Name:

DoB

NHS No:
NURSING CARE PLAN
HEALTH NEED / PROBLEM GOAL PLAN
• Provide verbal and written advice to patient / carers
To promote comfort and
REQUIRES A LONG TERM reduce anxiety • Ensure patient / carers understand the signs & symptoms of possible urine infection
URINARY / SUPRA-PUBIC
CATHETER To reduce risk of • Advise to contact Central Booking Service, District Nurse or GP if patient has any
(cirlce as appropriate) infection and obstruction symptoms of infection or the catheter is not draining properly

• Ensure patient / carers know how to obtain new supplies of catheters and bags and
understand the importance of maintaining availability of sufficient supplies
DATE ORIGINALLY INSERTED:
• Competent practitioner to change catheter as necessary and / or at …………weekly
…………………………………….. intervals (no longer than 12 weeks) following Trust policy and procedure and
manufacturers guidelines
RATIONALE FOR CATHETER:

…………………………………….. Care of the catheter in the community leaflet Date given: ……………………

……………………………………..

To maintain patency of • Points to consider: constipation, positional, tube kinked, use of straps, fluid intake,
CATHETER NOT catheter and drainage of trauma, UTI, anti-cholinergic (bladder spasm), blockage
DRAINING urine • Observe catheter draining after 10 minutes

If blocked more than 3 times consider bladder maintenance solution – refer to

preferred prescribing guidelines

Date commenced …………….. .….. Print name……………………….............. Signature……………………………… Role………………………

Review dates …………………… Print name………………………………... Signature……………………………… Role………………………
…………………… Print name………………………………... Signature……………………………… Role………………………
…………………… Print name………………………………... Signature……………………………… Role………………………
…………………… Print name………………………………... Signature……………………………… Role………………………
Date discontinued ………………....... Print name………………………………... Signature……………………………… Role………………………

E12 Catheter Care Plan, July 2015

Catheter change diary Date/Time Date/Time Date/Time

Make /Size /Lot /Expiry date:

supra-pubic / urethral
Sticker if available
Reason for change
(routine / blocked)
Next due date for change

Catheter care reinforced (please circle) Verbal Written Verbal Written Verbal Written
Urine draining post catheterisation Yes No Yes No Yes No
Urine clear post catheterisation Yes No Yes No Yes No
Is catheter still required? Yes No Yes No Yes No
Comments eg: urinalysis, CSU
encrustation, debris/mucus, haematuria,
catheter maintenance solution used
Name, role and signature

Catheter change diary Date/Time Date/Time Date/Time

Make /Size /Lot /Expiry date:

supra-pubic / urethral
Sticker if available
Reason for change
(routine / blocked)
Next due date for change

Catheter care reinforced (please circle) Verbal Written Verbal Written Verbal Written
Urine draining post catheterisation Yes No Yes No Yes No
Urine clear post catheterisation Yes No Yes No Yes No
Is catheter still required? Yes No Yes No Yes No
Comments eg: urinalysis, CSU
encrustation, debris/mucus, haematuria,
catheter maintenance solution used
Name, role and signature