Urology - Catheter Insertion and Management, Bladder Irrigation, Nephrectomy and Trans Urethral Prostatectomy (TURP)

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Canberra Hospital and Health Services

Clinical Procedure
Urology – Catheter Insertion and Management, Bladder
Irrigation, Nephrectomy and Trans Urethral Prostatectomy
(TURP)
Contents
Contents................................................................................................................................... 1
Purpose.................................................................................................................................... 3
Alerts........................................................................................................................................ 3
Scope........................................................................................................................................ 3
Section 1 – Catheter Management for Adults (Inpatients and Community Based Patients)....4
Section 2 – Insertion of Female Indwelling Catheter (IDC).......................................................6
Section 3 – Insertion of Male Indwelling Catheter (IDC)..........................................................8
Section 4 – Suprapubic Catheter (SPC) Procedures for Inpatients and Community Based
Patients.................................................................................................................................. 10
4.1 Insertion of Suprapubic Catheter.............................................................................11
4.2 Changing Suprapubic Catheter: Inpatient................................................................14
4.3 Removal Suprapubic Catheter.................................................................................16
4.4 Management of Supra Pubic Catheter: Community Based Patient.........................17
Section 5 – Catheterisation Intermittent in the adult Inpatient.............................................19
Section 6 – Catheter Intermittent: Patient Education............................................................20
Section 6 – Catheter Flushing for Adult Community based patient........................................24
Section 7 – Trial of Void: Community based patient..............................................................25
Section 8 – Indwelling Urinary Catheter Management: Inpatient and Community...............27
8.1 Emptying a Urinary Drainage Bag: Inpatient specific...............................................28
8.2 Urinary Drainage Bag Management: Community Specific.......................................29
8.3 Removal of Indwelling Urinary Catheter..................................................................30
Section 9 – Trans Urethral Prostatectomy (TURP)..................................................................31
Section 10 – Bladder Irrigation...............................................................................................35
10.1 Continuous Bladder Irrigation..............................................................................35
10.2 Manual Bladder Irrigation....................................................................................37
Section 11 – Pre and Post Operative Management of patients undergoing a Nephrectomy. 39
Doc Number Version Issued Review Date Area Responsible Page

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Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register
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Section 12 – Management of patients undergoing a Percutaneous Nephrolithotomy..........44

Section 13 – Management of patients admitted with Pre-Existing Continent Urinary
Reservoirs/Neobladder during routine hospital admissions..................................................50
Implementation......................................................................................................................50
Related Policies, Procedures, Guidelines and Legislation.......................................................51
Search Terms..........................................................................................................................51
References..............................................................................................................................51
Attachments........................................................................................................................... 53
Attachment A: Stat Lock – Foley Stabilisation Device.........................................................54
Attachment B: Insertion of Urinary Catheter Sticker..........................................................55
Attachment C: How to care for your Urinary Catheter.......................................................56
Attachment D: Troubleshooting guide for urinary catheters.............................................58
Attachment E: Source of information and/or suppliers for urinary catheter equipment...67
Attachment F: Catheter selection.......................................................................................68

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Purpose
The Urology Assessment and Management Procedures describe practice which will be
performed by registered nurses, medical staff and allied health. New nursing or medical
staff, or students (within their defined scope of practice) will be required to perform these
skills under the direct supervision of a competent practitioner.
Clinicians providing assessment, education and clinical procedures must have current
theoretical and clinical knowledge in continence management.
To provide best practice in managing, educating and supporting patients requiring short/
long term management of urinary catheters.
Back to Table of Contents

Alerts
Strict hand hygiene should be adhered to at all times when performing all clinical procedures
as per Healthcare Associated Infections Procedure-Section 2 Infection Prevention & Control
Strategies
Consent must be gained for all interactions with patients and care provided consistent with
Intimate Body Care and Examinations by Health Care workers Standard Operating Procedure
All staff to adhere to Patient Identification and Procedure Matching Clinical Policy
Scope
This document applies to:

 Medical Officers (MO)
 Nurses and Midwives who are working within their scope of practice
 Students under direct supervision of a registered nurse.
Note: A medical officer/ nurse/ midwife is assessed as competent when they have:
 Observed the procedure

 Performed the procedure at least once under the supervision of a competent medical
officer/ registered nurse/ midwife
 Been assessed as competent by another competent registered nurse/midwife, medical
officer nominated by the Clinical Nurse Consultant (CNC) or CDN.

Section 1 – Catheter Management for Adults (Inpatients and Community
Based Patients)
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General Information:
 It is recommended that nursing staff who are inserting urinary catheters and/or caring
for and/or removing urinary catheters from patients complete the eLearning course
Indwelling Urinary Catheter and the competency assessment form, accessible via
Capabiliti.
 To introduce a urinary catheter to drain urine from the bladder. If a latex catheter is to
be inserted determine the patient’s latex allergy status.
 Patient assessment prior to catheterisation should include the exploration of possible
patient’s cultural values and beliefs that may influence healthcare practices and
consistent with ‘Intimate Body Care and Examinations by Health Care Worker SOP’ .
Verbal consent should be obtained especially where catheterisation of males by a
female nurse or female catheterisation by a male nurse is required.
 For patients with large capacity bladders, indwelling catheters and slow bladder
decompression are recommended. No more than 600mls is to be withdrawn from the
bladder at any one time unless otherwise indicated by the medical officer as this may
induce a syncopic episode.
Community Based Patients:

Contraindications for Catheterisation in the Community
 Acute prostatitis.
 Suspicion of urethral trauma.
1. ‘Medical Officer’s Orders for Urinary Catheter Management’ clinical record form (form
no. 40950) must be completed for all urinary management in the community setting.
Medical Officers orders for Catheters should be reviewed every three (3) years.
2. Catheters should be appropriate, comfortable, easy to insert and remove and must
minimize secondary complications such as tissue inflammation, encrustation and
colonisation by micro- organisms (See Attachment F)
3. The smallest gauge catheter suitable for the patient needs should be used and balloons
should generally be 5 to 10ml in size. Patients with a lesion above T6 should use a size
18 to 20Frg to avoid blockage and complications of autonomic dysreflexia.
4. Community Nurses will identify patients with spinal lesions at or above T6 and monitor
for autonomic dysreflexia during catheterisation. Where applicable first line emergency
management should be provided to those patients. Care provided should be consistent
with ‘Autonomic Dysreflexia SOP’
5. All catheters become colonised with bacteria after a few days. If a catheter specimen of
urine (CSU) is required this should only be obtained on change of the catheter not the
bag.
6. Community nurses will document the management of a patients ‘Urinary Catheter
Management Chart’ clinical record form (form no.60535)
7. Patients and/ or carers should be educated on how to care for their catheters and also
be provided with the pamphlet ‘How to care for your urinary catheter’, which can be
found on the Policy Register (see sample at Attachment C)

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8. Catheter flushing is a prescribed procedure using a small amount of fluid to maintain

patency of a catheter
9. Manual bladder irrigation or washout involves instilling large amounts of fluid into the
bladder withdrawing fluids for the purpose of removing debris and mucus from the
bladder. This procedure should be done under medical supervision and is not suitable
to be done in the community.
10. Patients with long - term catheter requirements are responsible for the provision of
ongoing equipment (catheters, leg bags, overnight bags, catheter straps, catheter
valves. Consider funding sources such as:
o Continence Aids Scheme (CAPS)
o ACT Equipment Subsidy Scheme (ACTES)
o Rehabilitation Appliances Program (RAP) of Department of Veterans Affairs (DVA)
11. If the patient is not eligible for any of these schemes, they may source equipment from
supplies either locally or interstate (see Attachment E)
12. Where possible, liaison should occur with the medical practitioner or management
team who inserted the catheter if there are any concerns regarding catheter
management in the community
13. Where possible patients should be encouraged to access one of the Community Health
Centres ambulatory clinics for their routine catheter change.
14. Where difficulties are experienced or anticipated, contact the continence CNC or GP; if
the matter is urgent call an ambulance.
15. If a catheter requires permanent removal, medical orders should be obtained from the
treating doctor and documented in client’s file (refer to Removal of Catheter) attached.
Alerts:
 Seek expert advice for patients with artificial heart values who grow Enterococcus
species in the urine prior to the procedure
 Patients with spinal lesions at or above T6 require monitoring for Autonomic
Dysreflexia: refer to ‘Autonomic Dysreflexia SOP’ for management pathway
 Do not clamp catheter prior to change
 The following conditions do not preclude catheterisation but extra care should be taken
when:
o The Patient is taking high dose anticoagulants increasing the risk of haemorrhage.
o If there is a history of recent surgery, cancer or radiotherapy to the lower urinary
tract, as there is increased risk of damage
o Consult with Medical officer or CNC if in doubt

