A closed ‘LINK’ system for urinary collection is essential, minimising the risk of ascending
infection. (see section below)

• Drainage bags should remain at a level BELOW the patient’s bladder at all times.

• In females it is advisable to fit a Holster or Sporran type garment to ensure the system is
not visible below skirt level.

• Fluid intake should be at least 2 pints/1 litre over 24 hours. 4.5

• Patients should be advised, in addition to a high fluid intake, to eat a high fibre diet to
avoid constipation.

Supra-pubic catheters

The following principles apply where a patient has a suprapubic catheter in-situ.

• Regular wound care of the insertion site is imperative. A dressing should not be necessary.

• Over granulation (occasional overgrowth of the tissue from the insertion site), if not causing
concern, does not require intervention. It may respond to Silver Nitrate Cauterisation or
application of a foam dressing. Silver Nitrate should not be the first choice to treat over
granulation. 5

• When using Silver Nitrate, care should be taken to protect the catheter. DO NOT use
petroleum based ointments or creams.

• Movement of the suprapubic catheter into/out of the wound should be avoided by careful
fixation of the catheter and connection tubing at or below the insertion site.

• Traction on the catheter should be avoided at all times, by regularly emptying the urine
drainage bag and by the use of supporting straps/garments, bag stands or hangers.

• The drainage bag should always be kept below the level of the bladder to maintain
gravitational flow and prevent backflow of urine.

Catheter Care Guidelines WPCT Page 7 of 35

• Avoid disconnecting the drainage bag from the catheter in order to maintain a closed
system at all times.

Closed drainage system: principles of management

There is a clear correlation between the number of times the drainage system is disconnected
and the rate of infection. It is important, therefore, to keep the drainage system CLOSED at all
times. The bag should only be disconnected from the catheter when the following occurs:

• The bag requires changing

• Bladder irrigation is necessary

• The catheter becomes blocked

Changing of urine drainage bags - Day/Night

The bag should be changed when there is an accumulation of sediment, leakage, when a
new catheter is inserted, or when the bladder has been irrigated. Bags should last for at least
5 to 7 days.

The changing of urine drainage bags on a daily basis incurs unnecessary expense and entails
disconnection of the system more often than is necessary.

A leg bag should be in situ for approximately 5 for 7 days, but changed more often if there is
infection present. The tap end of the leg bag should be wiped with a 70% Isopropyl Alcohol
Swab before fitting the night bag connector (2000ml). 2

A disposable night drainage bag should be used, and disposed of accordingly each morning.

N.B For patients who are bed bound, a drainable 2 litre drainage bag may be used only if
connected directly to the catheter, and left in situ for 5 to 7 days.

Catheter Change

Catheters need changing only if they become obstructed or a malfunction occurs. If a catheter
continues to drain adequately, LEAVE IT ALONE, until its 12 week life expires.

Urine Samples

Urine samples should always be taken from the sample sleeve on the drainage bag and
never from the catheter itself. (See Appendix 9)

Catheter Strap

It is preferable to use a catheter strap to anchor the catheter to the patient’s thigh. This
prevents the catheter pistoning and subsequent trauma.

Catheter Care Guidelines WPCT Page 8 of 35

Bathing the catheterised patient

The leg drainage bag should not be disconnected but should be emptied before bathing and
can either be immersed in the bath or placed on a suitable surface at the edge of the bath.

The use of showers is strongly recommended, since there is less risk of infection.

Clamping

If for any reason clamping of the system is necessary, use the drainage bag tubing for this
purpose, never the catheter.

Use of spigots

Spigots should never be used, as they must be removed from the catheter to allow drainage,
thereby breaking what is essentially a closed drainage system and increasing the risk of
infection.

Catheter valves

Catheter valves are designed to ensure a free flush of urine through the catheter. This gives
less opportunity for blockage and, because the valve remains permanently connected to the
catheter, the chances of ascending infection are greatly reduced. Catheter valves should be
in situ for 5/7 days.