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Section 2 – Insertion of Female Indwelling Catheter (IDC)
Equipment:
 Disposable catheter pack (includes extra gloves)
 0.9% Sodium Chloride 60ml
 Lubricant sachet Latex (short-term) or Silicone (long-term) catheters x two, usually 14 or
16F
 Sterile urinary drainage bag to meet patients needs
 One x 10ml syringe
 One x 10ml Sterile Water for Injection
 Securement device
Inpatient specific: Foleys Statlock device pack including skin prep
Community specific: Urinary Retaining Strap
 Measuring jug if required
 Procedural under pad
 Clean gown
 Sterile gloves
 Community specific: Sterile gloves x two
 Community specific: non sterile gloves
 Safety glasses or goggles
 Sterile specimen jar, if required
Procedure:
1. The medical officer must document the order for catheter insertion and removal in
clinical record
2. Community Specific: Medical Officers Catheter Management
3. Explain procedure to patient and ensure privacy
4. Patient identification and allergy band are checked against clinical notes and stickers.
5. Prepare equipment
6. Don safety goggles
7. Inpatient specific: Raise bed to the appropriate height
8. Position the patient supine with knees flexed drawn up soles of feet together, or knees
wide apart
9. Place procedural under pad beneath the buttocks
10. Don clean gown
11. Don sterile gloves (separate) then gloves from catheter pack
12. Remove the protective cover from the tip of the catheter ONLY. Lubricate, leaving the
catheter cover in place
13. Place the catheter in the dish
14. Using a clean swab each time, cleanse the labia majora with 0.9% Sodium Chloride using
downward strokes
15. Separate the labia with free hand, using gloved hand
16. Cleanse the labia minora and urethral meatus
17. Discard forceps and first pair of gloves. Drape patient with fenestrated sheet to
establish sterile area
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18. Separate the labia with free hand

19. Maintain the separation until the catheterisation is complete
20. Place the dish containing the catheter between the patient's thighs
21. Identify the urethra
22. Ask the patient to take a deep breath to relax the sphincter
23. Gently insert the catheter until urine flows, then advance 2.5cm further into the orifice
using the sterile catheter sleeve.
Note: Do not use force
24. Remove the sterile catheter sleeve and drain urine into the dish
25. Collect sterile urine specimen if required
26. Inflate the balloon with the required amount of sterile water (see balloon hub)
27. Remove the protective cap from the urinary drainage bag, seal outlet tube and attach to
the catheter
28. Inpatient specific: Attach statlock (dated) to the leg to anchor urinary catheter bag
(Attachment A)
Community specific: Catheter Retention Strap
29. Drain 600ml only then clamp for one (1) hour
30. Leave the patient comfortable
31. Lower the patient’s bed
32. Discard equipment
33. Inpatient specific: Record the procedure in the patient's clinical record (Attachment B):
a. Date and time of procedure
b. Type and catheter size
c. Amount of water in the balloon
d. Indication and scheduled date for removal or change
34. Community specific: Record the procedure using the ‘Urinary Catheter Management
Chart’ clinical record form (form no.60535)
35. Record output, clarity, colour and odour on the patient's FBC and clinical record
36. Perform urinalysis and document on General Observation Chart and clinical record
37. Record if a specimen is sent to pathology
38. Watch for haematuria and diuresis in patients with chronic urinary retention
39. Adjust the Patient Accountability and Care Plan to indicate IDC insitu and associated
perineal toilets required for hygiene needs
Alert: Companies who manufacture latex catheters recommend that the catheter be
changed every seven days. Silicone catheters as per manufacturers’ recommendations to be
changed 6 to 12 weekly.
Stabilisation of Urinary Catheters:

 Prepare skin with protectant and allow to dry
 Align anchor pad over securement site (arrow towards body)
 Press catheter into anchor and close lid
 Position on anterior thigh or abdomen

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 Peel away paper backing and place on skin (See Attachment A)

Section 3 – Insertion of Male Indwelling Catheter (IDC)
Equipment:
 Disposable catheter pack (contains extra gloves)
Community specific: sterile gloves x two
Inpatient specific: Betadine (check for Iodine allergy)
 10ml Lignocaine gel syringe
 Latex (short-term) or Silicone (long-term) catheters x two, usually 14 or 16F Sterile
urinary drainage bag
 1 x 10ml syringe
 Community specific: two x 10ml syringe
 1 x 10mls Sterile Water for Injection
 Securement devices
Inpatient specific: Foleys Statlock device
Community specific: Catheter Retention Strap
 Inpatient specific: Measuring jug
 Procedural under pads (one large & one small)
 Clean gown
Community specific: non sterile gloves
 Sterile gloves
Community specific: two x sterile gloves
 Sterile specimen jar, if required
 Sterile catheter introducer, if required (to be used by Medical Officer only).
Alert: A catheter introducer for the introduction of a catheter for male catheterisation is
only to be used by a medical officer
Procedure:
1. Inpatient specific: The medical officer must document the order for catheter insertion
and removal in clinical record
Community specific: Medical Officers Catheter Management
3. Remove the protective cover from the tip of the catheter only. Lubricate, leaving the
catheter cover in place
4. Place the catheter in the dish
5. Drape the genital area around the penis
6. Don safety eyewear and gown
7. Inpatient specific: Raise bed to appropriate height
8. Wash hands and don sterile gloves x two

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9. Position fenestrated drape to provide sterile field

10. Use non dominant hand to hold the penis. Where present retract the foreskin and swab
head of the penis paying particular attention to the urethral meatus and glans
11. Hold penis at a right angle (90 degree) to the body and gently instil Xylocaine lubricant
into the urethra: Gentle pressure underneath the head of the penis will minimise
lubricant leaking out. Allow sufficient time for anaesthetic to work (three to five
minutes).
Note: Do not proceed if patient has an erection, wait until this subsides
After this time you may:

12. Remove outer pair of sterile gloves if contaminated during the procedure
13. Holding penis at 90 degree angle, gently insert and advance catheter to the Y hub.
14. If resistance is felt at the bladder neck, lower the penis slightly and suggest that the
patient breathe slowly whilst pretending to pass urine. The catheter should never be
forced
15. If resistance continues, withdraw catheter and insert more anaesthetic gel. Re-insert
sterile catheter after a further three to five minutes. If further resistance is
encountered, seek advice from CNC, Continence CNC or Medical Officer
16. When urine begins to flow,(at least 15-20mls ) re-check the position of the catheter to
ensure it is still in the bladder, then inflate balloon with required volume of sterile
water (according to manufacturer’s instructions)
Alert: If resistance is felt at the external sphincter, slightly increase the traction on the penis
and apply steady, gentle pressure on the catheter. Ask the patient to attempt to void in
order to relax sphincter
17. Attach sterile drainage bag

18. Where present, replace foreskin to natural position
19. Secure bag to patients requirements
Inpatient specific: Attach statlock to the leg to anchor urinary catheter bag (See
Attachment A)
Community specific: Attach Catheter Retaining Strap
20. Drain 600ml only then clamp for one hour
22. Documentation:
Inpatient specific: Record the procedure in the patient's clinical record using the
Urinary Catheter Label: (See Attachment B):
c. Amount of water in the balloon
d. Indication and scheduled date for removal or change
16. Community specific: Record the procedure using the ‘Urinary Catheter Management
Chart’ clinical record form (form no.60535)
23. Record output, clarity, colour and odour on the patient's FBC and clinical notes

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24. Perform urinalysis and document on General Observation Chart and clinical notes
25. Inpatient specific: Record if a specimen is sent to pathology
Community specific: Contact GP if signs of infection present
26. Observe for haematuria and diuresis in patients with chronic urinary retention.
Inpatient specific: Adjust the Patient Accountability and Care Plan to indicate IDC insitu
and associated penile toilets required for hygiene needs
27. Perform hand hygiene when leaving the patients environment as per the 5 moments of
hand hygiene
Alert: Companies who manufacture latex catheters recommend that the catheter be
changed every seven days. Silicone catheters as per manufacturers’ recommendations to be
changed 6 to 12 weekly

Section 4 – Suprapubic Catheter (SPC) Procedures for Inpatients and
Community Based Patients
Background:
An SPC may be used for:
 The management of long-term urinary incontinence or retention of urine
 The drainage of urine post operatively in urological or gynaecological patients
 Patients with urethral and/ or pelvic trauma where the utilisation of a urethral catheter
is not possible
 Patients with ongoing problems associated with urethral catheters such as irritation or
continued blockage
The purpose of this is to provide guidelines for the management of a Suprapubic Catheter
(SPC) including:
 Insertion
 Catheter Change
o Inpatient
o Community based patient
 Dressing Changes
 Removal
 Management in the Community
This document pertains to adult patients requiring management of a SPC at the Canberra
Hospital and Community based patients
4.1 Insertion of Suprapubic Catheter

Initial insertion of a SPC may only be performed by a Medical Officer. Further catheter
changes may be attended in the community by nursing staff.
Equipment:

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 Alcohol based hand rub (ABHR)

 Basic dressing pack
 Sterile dressing towels x two
 Sterile gown and gloves
 Sterile water x 20 ml
 10ml syringes x three
 21g needle
 1% Lignocaine x10ml
 Drain sponge dressing
 Foleys Statlock device
 Suture material (as per medical officer’s preference)
 Suture set
 Suprapubic catheter introduction kit available from the operating rooms
 Sterile urinary drainage bag
 50ml bladder syringe
 500mls bottle 0.9 Sodium Chloride at room temperature
 Chlorhexidine skin preparation
 Adhesive tape of choice
 Safety goggles or shields
 Procedure underpad
 Clean gown
Alert: The patient will be required to have a full bladder for initial insertion to assist in the
palpation of the bladder and to prevent perforation of the bowel. A full bladder is not
required for routine subsequent changes.
Procedure:
1. Inpatient: The medical officer must document the order for the SPC insertion and
removal in the clinical record
2. Community specific: Medical Officers Catheter Management
3. Obtain the verbal consent
4. Explain to the patient the process and purpose of the procedure
5. Ask the patient if they have any allergies to dressings or tapes.
6. Ensure the patient has adequate analgesic cover prior to procedure if required or
requested
7. Assist patient to the supine position, placing procedure underpad beneath the buttocks
8. Don PPE
9. Clean trolley with detergent impregnated wipes and disposable towel, wipe dry
10. Set up equipment on trolley at the patient’s bedside
11. Don clean gown prior to opening sterile equipment
12. Open the procedure pack
13. Assist the medical officer with gowning after performing a procedural wash
14. Don clean gloves
15. Expose the suprapubic area

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16. Attend hand hygiene by either hand washing or using ABHR

17. Open further equipment required, such as the catheter pack, local anaesthetic, water
for balloon, suture material
18. Pour chlorhexidine skin preparation into sterile tray
19. The medical officer will insert the SPC, provide assistance if required
20. Reassure patient throughout the procedure whilst maintaining privacy
21. Once SPC inserted, attach urinary drainage bag, ensuring drainage system is closed
22. Place drainage bag below the patient’s waist height
23. A leg bag may be utilised, however is not advised at initial insertion time
24. Ensure Foleys Statlock device is securely attached to the patient’s skin and secure the
catheter
25. Apply drain sponge around SPC and secure with tape
26. Discard equipment and gloves into clinical waste receptacle
27. Clean trolley with detergent impregnated wipes
28. Ensure patient is comfortable with new dressing change and understands when the
next dressing change will be attended
29. Document in the patient’s clinical record using the Urinary Catheter Label:
o Date of SPC insertion
o Type and size of catheter
o Amount of water in the balloon
o Amount of urine drained
o Patient’s response to the procedure
30. Change dressing as frequently as required
Note: The insertion of a SPC for gynaecology patients on the ward may be performed under
ultrasound.
Dressing Change
Equipment:
 Sterile drain dressing
 0.9% Sodium Chloride (30ml)
 Personal protective equipment (PPE) including clean gloves and safety goggles or shield
 General waste receptacle
 Clinical waste receptacle
 Stat lock (optional)
Procedure:
1. Attend steps 1 to 14 of Insertion of SPC
2. Don PPE prior to opening sterile equipment
3. Open the basic pack and position equipment using the setting up forceps
4. Pour normal saline to tray

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5. Don clean gloves

6. Expose the SPC site
7. Remove the soiled dressing with setting-up forceps
8. Discard the dressing and forceps and gloves into the clinical waste receptacle
9. Inspect the SPC site for clinical signs of infection and healing
10. If signs of infection notify the Medical Officer and consider swab
Note: Once the SPC insertion site is healed, it does not require a dressing. The site may be
cleaned with warm soapy water during daily hygiene routines. Statlock device must remain
insitu to anchor the SPC to the body to avoid dislodgement.
11. Don clean gloves

12. Use wound cleansing solutions at body temperature .Irrigate with normal saline solution
to remove debris and contaminants
13. Swab gently and in one direction only
14. Ensure the site is dry before applying new dressing
15. Apply new dressing and secure with adhesive tape or bandages
16. Statlock device must remain insitu to anchor the SPC to the body to avoid dislodgement
19. Ensure patient is comfortable with new dressing change and understands when the next
dressing change will be attended
20. Change dressing or appliances as frequently as required to effectively remove excessive
exudate or infected material
21. Document in the patient’s clinical record and wound care chart:
o A description of the wound
o Type of dressing applied
o Any change of dressing
o The reason for the change
22. Urinary bags are to be emptied and cared for as per Urinary Bladder Management
23. Ensure the patient is involved in the care and management of the SPC in preparation for
discharge
Alert: Maintain a closed drainage system as much as possible so as to prevent infection. Do

not use talcum powder, creams or strongly scented soaps near the catheter site to avoid
irritation.

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4.2 Changing Suprapubic Catheter: Inpatient

First SPC change following initial insertion must be attended four to six weeks post insertion.
Medical Officers or Registered nurses may perform the first and subsequent suprapubic
catheter changes, where the catheter is a balloon catheter (Foley) or a Bonanno (Pigtail)
utilising aseptic technique unless otherwise specified by the Urologist.
If symptomatic urinary tract infection is suspected and patient is not on antimicrobial

therapy then reconsider need for change of SPC prior to clarification of infection status. If
change is still required then consult the medical team for consideration of treatment
immediately after change ensuring a mid-stream urine is obtained once the new catheter is
inserted.
Alert:
Size 16 and above catheters are recommended for Suprapubic catheterisations:
 Latex SPC’s must be changed every two weeks
 Silastic SPC’s must be changed every six weeks
 Hydrogel coated and 100% silicone catheters can remain insitu for up to 12 weeks
 It is recommended that Catheter changes are based on clinical indications such as
infection, obstruction, or when the closed system is compromised within the
manufacturers recommend time frame.
Equipment:
 ABHR
 Sterile dressing towels x two
 Sterile gown and gloves
 Clean gown
 Catheter of choice – preferably silastic
 Gauze swabs x two packs
 0.9% Sodium Chloride 30 to 60mls
 Sterile water 20ml
 Syringe 10ml
 Syringe 20ml
 Drainage tube dressing
 Sterile kidney dish
 Clean clamp
 Adhesive tape of choice (if required)
 General waster receptacle

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Alert: The patient’s SPC is to be clamped for 30 to 60 minutes prior to the procedure so as
to allow the bladder to fill for easier palpation
Community specific: Patient to consume oral liquids 30- 60 minutes prior to SPC change to
ensure bladder volume. Clamping of SPC not required in community setting. Clamping of
SPC not recommended in patients with spinal cord injury at T6 level or above or patients
with a diagnosis of Autonomic Dysreflexia
An assistant is required to assist gowning and to open further equipment such as the
catheter, sterile water and drainage bag
Procedure:
1. Attend steps 1 to 14 of SPC Dressing
2. Don Sterile gloves
3. Sterile catheter is placed in the sterile kidney dish
4. Swab around catheter site with 0.9% Sodium Chloride and gauze swab
5. Place sterile towels around SPC site
6. Second person to withdraw fluid using 20ml syringe from catheter balloon insitu
7. Catheter is then gently withdrawn; gentle rotation of the catheter may assist in removal
8. Discarded into clinical waste receptacle
9. Swab fistula site with 0.9% Sodium Chloride and gauze swab
10. Sterile dish containing catheter is placed on the sterile field
11. Catheter is inserted through the fistula at a 90 degree angle to the abdominal wall
12. Insert the catheter approximately 8 to 10cm or until urine is returned
13. Urine specimen may be collected if required
14. Inflate the balloon with the sterile water and 10ml syringe following manufacturer’s
instructions (5 to 10mls)
15. Connect the drainage bag to the catheter ensuring closed system
16. Apply drainage tube dressing if required
17. Secure the catheter to the abdomen with Foleys Statlock device
20. Ensure patient is comfortable with new SPC and dressing change and understands when
the next SPC and dressing change will be attended. Advise patient of signs and
symptoms of infection and to notify to the medical officer in charge of their case and
notify of any changes in the patients clinical condition post procedure.
21. Document in the patient’s clinical record using the Urinary Catheter Label:
o Date of SPC change
o Type of catheter and size
o The amount of water in the balloon
o The condition of the fistula
o The patient’s response to the procedure.