Bladder irrigation in the home

Bladder irrigation is the process of flushing the bladder with a sterile fluid. It is performed for
the following reasons:

• To prevent formation and retention of blood clots, tissue debris, pus and calculi

• To clear an obstructed catheter

• To remove debris from a diseased or infected urinary bladder

• To instil prescribed fluids into the bladder

The procedure is included in Appendix 13

Removal of a self-retaining catheter

There is strong evidence that return to a normal voiding pattern occurs more rapidly if
catheters are removed at midnight.

Exercise extreme care to prevent urethral trauma.

Citric Acid 6% may be used prior to removal, if encrustation is suspected in long-term

catheterised patients. If used, it should be inserted 20 minutes before removal of the catheter.

Catheter Care Guidelines WPCT Page 9 of 35

Once the balloon has been deflated, the patient may remove his own catheter under
supervision.

The procedure is included in Appendix 10

Collection of mid stream specimen of urine

The object of collecting a mid-stream specimen is to obtain a fresh, clean and

uncontaminated specimen of urine. Old and stale specimens are useless. Contaminated
specimens will give an incorrect reading in laboratory tests.

The procedure is included in Appendix 12

Monitoring Tool
Standards

Aspect % Exceptions

All healthcare personnel involved in care 100 None

are trained and updated.

Individual patient care is observed 100 None

All healthcare personnel involved in care 100 None

are up to date with Continence Prescribing
Formulary

All healthcare personnel involved in care 100 None

are up to date with Infection control
policies.

How will monitoring be carried out? Observation/

Questionaire

When will monitoring be carried out? 12 monthly intervals

Who will monitor compliance with the guideline? Continence Advisory

Team

Catheter Care Guidelines WPCT Page 10 of 35

References
Abrams and Klevner (1996) Scandinavian Journal of Urology Vol 179, p47-53

Addison, R (2000) Bladder washout/irrigation/installation. A guide for nurses.

Association for Continence Advice (2003) Notes on good practice

Baun (2000) British Association for Urology Nurses

Britton Petra M, Wright Elizabeth S, (1990) Nursing care of catheterised patients. The
Professional Nurse

De Courcy-Ireland, K. (1993) An issue of sensitivity. Professional Nurse, Aug 1993.

EPIC Guidelines – Developing National Evidence-based Guidelines for Preventing Healthcare

Fader M, Pettersson L, Brooks R, et al (1997) A multi-centre comparative evaluation of

catheter valves. British Journal of Nursing Vol. 6(7): 359 – 67

Gentry H, Cope S (2005) Using silver to reduce catheter-associated urinary tract infections.
Nursing Standard. 19,50,51-54. Date of acceptance: June 20 2005

Getliffe, K. (1995) Bladder installations and bladder washouts in the management of

catheterised patients. Journal of Advanced Nursing 1996, 23, 548-554.

Getliffe, K. (1996) Care of urinary catheters. Nursing Standard. Vol 11, no.11.

Getliffe, K and Dolman, M (1997) Promoting Continence

Glenster, H. (1987) The passage of Infection Nursing Times. June 3-9,(22), 68-73Associated
Infections (Jan 2001), Vol 47

Lowthian, P. (1998) The dangers of long term catheter drainage. British Journal of Nursing
1998. Vol 7, no.7.

Medical Devices Agency (2001 FEB)

Mulhall AB, King S, Lee K, Wiggington E (1993) Maintenance of closed urinary drainage
systems: are practitioners more aware of the dangers? Journal of Clinical Nursing Vol.2 135 -
140

NICE Guidelines – Prevention of Healthcare Associated Infection in Primary and Community

care. (June 2003)

Pomfret, I. (1994) An Unsuitable Job for a woman? Nursing Times. Vol, 90 no.22.

Public Health Laboratory Services (1997) Preventing Hospital Acquired Infections –

Guidelines.

Catheter Care Guidelines WPCT Page 11 of 35

Roe B (1993) Catheter -associated urinary tract infections: A review. Journal of clinical
Nursing Vol. 2 197 – 203

Royal Marsden Book of Procedures (1996)

Winn, C. (1996) Catheterisation : extending the scope of practice. Nursing Standard. Vol 10,
no.52.

Worcestershire Health Authority Infection Control Manual (2000)

WSSA Infection Control Policy (August 2002)

Catheter Care Guidelines WPCT Page 12 of 35

 Catheter Care In the Community Guidelines
Appendices

1. Catheterisation Procedure: requirements

2. Male Catheterisation

3. Acute retention pathway

4. Trial without catheter

5. Female Catheterisation

6. Supra-pubic Catheterisation

7. Intermittent Self-Catheterisation (Female)

8. Intermittent Self-Catheterisation (Male)

9. Emptying the Urine Drainage Bag

10. Changing a Urine Drainage Bag

11. Obtaining a Catheter Drainage Specimen of Urine

12. Removal of a Self-retaining Catheter

13. Bladder irrigation

14. Collection of a Mid Stream Specimen of Urine: Male/Female

Catheter Care Guidelines WPCT Page 13 of 35

Appendix 1: Catheterisation Procedure: requirements
Sterile Catheterisation Pack

Protection for bed

Normal saline

Catheter

Shermond Polyfield Dressing aid or Sterile gloves (Latex/Vinyl)

Drainage bag and holder

Lignocaine 2% Antiseptic Gel (e.g. Instillagel)
10ml Syringe, needle

10ml sterile water

Sterile Boric Acid container and laboratory form, if CSU required

Apron

Patient’s notes

Catheter Care Guidelines WPCT Page 14 of 35

Appendix 2: Male Catheterisation
Only appropriately trained staff who are competent and confident should carry out Male
Catheterisation.

Procedure Notes

Explain fully to the patient why and how

the procedure will be carried out.

Cleansing of area prior to procedure. If possible the patient should have a bath or
shower prior to catheter insertion, or,
alternatively, a thorough wash with soap and
water of the genital area.

The patient is asked to lay flat on the bed

and bed protection placed in situ.

Prepare clean working surface, ensuring
good light. Wash hands and put
disposable plastic apron on. Open packs
and prepare equipment required. Do not
remove inner wrapper from catheter at
this stage.
Failure to adhere to strict aseptic technique
could lead to the patient acquiring a urinary
tract infection which would mean pain and
discomfort.

Apply Stermond Polyfield dressing

gloves, apply drape and place around
penis.

The foreskin is then retracted and the This area must be cleaned thoroughly, as it
glans penis cleaned with soap and water can harbour many bacteria.
or normal saline

Holding the penis upright, retract foreskin WAIT a minimum of 4 minutes (as per
if necessary, local anaesthetic gel is then manufacturer’s instructions) before carrying on
instilled slowly into the penis. with procedure.

Remove gloves, wash hands. Apply

sterile Latex/Vinyl gloves. Place receiver
between patient’s legs.

Proceed with catheterisation holding the

penis at an angle of 45 degrees, and
extending slightly, expose the tip of the
catheter from the inner wrapping insert
the catheter into the urethra pushing
gently and slowly, and simultaneously
remove wrapping until urine appears.

Catheter Care Guidelines WPCT Page 15 of 35

Do not force the catheter. In case of Resistance may be due to insufficient
resistance, encourage the patient to relax anaesthesia or muscle spasm.
and try to pass urine. If resistance
continues, medical advice should be
sought.

When urine drains back, slowly insert the If a specimen of urine is required it should be
required amount of water in balloon. taken at this stage. Ensure the outlet tap of the
bag is n the closed position.
Apply drainage bag.

When the catheter is in situ, the foreskin This is to prevent phimosis occurring.
must be drawn back over the glans penis.

Make patient comfortable and ensure

catheter is draining adequately.

Chart output. Record type and size of catheter, catheter

number, lot number, together with date and
time of insertion in care plan. Record the
amount of residual urine drained from the
bladder. Note any abnormalities, e.g. blood-
stained urine.