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4.3 Removal Suprapubic Catheter

Prior to the removal of the SPC ascertain if the patient is able to void by clamping the
catheter for two hours prior to the removal procedure. Check the urine residual using a
bladder scanner. The tip of the SPC is sent to pathology for analysis following removal where
ordered by a Medical Officer.
Equipment:
 Sterile gloves
 Stitch cutter or fine suture removal set, if required
 Syringe one x 20ml
 0.9% Sodium Chloride 30 to 60mls
 Sterile specimen jar
 Dry absorbent dressing
 Safety glasses or goggles (need to ensure this included in the steps)
 Bladder scanner
Procedure:
1. Attend steps 1-13 of SPC Dressing Change
2. Collect catheter specimen of urine (if required)
3. Don sterile gloves
4. Remove the suture (if present) holding the catheter insitu
5. If the SPC has a balloon, deflate using the relevant size syringe
6. Gently withdraw the catheter in a steady continuous motion
7. Using sterile scissors cut the tip off into a sterile specimen jar and send to pathology for
analysis if required
8. Use wound cleansing solutions at body temperature irrigate with normal saline
solution, to remove debris and contaminates
9. Swab gently and in one direction only
10. Ensure the site is dry before applying new dressing
11. Apply new dressing and secure with adhesive tape or bandage
14. Ensure patient is comfortable with new dressing change and understands when the
next dressing change will be attended
15. Document Inpatient’s clinical record using the Urinary Catheter Label:
o Date and time of the SPC removed
o Condition of fistula
o If the catheter tip is sent for MC&S
o Patient’s reaction to the procedure.

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Note: It is not unusual for a small amount of leakage at the fistula site on removal of SPC.
Regularly change the dry dressing and reassure the patient that this may continue for a few
days, however, no medical intervention is required
4.4 Management of Supra Pubic Catheter: Community Based Patient
Alert: If the Supra pubic catheter becomes dislodged it should be replaced within 30 - 45
minutes to prevent the stoma closing over.
 Following initial insertion, the tract will take 10 days to four weeks to become
established. If the catheter becomes blocked or dislodged within this initial phase,
expert medical advice should be sought as soon as possible. The patient should return
to the treating hospital for management.
 Prior to first change of a suprapubic catheter the ‘Medical Officer’s Orders for Urinary
Catheter Management’ clinical record form (form no. 40950) must be completed and
signed by the referring medical officer.
 Community nurses may perform the first and subsequent suprapubic catheter changes,
where the catheter is a balloon catheter (Foley) and NOT a Bonanno (Pigtail)
 First change of suprapubic catheters can be performed in the ambulatory clinic or in the
client’s own home unless otherwise documented by specialist or General Practitioner
(GP)
 The size of the catheter should be no smaller than 16Fg in adults with a 10ml balloon
 Ensure patient has had adequate fluid intake prior to procedure
 Catheters should not be clamped prior removal
 Always endeavour to re-insert same size catheter where possible
 If unable to re-insert a catheter, insert a nelaton catheter to keep stoma open and
arrange prompt transport to treating hospital for catheter reinsertion
 Urinary Catheters need to be changed at intervals that meet each client’s specific needs
and comply with manufacturers’ recommendations (usually 6 to 12 weeks). Careful
evaluation of each catheter change will enable the nurse to establish each patient’s
individual catheter change routine. Use a ‘Urinary Catheter Management Chart’ to
assist with this process
 Stabilising the catheter to the abdomen as well as to the upper thigh with a securement
device is vital to reduce adverse events such as dislodgement, tissue trauma, hyper-
granulation, inflammation and infection
 SPC stoma sites do not routinely require a dressing after the first 24 hours of initial
insertion. If the site is discharging a temporary sterile gauze dressing should be applied
 Ensure the patient is informed of the procedure should the catheter become dislodged
and that contact numbers are in place for Community Nursing team leader, the LINK
after hours service and the treating hospital
 Where difficulties are experienced or anticipated seek medical assistance
 Where a catheter is required to be removed permanently, medical orders should be
obtained from the treating doctor and documented Inpatient’s file
 Medical Officer’s Orders for Urinary Catheter Management should be reviewed every 3
years
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Patients with spinal lesions above T6 require monitoring for Autonomic Dysreflexia (do not
clamp catheter prior to change). The following conditions do not preclude catheterisation
but extra care should be taken when:
 The client is taking high dose anticoagulants as these increases the risk of haemorrhage.
 There is a history of recent surgery, cancer or radiotherapy to the lower urinary tract.
Consult with medical officer if in doubt.
Equipment:
 Sterile catheter pack
 Urinary catheter to meet patient’s specific needs (size 16 or above)
 Sterile Normal Saline (cleansing solution)
 Sterile gloves
 Non-sterile gloves
 Water soluble lubricating gel. (Lignocaine 2% gel for patient with SCI and/ or bladder
spasms)
 10 ml syringe
 Drainage equipment to meet patient’s specific needs
 Safety goggles
 Disposable Gown
 Antimicrobial hand gel
 Small sterile dry dressing may be required
Procedure:
1. Read medical order, identify correct client for catheter removal and re-insertion,
explain procedure and obtain consent from patient
2. Position patient appropriately for their comfort, condition and delivery of care:
clinic/home
3. Don safety eyewear and gown.
4. Deflate balloon, do not remove catheter (allow balloon to deflate without drawing back
on syringe to prevent balloon distortion)
5. Hand hygiene and don sterile gloves. Drape with sterile towel.
6. Lubricate tip of catheter. (Lignocaine 2% gel for patient with SCI and/ or history of
bladder spasms)
7. Clean around catheter insitu with normal saline
8. Place sterile fenestrated drape over area
9. Grasp the catheter with non dominant hand under the drape and remove catheter from
bladder.
Note: position, angle and length of the catheter from the stoma exit to the catheter hub
10. Insert new catheter immediately using your dominant hand at the angle and length of
catheter previously removed

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11. Advance the catheter into the tract a further 3 cm (not more) to prevent the catheter
tip irritating the bladder wall and to ensure the catheter passes into the urethra. If no
urine drains gently apply pressure over the symphysis pubis area
12. Once urine drains, insert the catheter approximately 3 cm further to ensure the
catheter is in the bladder and not the suprapubic tract
13. Slowly inflate balloon with required volume of sterile water (according to
manufacturer’s instructions), check patient for any ongoing discomfort or pain
14. Withdraw the catheter slightly and attach sterile drainage bag
15. Secure catheter to patient’s abdomen and the top of the thigh with securement device
then secure the drainage bag to the leg with leg straps. Discard equipment and attend
hand hygiene
16. Document the procedure in the client’s clinical and on Urinary Catheter Management
Form
Care of the Suprapubic Catheter:

 See Suprapubic Trouble shooting guide (Attachment D)
 The suprapubic catheter emerges at a right angle to the abdomen and needs to be
supported in this position
 It is not necessary to rotate the catheter at the insertion site between catheter changes
 Observe the SPC site for signs of infection and/ or over granulation
 Dressings should not be routinely used. If a dressing is required it must be sterile and
applied using an aseptic technique
 Hygiene is important and once healed the site should be washed with warm soapy
water, preferably twice daily. Cleaning should be directed away from the insertion site
 Talcum powder, creams and strongly perfumed soaps should be avoided.
 Patients should be made aware of the importance of hand washing both before and
after handling the catheter drainage system
Supply of catheter equipment:

 The treating nurse will educate the client on how to access the necessary supplies. (See
Urinary Drainage System Management for Community Based Patient)

Section 5 – Catheterisation Intermittent in the adult Inpatient
The purpose of this section is to introduce a catheter into the bladder to completely empty
the bladder or to measure residual urine volume
Equipment:
 Disposable catheter pack
 Short term Nelaton catheter of correct size (female 12-14 Fg/male 14-16Fg) i.e., smallest
size suitable
 Lubricant sachet
 Measuring jug
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 Clean gown
 Sterile gloves
 Sterile specimen jar, if required.
Procedure:
1. Follow the insertion procedure as noted for either female or male catheterisation,
however, you do not require anchoring device, urinary drainage bag or syringe and
water for injection
2. Once the catheter is inserted and urine starts to drain, hold the catheter in place
digitally until the urine ceases to flow. Withdraw the catheter gently until urine
recommences flowing. Once urine flow ceases gently withdraw catheter completely.
4. Lower the patient’s bed
5. Discard equipment.
6. Record the procedure in the patient's clinical record:
c. Reason for insertion
7. Record output, clarity, colour and odour on the patient's FBC
8. Perform urinalysis
9. Record if a specimen is sent to pathology
Alert: Specific Spinal Cord Considerations. Do not clamp the catheter in spinal cord injured
patients above T6. Ascertain if patient is on anticoagulants prior to procedure. Seek expert
advice for patients with artificial heart values who grow Enterococcus species in the urine
prior to the procedure. Potential risk of creating a false passage associated with forced
instrumentation. Balloon inflated in urethra/ tract resulting in haematoma, haemorrhage,
rupture or necrosis

Section 6 – Catheter Intermittent: Patient Education
The purpose of this section is to provide procedural information for nurses to assist in
supporting and educating patients in the procedure of clean intermittent catheterisation.
Registered Nurses who educate clients in the procedure for Clean Intermittent
Catheterisation (CIC) must have current theoretical knowledge and be clinically competent
in the procedure. A student nurse may undertake the procedure under the direct
supervision of a competent clinician.
This applies to all nurses and contains information on
 Documentation and patient education requirements
 Self catheterisation procedure and equipment