Catheter Care Guidelines WPCT Page 16 of 35

Appendix 3: Acute Painful Retention in Adult Males Care Pathway
ACUTE PAINFUL RETENTION IN
ADULT MALES

CATHETERISE and HISTORY TAKEN by

COMPETENT CLINICIAN

SUCCESSFUL HIGH RISK PATIENT UNSUCCESSFUL

DISTRICT NURSE REVIEW ADMISSION TO ADMISSION TO

NEXT WORKING DAY COMMUNITY UNIT UROLOGY INDICATED
INDICATED IF BED
AVAILABLE

GP REVIEW
BLOODS REQUIRED:
PSA, U&E, CREATININE
*(NEXT WORKING DAY)
CHECK BLOOD PRESSURE COMPLICATIONS EMERGENCY
START ALPHA BLOCKERS** UROLOGY REFERAL
(EG: Alfuzosin Hydrochloride)

TWOC within 4 days BY UNSUCCESSFUL

DISTRICT NURSE TWOC

SUCCESSFUL TWOC
IF PSA WAS ABNORMAL RECATHERISE and REFER
REPEAT IN 6 WEEKS TO UROLOGY

NURSE LED BPH FU RECURRENT

NO ACUTE REFERAL EPISODES OF
UROLOGY OPD MARKED
INDICATED RETENTION
URGENT (WITHIN 4-6 WEEKS)

MANAGEMENT OF ACUTE PAINFUL

RETENTION IN ADULT MALES
CARE PATHWAY OCT. 2005

Worcestershire Acute Retention Pathway Group 2006

Catheter Care Guidelines WPCT Page 17 of 35

Acute Urinary Retention in Adult Males: Definitions for Pathway
ƒ Catheterisation arranged by first contact. Catheterised at
home/PCC/Surgery/Community Unit by competent clinician

ƒ Successful catheterisation presenting with haematuria within one hour of

catheterisation should have an emergency urology admission

ƒ Patient presenting at A&E should be catheterised and follow pathway with referral
to community clinicians (see contacts)

ƒ High risk patients include: Ca Prostate, Elderly frail, Living alone, Heart valves

ƒ If admission required for infection, elderly unable to cope, social care, high risk (as
above) explore community beds in locality before acute admission

ƒ DN to review patient next working day and arrange catheter supplies

ƒ GP review within 24 hours. Take bloods, check Blood Pressure and start Alpha
Blockers (e.g. Alfuzosin Hydrochloride)

ƒ *Bloods required: U&Es, PSA, Creatinine, If weekend, bloods preformed on next

working day

ƒ Complications include: bleeding, haematuria, abnormal blood results

ƒ Trial without Catheter (TWOC) undertaken by DN in community location

ƒ Nurse led BPH (Benign Prostatic Hyperplasia/Prostate assessment) clinics for

follow up in uncomplicated cases

ƒ Recurrent means more than 2 episodes in 12 months. Referral direct to Urology

ƒ Outpatient referrals for failed TWOC will be seen within 4-6 weeks as agreed by
Urology Department. These should be marked as URGENT

ƒ More urgent cases should be referred as such using pathway

ƒ Female Acute Retention should be catheterised then discussed with on-call

urologist. If unable to catheterise then acute admission indicated

TWOC = Trial without Catheter

BPH clinic = Benign Prostatic Hyperplasia

**Alpha Blockers may be continued for BPH following a successful TWOC

Page 18 of 35
Appendix 4: Trial without Catheter

Worcestershire Community Continence Advisory Service

Trial without Catheter (TWOC)

Community Protocol

Referral made to District Nursing Service for TWOC

ƒ A qualified/competent healthcare professional should remove the catheter

early morning on the day for TWOC

ƒ The healthcare professional will instruct the patient to record fluid intake and
output on the attached form

ƒ An emergency contact telephone number should be given for the during the
day in case the patient has voiding difficulties

ƒ Re-visit patient mid-afternoon and review patient output during the TWOC

ƒ If frequency and output volumes satisfactory arrange follow up or refer to

Continence Advisory Service (CAS)/BPH clinic for further assessment

ƒ If symptoms indicate retention, re catheterises and follow Acute Retention

pathway (if appropriate)

ƒ If in any doubt refer to the Continence Advisory Service for further advice

Catheter Care Guidelines WPCT Page 19 of 35

 TRIAL WITHOUT CATHETER (TWOC) COMMUNITY PROTACOL

NAME:____________________________DOB_______________
_

DATE UNDERTAKEN:_________TIME CATHETER REMOVED:___________

PATIENT INSTRUCTIONS
1. Please drink at regular intervals through out the day to comfortably fill your bladder.

2. Please measure and record all fluids drunk and all urine passed.

3. If at anytime during the day you cannot pass urine and it becomes
uncomfortable, please contact the District Nurse on the emergency number given.

PATIENT PLEASE COMPLETE THIS SECTION

TIME INTAKE OUTPUT TIME INTAKE OUTPUT

0830 1230
0900 1300
0930 1330
1000 1400
1030 1430
1100 1500
1130 1530
1200 1600

DISTRICT NURSE or NURSE ADVISER TO COMPLETE THIS SECTION

Bladder control during trial: Good Fair Poor

Bladder emptying: Completely Partially Not at all

Catheter Care Guidelines WPCT Page 20 of 35

 Overall Outcome

Discharged successfully without catheter – referred to BPH clinic

Re catheterised with referral back to consultant
Treatment of urinary symptoms post TWOC eg; Alphablockers , UTI
Other – Specify

Other Useful Information:

Signature of Nurse_____________________________

Date __________________________

Catheter Care Guidelines WPCT Page 21 of 35

Appendix 5: Female Catheterisation
Procedure Notes

Explain fully to the patient why, and how

the procedure will be carried out.

Cleansing of area prior to procedure. Failure to adhere to an aseptic technique could

lead to the patient acquiring a urinary tract
infection, which would mean pain and
discomfort. If possible, the patient should have
a bath or shower prior to insertion, or,
alternatively, a thorough wash with soap and
water of the genital area.

Lie patient in semi-recumbent position Alternatively, if the meatal opening is

with knees bent and abducted to either concealed, it may be easier to find with the
side as far as possible. Place bed patient in the left lateral position, with her knee
protection under patient’s buttocks. drawn up to her chest, so that the anterior
vaginal wall can be seen from behind.

Prepare clean firm working surface

ensuring good light. Wash hands and put
on disposable plastic apron. Open packs
and prepare equipment required. Do not
remove inner wrapper from the catheter
at this stage.

Apply Stermond Polyfield dressing gloves

and clean genital area downwards with
normal saline and cotton wool. Separate
labia whilst cleaning, using gauze swabs.

Insert Anaesthetic Lubricating Gel. A Lubricating the urethra reduces friction and
small amount placed around the urethral trauma to the urethral mucosa. Use of a local
meatus will help to dilate the urethra anaesthetic minimises the patient’s discomfort.

Remove gloves, wash hands.

Apply sterile Latex/Vinyl gloves. Place

receiver between patient’s legs.

Expose catheter tip from inner wrapping.

Gently expose meatus and insert catheter
slowly, gradually removing remaining
wrapping simultaneously.

Page 22 of 35
When urine drains back, slowly insert If a specimen of urine is required, it should be
required amount of water into balloon. taken at this stage. Ensure clamp is closed at
Apply drainage bag. the end of bag.

Make patient comfortable.

Chart output. Record type and size of catheter, catheter

number, lot number, together with date,
balloon size and time of insertion in care plan.
Record the amount of residual urine drained
from the bladder.

Note any abnormalities, e.g. blood- stained

urine.

Catheter Care Guidelines WPCT Page 23 of 35

Appendix 6: Supra-pubic Catheterisation
Only appropriately trained staff that are competent and confident should change a supra-
pubic catheter.

Procedure Notes

Explain fully to the patient why Failure to adhere to strict aseptic technique could
and how the procedure will be lead to the patient acquiring a urinary tract
carried out. infection which would mean pain and discomfort

Cleansing of area prior to If possible the patient should have a bath or

procedure shower prior to catheter insertion, or, alternatively,
a thorough wash with soap and water.

The patient is asked to lie flat on

the bed and bed protection placed
in situ.

Prepare clean working surface

ensuring good light. Wash hands
and put disposable plastic apron
on. Open packs and prepare
equipment required. Do not
remove inner wrapper from
catheter at this stage.

Apply latex/vinyl gloves. Cleanse

around the insertion site with
normal saline

Gently attach syringe nozzle to Make a mental note of the length of catheter
the valve on the inflation channel removed from the abdomen.
and deflate the balloon steadily
and unhurriedly, i.e. 10-20
seconds.