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 Catheter equipment
Procedure:
 A Medical or Nurse Practitioner must order intermittent catheterisation
 The patient’s ability to perform catheterisation and adhere to a schedule is essential to
the success of the CIC program. They must have adequate hand dexterity, mobility and
cognition to learn the procedure and understand the principles of management. Age is
not a barrier to learning self-catheterisation where the above points are noted
 The aim of the technique is to achieve bladder emptying at regular intervals, to reduce
urinary tract infections, to promote bladder function and maintain continence
 Nurses must utilise a clean technique when teaching and performing intermittent
catheterisation
 Utilise clean working surfaces for the procedure
 Urinary volumes, both voided and residual (where appropriate) should be recorded
until a pattern has been established. If large amounts urine (more than 500mls) is
drained consider more frequent catheterisation
 Patient Accountability and care plans will document a personalised timetable of self-
catheterisation
 Patient education will include anatomy and function of the urinary system, infection
control, fluid balance, bowel management and the management of complications.
 Once the technique is mastered, the patient may work towards performing the
procedure without a mirror and in any position that suits the client. Assistance in
determining this routine may be obtained from Continence Advisors, Continence CNC,
Medical Officer or Urologist
Equipment:
 Intermittent (nelaton) catheter, recommended sizes 8 to 10Fg children, 12 to 14Fg
adults. Male 400mm length and female 160mm length
 Warm water and a clean face washer (or moist towelettes)
 Water soluble lubricant or anaesthetic gel
 Container to collect and measure urine (e.g. measuring jug, kidney dish, slipper pan)
 Appropriate light source
 Hand held mirror for females (initial use only)
 Cotton tip (initial use only)
 Protective sheet (initial use only)

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Female
Procedure:
1. Nurse and patient to wash hands thoroughly. Nurse to apply non sterile gloves and
lubricate catheter
2. Place patient in a comfortable sitting position, back supported, knees apart and legs
bent so that the perineum is visible in a mirror
3. Instruct patient to separate the labia majora with the non-dominant hand to expose the
urethral opening, and with the dominant hand, wash this area with warm water or
moist towelettes. Start at the top and work downwards
4. With the labia still separated by the non-dominant hand, using the first and third
fingers, the nurse uses the cotton bud and mirror to point out the anatomy of the
clitoris, urethral opening and the vagina
5. Patient then palpates the urethra with the second finger (feels like a small hole or
donut) and leaves it over the urethral meatus. The client then takes the catheter in the
dominant hand, holding it two to three cm away from the tip, and gently inserts into
the urethra, sliding it under the palpating finger in a gentle upwards and backwards
motion
6. Allow urine to drain into container and apply gentle pressure over the suprapubic area
when flow ceases. This will ensure the bladder is empty
7. Withdraw catheter slowly, stopping if urine begins to flow again
8. Measure and record amount of urine
9. Nurse and patient to wash hands thoroughly and clean up
10. Document Inpatient file
11. Once the patient is efficient and confident, the procedure may be carried out on the
toilet
Note: it is not harmful should menstrual blood be introduced into the bladder during this
procedure
Male
Procedure:
1. Nurse and patient to wash hands thoroughly. Nurse to apply non sterile gloves and
thoroughly lubricate the first 15cm of the catheter tip
2. Patient sits in a comfortable position with legs separated
3. Instruct patient to grasp the penis at the sides (so as not to compress the urethra) with
the non-dominant hand
4. If the patient is not circumcised, instruct to gently retract foreskin
5. Wash the end of the penis gently with a clean sponge or moist towelettes
6. Instruct the patient to hold the penis upwards and outwards from the body at a 90º
angle with thumb and finger on either side of the penis. Instruct patient to grasp
catheter about seven cm from tip
7. Identify the urethral meatus and insert well-lubricated catheter and gently advance
until urine flow is observed
8. Resistance may be felt when catheter reaches the bladder neck. This may be overcome
by encouraging the client to take a deep breath, exhale slowly and relax. Encourage the

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client to void and at the same time applying firm pressure to the catheter (this helps
open up the bladder neck)
9. Once the catheter is inserted, hold in place whilst urine flows. The penis and catheter
are now in a dependent position. Toward the end, ask the client to cough or strain or
apply gentle suprapubic pressure to assist with complete emptying. Gently withdraw
the catheter, stopping whenever urine begins to flow again
10. Measure and record amount of urine
11. Nurse and patient to wash hands thoroughly and clean up
12. Document Inpatient file
13. Once the patient is efficient and confident, the procedure may be carried out on the
toilet
Catheter types:
 Catheters for self-catheterisation do not require a retention balloon and comprise of a
plastic (PVC) tube with two eyes at the tip and a funnel at the other end
 Generally, the types of PVC catheters used are either coated or non-coated catheters
 Uncoated catheters require separate lubrication to enter the urethra easily and prevent
soreness and discomfort. Most of these catheters are single use only, though the
‘CLINY’ brand can be cleaned and reused
 Coated catheters feature a special coating that means lubrication is not required for
insertion, check manufacturers’ instructions as may need water to activate lubricant
They are generally well tolerated and more comfortable than non-coated catheters, but
also more expensive and single use only
 Catheters are available in paediatric, female and male lengths
Catheter supplies:
Catheters can be obtained via:
 Continence Aids Payment Scheme (CAPS) -
o ACT Equipment Scheme
 Department of Veteran Affairs Rehabilitation Appliance Program (RAP)
 Medical and Surgical wholesalers
 Some pharmacies
Catheter care:
 Catheters should be used according to manufacturer’s instructions, as many catheters
are labelled for ‘single use only’. The symbol for single use only is
 Where catheters are labelled single use only, ACT Health is obliged to recommend that
a new sterile catheter, in a sealed package within the use by date, be used for each
catheterisation
 Catheters that are not labelled ‘single use only’ see manufacturers’ guidelines for
instructions regarding cleaning and reuse

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Section 6 – Catheter Flushing for Adult Community based patient
Considerations
Catheter flushing is a prescribed procedure using a small amount of fluid to maintain
patency of a catheter. Manual bladder irrigation or washout involves instilling large amounts
of fluid into the bladder, withdrawing fluid for the purpose of removing debris and mucus
from the bladder. This procedure should be done under medical supervision and is not
suitable to be done in the community
Catheter flushing:
 May be indicated if a patient has a history of blocked catheter
 Is an aseptic procedure as the closed urinary drainage system is being broken which is a
high risk factor in the development of a UTI.
 Is prescribed by a medical practitioner; a treatment order is required stating:
o Normal Saline 9% (is the preferred solution)
o Maximum of two x consecutive flushes of 20mls each (no more than 40mls)
o Management of catheter if unable to flush
o Review date of treatment practice is a short term management option only and the
cause of the blockage should be investigated.
o A Urology review must be in place
 If a catheter is blocked and has been insitu for >2 weeks it may be replaced without
flushing
 Catheters that remain obstructed after second flush and catheters that remain patent
only with repeated flushing should be replaced and Urology team informed
Nursing Alert: Catheter flush is not considered safe practice following renal transplant, or
open bladder surgery: Patients with long term catheters are prone to develop decreased
bladder capacity. Caution should be practiced when performing catheter flush in these
patients with only the prescribed amount of fluid used and if a second flush is needed,
adequate care must be taken to ensure previous fluid volume has been drained out
Equipment:
 Personal Protective Equipment (PPE) and sterile gloves
 Disposable catheter pack
 50ml catheter tip syringe (to ensure low pressure on the catheter
 Blue under sheet
 One pair sterile gloves
 One alcohol wipe
 Normal Saline 9% (N/S) solution at body temperature (never use cold
solution to flush catheter as it can induce a bladder spasm

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Procedure:
1. Treatment orders are required for a catheter flush
2. Explain the procedure to patient
3. Gain verbal consent and document in the nursing notes
4. Prepare sterile setup, place N/S in catheter tray and draw up the required amount using
a sterile 50 ml catheter tip syringe
5. Place blue sheet under the catheter and drainage bag connection
6. Don PPE and sterile gloves
7. Place sterile towel under site where urinary catheter and drainage bag are attached
8. Clean catheter and drainage bag connection with alcohol wipe (allow to air dry)
9. Disconnect and wrap the drainage bag end in a sterile gauze swab, if possible give to
the patient to hold. Keep connection end sterile.
10. Pinch the end of the tubing about an inch from the end of the catheter, and carefully
insert catheter tip syringe
11. Using up to 20mls of N/S flush the catheter to evacuate any debris. Do not withdraw
fluid. If resistance is encountered allow syringe to refill by gravity, discard fluid and
repeat flush. (If resistance remains the catheter should be replaced as per catheter
management policy)
12. Pinch the end of the tubing about an inch from the end of the catheter, and carefully
pull to remove the catheter tip syringe
13. Reconnect catheter to drainage bag without contaminating either connection
14. Secure catheter to the abdomen/thigh
15. Evaluate outcome and document in the nursing notes