N.B. It has been noted that the catheter balloon is less likely to cuff, if you do not pull back on
the syringe when deflating the balloon. This is currently being researched.

Withdraw the catheter from the
tract Note the angle that it
comes out at. Put catheter to
one side so that it can be
examined later on.
You may need to corkscrew it a bit and there may be
a gush of urine as you withdraw it, have some gauze
ready?

Put on sterile gloves.

Catheter Care Guidelines WPCT Page 24 of 35

 Insert the new catheter into the
tract a little further than the one
you removed, again you may
need to corkscrew the catheter
in. Inflate the balloon with 10ml
of ‘water for injection’ or inflate
the pre-filled balloon, and pull
back until you feel resistance.
The new catheter needs to be inserted within
approximately 10mins, so although there is no need
to panic and rush, it should be readily available. It
should be the same size, even if the one you
removed seemed a little tight.
Connect new sterile collection system. Observe for
drainage, which may not be immediate and might be
a little blood stained. Examine the old catheter for
signs of encrustation, including cutting it across the
lumen to examine the internal surfaces.

Record type and size of catheter, catheter number,

lot number, together with date and time of insertion in
care plan.

Record the amount of residual urine drained from the

bladder. Note any abnormalities, e.g. blood-stained
urine.

NOTES:

• Nurses worry about getting the catheter in the peritoneal space rather than in the bladder.
If the catheter is not far enough into the bladder, résistance will be felt when attempting to
fill balloon, and patient will feel pain. If this happens, deflate the balloon and advance the
catheter in further before re-inflating. There may not be any urine drained straight away,
but you should see some in the next ½ hour.

• A small amount of blood may be apparent at supra pubic catheter changes, but this should
stop in the next 24 hours.

• Discomfort due to bladder spasm may also occur.

Catheter Care Guidelines WPCT Page 25 of 35

Appendix 7: Intermittent Self-Catheterisation (Female)

Guidance for teaching self catheterisation to female clients.

Equipment Required:
• Appropriately sized catheters
• Clean catheter
• Mirror

Procedure Notes

Explain and discuss the

procedure with the patient.

Wash hands using soap and To reduce the risk of cross-infection.

water.

Ask the patient to prepare the

catheter as per manufacturers
instructions.

Ensure the patient is in a To facilitate insertion of the catheter.

comfortable position. Eg, either
sitting on toilet; standing upright
or lying on the bed.

Using a mirror, if required, ask

the patient to locate and spread
the labia to expose the urethra.

Ask the patient to insert the To reduce risk of infection and ease insertion of
catheter into the urethra, using catheter.
non-touch technique.

Drain urine into the toilet or

container.

Explain they should remove the

catheter when the flow has
ceased.

Dispose of the catheter. To reduce risk of environmental contamination.

Wash hands using soap and

water.

Catheter Care Guidelines WPCT Page 26 of 35

Appendix 8: Intermittent Self-Catheterisation (Male)
Guidance for teaching self catheterisation to male clients

Equipment Required:
• Appropriately sized catheters
• Clean catheter

NB.
It is advisable that the patient has a bath or shower prior to catheterisation.

Procedure Notes

Explain and discuss the

procedure with the patient.

Wash hands using soap To reduce the risk of cross-infection.

and water.

Ask the patient to prepare

the catheter as per
manufacturers instructions.

Clean the glans penis. If To reduce risk of infection and ease insertion of catheter.
the foreskin covers the
penis it will need to be
retracted during the
procedure.

Ensure the patient is in a To facilitate insertion of the catheter.

comfortable position. E.g.,
either sitting on toilet;
standing upright or lying on
the bed.

The penis should be held

straight at an angle of 45
degrees to the abdomen.
A stand up mirror is helpful
for patients with a large
abdomen

Catheter Care Guidelines WPCT Page 27 of 35

 Ask the patient to insert the The prostate gland surrounds the urethra just below the
catheter into the urethra, neck of the bladder and consists of much firmer tissue.
using non-touch technique. This can enlarge and cause obstruction, especially in
older men.
NB: There maybe a
change of feeling as the
catheter passes through
the prostate gland and into
the bladder. Explain if
resistance is felt, DO NOT
continue; withdraw and
seek medical advice.

Drain urine into the toilet or

container.

Explain they should

remove the catheter when
the flow has ceased.

Dispose of the catheter To reduce risk of environmental contamination.

Wash hands using soap

and water.

Catheter Care Guidelines WPCT Page 28 of 35

Appendix 9: Emptying the Urine Drainage Bag

Requirements:
Plastic Apron
Latex/Vinyl Gloves
Suitable Receptacle e.g. Jug, Bottle, Urinal etc (single patient use only)
70% Isopropyl Alcohol Swab

Procedure:

• Wash and dry hands, thoroughly.

• Apply apron and gloves.

• Place receptacle under drainage bag outlet.

• Drain urine into receptacle.

• Close drainage outlet and wipe with 70% Isopropyl Alcohol Swab.

• Dispose of urine.

• Wash and dry receptacle thoroughly.

• Remove gloves and apron, wash and dry hands.

• Record output in patient’s notes.

Catheter Care Guidelines WPCT Page 29 of 35

Appendix 10: Changing A Urine Drainage Bag

The bag should be changed when there is an accumulation of sediment, leakage, and a new
catheter is inserted, or when the bladder has been irrigated. Bags should last for at least 5 to
7 days. It is false economy to employ cheap bags and change them daily.

Requirements

Latex/Vinyl Gloves
Plastic apron
Sterile urine drainage bag
70% Isopropyl Alcohol Swab.
Procedure

• Protect bed/chair

• Apply plastic apron

• Wash and dry hands

• Apply gloves

• Loosen cover from end of ‘NEW’ tubing

• Pinch catheter 3-5 cms from end and disconnect ‘OLD’ drainage bag, raising end of
tubing to drain residue urine into bag

• Wipe open end of catheter with a 70% Isopropyl Alcohol Swab.

• Holding ‘NEW’ tubing 3-5 cms from end, connect to catheter

• Remove used bag, measure and record volume of contents where appropriate

• Wash hands

• Write up notes

Catheter Care Guidelines WPCT Page 30 of 35

Appendix 11: Obtaining a Catheter Drainage Specimen of Urine
Using Self sealing band on drainage tubing

Requirements
Sterile 5 ml syringe and needle (BLUE no.12 recommended)
Plastic apron
Latex/Vinyl Gloves
70% Isopropyl Alcohol Swab
Sterile urine specimen bottle
Laboratory request card and bag
Clamp or artery forceps (if required)

Procedure

• Clamp tubing approximately 5 cms BELOW self sealing band on drainage tubing

• Wait until urine is visible above self sealing band

• Wash and dry hands. Apply sterile gloves

• Swab self sealing band with 70% Isopropyl Alcohol Swab

• Attach needle to syringe, insert the needle at an angle of 45 degrees through the
sample sleeve

• Aspirate 5 mls of urine, remove the needle from the syringe, and place the specimen
into the sterile container

• Dispose of syringe and needle in sharps box

• Release clamp on drainage tube (if used)

• Label Specimen, complete card, send to laboratory using Boric acid urine container

• ( If the specimen has to be left overnight, it should be stored in a refrigerator)

• Wash hands

• Write up notes

Catheter Care Guidelines WPCT Page 31 of 35

Appendix 12: Removal of a Self-retaining Catheter
*There is strong evidence that return to a normal voiding pattern occurs more rapidly if
catheters are removed at midnight.

Requirements
Latex/Vinyl Gloves
Plastic Apron
10 ml syringe
Citric Acid 6% (e.g Solution R) if appropriate
Suitable receptacle for collection
Note: Exercise extreme care to prevent urethral trauma

* Citric Acid 6% may be used prior to removal, if encrustation is suspected in long-term

catheterised patients. If used, it should be inserted 20 minutes before removal of the catheter.

Once the balloon has been deflated, the patient may remove his own catheter under
supervision.

Procedure
• If patient is bed bound, protect the bed
• Apply plastic apron
• Wash hands, apply gloves
• Gently attach syringe nozzle to valve on the inflation channel and deflate the balloon
steadily and unhurriedly, i.e 10-20 seconds at least
N.B. It has been noted that the catheter balloon is less likely to cuff, if you do not pull
back on the syringe when deflating the balloon. This is currently being researched.
• If standard deflation procedure fails, do not cut off the inflation funnel
• Check whether the non-return valve on the inflation channel is sticking.
If so :
• Use a syringe and needle to aspirate the inflation arm just above the arm.
• If unsuccessful, refer for Medical Advice
• Dispose of syringe and needle (if used) in sharps box
• Remove catheter very gently and unhurriedly
• Inspect catheter on removal for encrustation, damage etc., and establish future
catheter selection and optimum time for next catheter change
• Clear away equipment, wash hands and chart observations

Catheter Care Guidelines WPCT Page 32 of 35

Appendix 13: Bladder Irrigation
Bladder irrigation is the process of flushing the bladder with a sterile fluid. It is performed for
the following reasons:

a) To prevent formation and retention of blood clots, tissue debris, pus and calculi

b) To clear an obstructed catheter

c) To remove debris from a diseased or infected urinary bladder

d) To instil prescribed fluids into the bladder

Requirements for bladder irrigation

It is preferable that the appropriate solution should be used.

Shermond Polyfield dressing aid or Sterile Latex/Vinyl Gloves

Plastic apron

Sterile drainage bag

Appropriate solution

Non-sterile gloves

70% Isopropyl Alcohol Swab

Procedure Notes

Explain the procedure to the

patient

Protect bed or chair

Put on plastic apron, wash

hands and apply Non sterile
gloves, empty urine drainage
bag

Prepare solution in
accordance with
manufacturers instructions

Position comfortably, Maintain privacy and keep patient warm throughout

ensuring ease of access to procedure
the catheter

Catheter Care Guidelines WPCT Page 33 of 35

 Wash hands and put on sterile Handling of the irrigation system and catheter should
gloves using inner wrapping be performed aseptically.
as sterile field

Wipe open end of catheter

70% Isopropyl Alcohol Swab

Holding catheter 3 cms from

end, insert solution connector
into catheter,

Perform irrigation, following

manufacturers instructions

Remove connector from

catheter and re-connect to
sterile drainage bag

Clear away, wash hands

Write up notes

It is essential to check the following:

• that drainage is occurring

• the colour of the drainage

• that the patient has no pain/discomfort

• that there is more fluid draining out than being infused

• that there is no leakage around the catheter

Careful observation of patient, urine output and careful recording of fluid balance are
imperative

Catheter Care Guidelines WPCT Page 34 of 35

Appendix 14: Collection of a Mid Stream Specimen of Urine: Male/Female
The object is to obtain a fresh, clean and uncontaminated specimen of urine. Old and stale
specimens are useless. Contaminated specimens will give an incorrect reading in laboratory
tests.

Instruct the patient to:

1. (a) Thoroughly wash hands (as per local infection control policy) and genital region,
including between the labia and in the folds under the foreskin.

(b) Dry well with a clean towel

(c) Do not use talcum powder or disinfectant

(d) Use Boric acid urine container. This will preserve the specimen until it reaches the
laboratory.

(If the specimen has to be left overnight, it should be stored in a refrigerator.)

2 Remove the cap from the sterile bottle and put it down on a clean surface, rim
upwards. Be careful not to touch the inside of the bottle or cap

3. Instruct the patient to take the bottle in one hand, separate the labia with the fingers of
the other hand, males retract the foreskin with the other hand, and then begin to pass
urine

4. After the patient has started to urinate, he or she should hold the bottle in the flow; the
bottle must then be removed before the flow ends.

5. Replace the cap firmly and shake the bottle well. Rinse and dry the outside of the
bottle. Label the bottle clearly with the name, address, date and time, record
appropriate information on laboratory form. Ensure that specimen reaches the
laboratory as soon as possible

N.B If the patient is elderly or has poor manual dexterity, a sterile receptacle may be used
to collect the specimen, and the specimen transferred to the urine collection bottle.

Catheter Care Guidelines WPCT Page 35 of 35