Section 7 – Trial of Void: Community based patient
A trial of void (TOV) assesses the emptying ability of the bladder by recording voided
volumes and measuring the post void residual (See CHHS Continence Assessment and
Management Procedure for information on Bladder Scan)
TOV with IDC Pathway:

 Plan procedure with patient
 Removal of the catheter is normally between 6:00am (LINK Team) or community nurse
8:00am to 8.30am
 Drain the bladder and remove catheter
 Document time of catheter removal and urine volume
 Advise patient to maintain fluid intake of 200mls/hour capped at 1000mls over four to
five hours (unless contraindicated)
 Advise the patient to void urethrally when they have the desire to void, measure and
record all voided volumes on the bladder diary
If anytime the patient becomes uncomfortable and is unable to void it is recommended the
patient contact the RN (through the Team Leader) and be re-catheterised (as per medical
orders) as soon as possible.
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1. The attending nurse to contact the patient for progress call within three hours. (e.g. if
catheter is removed by LINK team at 6am call at 9.00am)
2. After the four to five hours from catheter removal , the attending nurse returns -
request the patient to void
3. Measure residual bladder volume by bladder scanner
4. Interpretation of TVO: successful or unsuccessful
5. Document outcome Inpatients’ records and inform Medical Officer at Urology Out
Patients Unit
The Medical Officers TVO order is only valid for 24 hrs post removal of catheter. If the
patient has a new episode of retention or other related urinary symptoms they should be
referred back to the Urologist or treating hospital.
TOV with SPC Pathway:

1. Explain the procedure to patient (nurse contact details should be provided)
2. If catheter is on free drainage – disconnect drainage bag and insert catheter valve into
catheter
3. Advice the patient to maintain fluid intake of 250mls hour during the day (unless
contraindicated) and record on chart provided
4. Measure and record each urethrally voided urine. Immediately following urethral
voiding release the valve and drain the bladder
5. Measure and record any residual
6. If the client is unable to void advice the client to release the valve, drain the bladder,
measure and record volume of urine. Resume timed emptying of the bladder via the
valve
7. Advise the client to void urethrally:
a. if they experience a strong desire to void
b. if they feel uncomfortable
8. Void volumes and post void catheter residuals are compared to parameters set by
medical officer’s guidelines
9. Document outcome in client notes and follow medical instructions for either repeat
TOV or removal of catheter
Educational Notes:
Bladder emptying occurs as a result of a complex interaction between the sympathetic and
parasympathetic nervous system and physical structures of the bladder and urethra.
Bladder dysfunction can result from a wide range of conditions, e.g.:
 Bladder outlet obstruction
 Neurogenic dysfunction
 Following childbirth
 Following some surgical procedures
 Medications e.g. anticholinergic can contribute to urinary retention
 Chronic constipation. Rectal examination may be required to assess for constipation

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Ensure that the client is not constipated at time of catheter removal as constipation can
contribute to urinary retention and this may result in failed trial of void
Medical authorisation is required prior to TOV:

 Knowledge of client’s medical history is crucial
 Knowledge of the client’s usual urine production is recommended to facilitate correct
 Timing of the TVO e.g. day time urine production maybe significantly reduced in the
elderly
 A maximum total bladder capacity should not exceed 600mls (void volume + residual)
 An assessment prior TOV will anticipate the expected 24 hours urine production, e.g.
some elderly clients will have low urine volume throughout the day and large volumes
diuresis overnight

Section 8 – Indwelling Urinary Catheter Management: Inpatient and
Community
Alert: In patients with an Indwelling Urinary Catheter, it is important to remove any obvious
signs of encrustations from around the urethral meatus. To achieve this, the catheter must
be washed gently with warm soapy water at the start of the procedure and during the
patient’s daily wash/shower. Avoid back and forth movement of the catheter at the urethral
meatus as this may cause unnecessary trauma or irritation and may increase the risk of
infection or pressure injury. Observe for any signs of pressure areas or trauma at the
urethral meatus. Document findings in appropriate patient records
The purpose of this section is to provide clinical care so as to:

 Maintain a patent urinary drainage system
 Prevent urinary tract infections
 Promote patient comfort
 Provide education for self management of urinary drainage systems
Perineal/ penile care: Inpatient specific procedure:

2. Ensure catheter is securely anchored at all times (See Attachment A)
3. Routine daily perineal/ penile care is performed Drainage bag must be kept below the
patient’s waist to prevent reflux of urine back up the IDC
4. Encourage a two to three litre fluid intake unless contraindicated
5. Record output, clarity, colour and odour
6. Perform and record urinalysis where indicated
7. Observe for Haematuria
8. Watch for Haematuria and diuresis in patients with chronic urinary retention
9. Adjust the Patient Accountability and Care Plan to indicate IDC insitu and associated
peri-toilets required for hygiene needs

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8.1 Emptying a Urinary Drainage Bag: Inpatient specific

A closed urinary drainage system should be maintained. The catheter and tubing should not
be disconnected unless absolutely necessary. This applies to:
 Urinary Drainage Systems
 Closed Drainage Systems
 Catheter Valve Drainage Systems
During urinary drainage bag changes, strict aseptic technique is essential to prevent
infection. Ensure that there are no dependent loops in the tubing, where possible, to
prevent stasis of the urine in the tubing.
Urinary Drainage Bag Change: Inpatient specific:

 To change a urinary drainage bag in order to maintain a patent urinary drainage system
 To prevent contamination of the urinary drainage system
 Promote patient comfort
Equipment:
 Alcohol swab
 Clamp
 Clean gown and gloves
Procedure:
1. Explain procedure to patient and ensure privacy is maintained
2. Prepare equipment and the patient
3. Don safety glasses
4. Attend hand hygiene before touching patient by either hand washing or using ABHR
5. Don gloves
6. Ensure the drainage system is closed, clamp off all clamps
7. Remove the protective cap from the drainage tube
8. Clamp the catheter above the tubing connector, and clean the catheter tubing junction
with an alcohol swab
9. Disconnect the catheter from the old tubing, being careful not to contaminate the end
of the catheter, and connect the catheter to the new tubing
10. Unclamp the catheter, and establish drainage by securing the tube and drainage bag to
the bed at the appropriate level
11. Leave patient comfortable and dispose of equipment
12. Remove gloves and perform hand hygiene after a procedure or body fluid exposure risk
as per the five moments of hand hygiene
13. Document the urinary bag change in the patient’s clinical record, FBC and Patient
Accountability and Care Plan

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8.2 Urinary Drainage Bag Management: Community Specific

Procedure:
Types:
 Leg bags are available in a range of capacities: 350ml, 500ml, and 750mI.
 Tubing on leg bags is available in different lengths, (5cm to 40cm) and can be tailored to
individual patient's requirements (adjustments can be made with extension tubing and
connecting pieces).
Management:
 Urinary drainage bags should be positioned below the level of the bladder to prevent
harmful reflux of urine.
 Leg bags can be placed on the thigh or calf and secured to the leg using straps
provided, to prevent urethral trauma and damage to the bladder wall.
 Aseptic technique should be used when attaching urine drainage bags directly to the
catheter.
 Urinary drainage bags should be emptied when half to two thirds full.
 Urinary drainage bags should be replaced as per manufacturer's recommendations;
every seven days for regular bags or at the time of catheter change for long life leg bags
Closed Drainage System

Types:
 Closed link system is used to facilitate overnight drainage and is appropriate for use
with indwelling urethral and supra-pubic catheter drainage systems.
 Closed drainage systems are available in drainage bags with a two litre capacity and
drainage bottles with a four litre capacity.
 Closed drainage systems are supplemented by the linking of a larger two litre capacity
bag or urinary drainage bottle with a four litre capacity to the outlet of the sterile leg
 The linked overnight drainage system need not be sterile but must be cleaned daily to
minimise the bacterial growth and extend the life of the bag. Manufacturer's
instructions for cleaning should be observed (outlined below)
Catheter Valve System

A catheter valve may be used in place of a urinary drainage bag, allowing bladder filling and
intermittent drainage. Catheter valves are recommended as single use only items and
should not be reused. Manufacturer's instruction regarding frequency of change should be
observed. Bard catheter valves are changed weekly, Coloplast Simpla catheter valves are
changed at the time of catheter change. For clients/ carers to use this system, they need to
have:
 The cognitive ability to learn strategies to prevent infection and/or urinary
complications
 An understanding of the principles associated with catheter management
 The ability to independently manage their catheter care, or a carer who is willing to
ensure safe management
 The awareness of bladder sensation and recognition of bladder fullness, and manual
dexterity to manipulate the outlet tap
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Alert: Catheter valves are inappropriate for clients with detrusor instability, lack of bladder
sensation or clients who are confused.
Instructions for patient/ carer regarding changing of drainage bags/valves:

 Wash hands
 Disconnect bag/valve from catheter
 Connect new bag/valve to catheter - avoid touching clean/sterile connections
 Wiping connection with alcohol wipe is not necessary
Instructions for patient/ carer regarding cleaning of overnight drainage:

 Rinse with cold water to prevent agglutination of urinary proteins
 Wash with warm soapy water (dishwashing liquid)
 Rinse with clean water
 Allow to drain and dry (by hooking bags onto a wire coat hanger from a bathroom
rail)
 Night drainage bottles may be left to dry in an upturned position on a clean towel
 ‘Urosol’, a deodorant and detergent cleansing agent, may be used to dissolve urinary
crystals. Vinegar or bicarbonate of soda may be used as a substitute
 Use of bleach should be avoided as it may damage rubber and plastic
8.3 Removal of Indwelling Urinary Catheter

To remove an indwelling urinary catheter
Equipment:
 Clean gloves
 Syringe (10 or 20ml)
 Clean kidney dish
Procedure:
1. Inform the patient and ensure privacy is maintained
3. Consent must be gained for all interactions with patients
4. Patient identification and allergy band are checked against clinical notes and stickers
5. Prepare equipment
6. Place patient in supine position
7. Check balloon capacity Inpatient’s clinical records
8. Don safety glasses
9. Don gloves
10. Detach catheter from Foleys Statlock device
11. Attach syringe to catheter balloon lumen and aspirate fluid slowly to deflate
12. Gently pull catheter to check balloon is deflated
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13. Inform patient to breathe slow deep breaths then withdraw the catheter gently
14. Check catheter tip is intact, if not inform medical officer immediately
15. Place catheter in kidney dish
16. Remove Foleys Statlock device from patient’s body with Alcohol swabs and clean skin
area as required (See Attachment A)
17. Discard equipment and ensure patient is comfortable
18. Document procedure including patient response Inpatient’s clinical record
19. Remove gloves and perform hand hygiene after a procedure or body fluid exposure risk
as per the 5 moments of hand hygiene
20. Document the time and date of removal in the patient’s clinical record, Patient
Accountability and Care Plan and FBC.
Alert: Do not cut the balloon lumen, as the balloon may not be fully deflated
Alert: Patients undergoing a trial of void (TOV) must be provided with either a pan or urinal
and inform nursing staff once they have voided. Nursing staff must check for residual urine
with Bladder scanner, record on fluid balance chart and inform medical officer of results
prior to discharge

Section 9 – Trans Urethral Prostatectomy (TURP)
Surgical procedure performed via the urethra to debulk the prostatic adenoma and relieve
obstruction. A transurethral resection removes only enlarged prostatic tissue, as in benign
Prostatic Hypertrophy (BPH). Normal prostatic tissue and its outer capsule are left intact.
Background:
 Patient usually attends preadmission clinic (PAC) and is admitted on the day of surgery
(DOSA). Investigations attended in the PAC are as follows:
o Baseline observations, including usual Systolic BP
o Height, weight and urinalysis
o Bloods – UEC, FBC, COAG’s, X – MATCH (2-4 units), LFT’s ECG, CXR, as per hospital
policy. Additional bloods, CT, MRI and or bone scan to determine probability of
metastasis to the body and the skeleton
o Micro culture & sensitivity of urine (MSU) one week prior to surgery
 Ensure UTI therapy has been completed prior to surgery as per recommendations in the
latest version of the Therapeutic Guidelines: Antibiotic, Prophylaxis: urological surgery
 Consent completed reflecting the Consent to Treatment Procedure
 Check reason for admission Inpatient’s clinical record and length of stay as per Request
for Admission form to predict estimated date of discharge (EDD), i.e., commencement
of Discharge Planning
Alert: Patients on anticoagulation therapy require further medical investigation, advice and
support and nursing observation
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Admission
 Explain the process and purpose of the Patient Care and Accountability Plan
 Patient identification and allergy band are checked against clinical notes/ stickers
 Document findings from Patient Care and Accountability Plan (PCAP) including Risk
Assessments and management plans in clinical records, provide education and CHHS
information booklet to patient and family regarding Patient’s Pressure Injury, fall and
VTE Risks and management. Measure and fit patient with short leg TED stockings
 Attend to height, weight and ward urinalysis and document in clinical records, Patient
Care and Accountability Plan and Observation Chart
 Obtain baseline observations, usual systolic BP and MEWS Score
 Provide patient with verbal and inform Pharmacist of patient’s admission and request
Medication Reconciliation is completed
 Ensure that patient is informed and educated in relation to fasting guidelines as per
guidelines or specific medical orders. Document care provided in clinical record. Inform
Food Services via DIETPas
 Commence discharge planning
 Educate patient in deep breathing and coughing exercises, and leg exercises
 Check consent form completed
 Bowel preparation if ordered
Preoperative:
 Attend to all documentation including Pre-op Checklist
 Measure and fit knee length Anti-embolic stockings and ensure documentation on
Medication Chart
 Ensure patient has early morning shower and dressed in theatre gown
 Usual medications are given at 0600
Receiving the patient from PACU:

 Don PPE as required
 Patient identification and allergy band are checked against clinical notes/ stickers.
Practice to reflect Patient Identification Checklist Procedure, Patient Identification Band
Procedure, Correct Patient, Correct Site, Correct Procedure
 Check patient’s airway is clear and observe for effort of breathing (i.e. use of accessory
muscles)
 If airway is compromised place the patient in the lateral position (if not
contraindicated), and consider Medical Officer review
 Ensure the oxygen is attached to wall oxygen outlet
 Confirm flow rate as ordered (PACU staff responsibility on arrival at ward – checked by
ward staff to ensure correct flow rate)
 Ensure equipment has been plugged in and cords are positioned safely under bed or off
the floor
 Clarify the operative procedure performed. All actions to reflect Correct Patient,
Correct Site, Correct Procedure
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 Discussion of patient medical history and impacting co morbidities should occur whilst
ensuring privacy
 The PACU nurse hands over verbally to the ward nurse at the patient bed side. At the
completion of Handover the PACU observation chart should be signed and dated by
both the PACU and ward nurse. Handover should include:
 Review of post operative vital signs, including any interventions required for
stabilisation
 Review the Fluid Balance Chart, check intravenous fluid insitu, received in PACU and
continuing orders, check IV device site e.g. CVC, PICC, IVC (date of insertion, patency,
site, and is appropriately secured) Monitor intravenous therapy and record IVT on Fluid
Balance Chart)
 Ensure that continuous bladder irrigation (CBI) and indwelling urethral catheter (IDC)
are patent – only 0.9% Sodium Chloride 2000ml solution to be used as irrigant for CBI
 Ensure Bladder Irrigation Chart is maintained- balances to be recorded on FBC
 Maintain accurate fluid balance chart for input and output, ensuring CBI fluid included,
and describe the type of output, for example, claret, rose or straw).
 IDC to be anchored with Statlock unless the surgeon specifically documents request for
Statlock not to used as per Urinary Catheter Management Procedure
 Ensure Indwelling Catheter is secured with appropriate device, e.g., Statlock
 Ensure traction is maintained on IDC to provide maximum pressure on the prostatic bed
following surgery. This traction helps to control bleeding and decreases the risk of
bladder neck damage. Check post-operative orders regarding the use of traction and
the length of time traction is to be applied, usually only for the first 24 hours
 If clotting occurs, nurse to initiate manual irrigation using aseptic technique
 Urine output is to be recorded hourly for 48 hours postoperatively
 Ensure all output is documented on Fluid Balance Chart
 Medications administered and documented on medication chart review
 Any intravenous medications ordered and given (e.g. antibiotics, antihypertensive)
 Observe the Catheter site for ooze or blood loss.
 Perform and document a full set of Vital signs and Modified Early Warning Score
(MEWS) including:
o Respiratory Rate (RR)
o Oxygen Saturations
o Temperature
o Blood Pressure (BP)
o Pulse (P)
o Level of Consciousness (LOC)
o Urine Output (UOP)
All observations are to be recorded on the Modified Early Warning Score (MEWS) charts and
appropriate adjunct charts (i.e. Continuous Bladder Irrigation etc). Ensure all of the above
interventions are completed prior to PACU nurse leaving ward area and patient care is
accepted.
 Complete Patient Care and Accountability Plan and action appropriately

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 Record in the patient's clinical record all post-operative nursing care provided and the
patients response
 Administer analgesia as per Medical Practitioner’s orders for pain and/ or spasms
 Administer IV antiemetic for nausea as per Medical Practitioner’s orders
 Offer and attend to post-operative bed bath
 Dress in personal nightwear if desired
 Offer and attend to mouth care, replacing dentures if applicable
 Position the patient in accordance to post operative instructions
 Ensure that the call bell is within reach and
 Lower bed and bed rails to maintain patient safety if required. Note: where patients are
disorientated consider hi low bed
 Educate and encourage deep breathing and leg exercises
 Ensure 2/24 Pressure area care and skin integrity checks and repositioning performed
(off affected side)
 Document all observations on the appropriate charts, e.g. MEWS, fluid balance chart, in
the patient’s clinical record and escalate if required according to MEWS and MET
criteria
 Record in the patient's clinical record all post-operative nursing care provided
Post operative Day 1:

 Attend to general observations fourth hourly
 Review by Medical Officer
 Medical Officer will cease CBI depending on consistency and type of urine output
 General post-operative diet
 Cease IV fluids if oral intake is adequate
 Continue oral analgesia as required
 Patient may shower if stable, or assist sponge
 Encourage patient to sit out of bed for a few hours
 Continue discharge planning – contact Discharge Liaison Nurse (DLN) if appropriate
 Continue patient education
 Commence ambulation (ensure patient has a functioning IV pole with tongue depressor
taped to the pole for hanging the urinary bag)
 Continue deep breathing and coughing, and leg exercises
 Attend to blood specimens – FBC and UEC’s as ordered by Medical Officer
 Ensure anti embolic stockings are in situ, correctly measured and fitted with no creases
 Request Medical Officer to commence Discharge summary document in preparation for
discharge
Post operative Day 2:

 Continue fourth hourly observations
 IDC removed at 2400 or 0600 hours or otherwise ordered by Medical Officer
 CBI ceased if not attended to during day one
 Trial of void (TOV) – document when patient voids – amount, consistency, pain, colour
etc., and attend bladder scan post void
 Review by Medical Officer after three consecutive bladder scans
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 Patient to attend to self care

 Complete patient education prior to discharge and provide written instructions
(Prostatectomy package)
 Ensure patient has received adequate education, and is self caring with leg bag should
discharge occurs with IDC insitu
Discharge:
 Advise patient to organise own follow-up appointment with Visiting Medical Officer
(VMO) if seeing Urologist privately
 Follow up in Outpatient Department Clinic (OPD) is usually in 4 weeks. Notification to
OPD of patient’s details is completed by RMO completing the Discharge summary
 Resident Medical Officer (RMO) to provide patient with Cystogram appointment details
prior to discharge
 Discharge with analgesia if deemed necessary by Medical Officer
 Educate the patient regarding the VMO’s post-operative instructions – no driving, heavy
lifting or sexual intercourse etc, until reviewed at follow-up appointment

Section 10 – Bladder Irrigation
10.1 Continuous Bladder Irrigation

Continuous Bladder Irrigation (CBI) is the continuous flushing and draining of the bladder
designed to prevent the formation and retention of blood clots following transurethral
resection of the prostate or where blood clot retention of the bladder occurs
To instil continuous bladder irrigation via a three-way IDC for the purpose of:
 Providing bladder washout to remove any residual urine and/or bladder sediment to
ensure IDC patency
 Removing blood clots that may develop post bladder, kidney or prostate surgery
 Ensuring debris removal from an infected or diseased bladder
 Introducing medicated irrigation to soothe an irritated bladder so as to promote
healing, and/ or to treat disease
A medical officer must prescribe continuous bladder irrigation (CBI) and a silicone three
way-indwelling catheter (22F or 24F) must be inserted prior to the commencement of
continuous bladder irrigation (CBI)
Equipment:
 Dressing Trolley
 Sterile dish x two
 Plain stickers to label consecutive irrigation bags
 Foleys Statlock Device-Not for Dr Chan’s patients
 Jugs x two
 50ml Bladder Syringes x two

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 Y-type CBI tubing (closed system where available)

 Three-way indwelling catheter
 Gloves: two pairs x sterile, one box clean gloves
 500ml bottle of 0.9% Sodium Chloride (at room temperature)
 2000mls 0.9% Sodium Chloride irrigation fluid bags x four or five bags (at room
temperature)
 Procedure under pads (small and large) e.g. Smart Barrier Touch Dry absorbent pad
 Safety goggles or shield and gown
 Portable, adjustable IV pole
 Cytotoxic Spill Kit where EPIRUBICIN or where patient is receiving Cytotoxic treatment
 Cytotoxic Bin where Cytotoxic precautions are required
Procedure:
 Check patients clinical record for any medical orders
 Maintain privacy and explain the procedure to the patient
 Place patient supine and ensure comfort and dignity
 Where Chemotherapy precautions are actioned, don non-permeable gown, and
gloves. Please refer to Chemotherapy Care of the Adult Patient eviQ Clinical
Procedure
 Don safety goggles or eye shield and gown
 Place procedure under pad beneath patient
 Place small procedure under pad across patients thighs to prevent fluid leaks whilst
connecting the irrigation fluid
 Commence irrigation and maintain a steady flow rate
Alert: Ensure that the irrigation is not running to fast or too slow. The irrigation rate is
dependent on the urine colour/ opacity. Refer to medical orders for any contraindications
 Hang irrigating fluid bags on portable IV pole, 60cms above the level of the bladder
 Label and number each bag when commencing
 Maintain strict Bladder Irrigation Chart and Urine Output records.
 Prior to commencing next irrigation fluid bag, completely empty the current IV irrigation
fluid bag into the urinary drainage bag so as to calculate and record the urine output.
Empty the urinary drainage bag. Subtract two litre irrigation fluids from amount of fluid
in the urinary drainage bag to calculate urine output
 Do not rest urinary drainage bag on the floor at any time
 Record the number of irrigation bags used and urine output on the bladder irrigation
chart and urine output on fluid balance chart at each bag change
 Ensure that the patient’s fluid input and urine output is measured and documented
accurately
 Adjust the Patient Accountability and Care Plan to indicate Bladder Irrigation
 Monitor the patient with fourth hourly general observations by nursing staff whilst the
indwelling catheter is insitu for signs of sepsis
 Regular and frequent Perineal toilets must attended whilst indwelling catheter is in situ-
the frequency of which will be documented in the Patient Accountability and Care Plan
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 In the event of a genitourinary tract infection, infection control will collate and present
data for reporting purposes
Alert: All patients with an Indwelling Catheter insitu are required to have a CHHS Insertion
of Urinary Catheter in their clinical records (See Attachment B). If the input and output
balance is negative notify the CNC/TL and medical officer to review the patient immediately
Epirubicin Alert: Clinical Handovers must reflect that Chemotherapy has been administered
and cytotoxic precautions will subsequently be required for seven days post administration.
Where Chemotherapy precautions are actioned, dispose of urinary catheter bags with
urinary output directly into the Cytotoxic bin.
10.2 Manual Bladder Irrigation

To instil manual bladder irrigation via a three-way IDC for the purpose of:
 Removing blood clots or blockage that may develop to maintain patency of an IDC
Equipment:
 Dressing Trolley
 Sterile dish x two
 Jugs x two
 50ml Bladder Syringes x two
 Gloves: two pairs of sterile, one box clean gloves
 500ml bottle of 0.9% Sodium Chloride (at room temperature)
 Procedure under pads (small and large) e.g. Kylie
 Where Chemotherapy precautions are actioned, don appropriate PPE
 Safety glasses, goggles or shield
 General waste receptacle
Procedure:
 Maintain privacy and explain the procedure to the patient
 Provide adequate and appropriate analgesia
 Place patient supine and ensure comfort
 Where Chemotherapy precautions are actioned, don appropriate PPE
 Don personal protective equipment (PPE) includes safety goggles or shield and gown
 Place procedure under pad beneath patient
 Place small procedure under pad across patients thighs to prevent fluid leaks whilst
connecting the irrigation fluid
 Prepare Sterile dish with approx 200mls 0.9% Sodium Chloride or open 500ml bottle of
0.9% Sodium Chloride
 Have jug ready at the IDC site
 Open syringe
 Turn off irrigation
 Disconnect tubing from Statlock device if present
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 Attend hand hygiene by either washing or using ABHR and don sterile gloves
 Using aseptic technique, detach the drainage bag from the IDC and attach syringe filled
with 0.9% Sodium Chloride and flush into bladder
 Apply suction to the IDC to clear clots from the IDC
 Disconnect syringe and fill with a further 40mls of 0.9% Sodium Chloride, reconnect to
IDC and flush bladder
 Continue this procedure until return is clear and free of clots and/ or debris
 Where closed system is in use, do not disconnect indwelling catheter to manually
irrigate
 Clamp the tubing below the bulb
 Firmly squeeze the bulb to commence manual irrigation
 Repeat process until clear urine is flowing at a steady rate
 If no urine return after manually irrigating IDC, contact medical officer
 Repeat the above steps until urine is flowing at a steady rate
 Reconnect the IDC to the drainage bag and reset the irrigation fluid
 Secure tubing with appropriately placed Statlock device (Attachment A) to prevent
movement and urethral traction unless contraindicated (as per Dr Chan’s orders)
 Attend Perineal toilet-The patient will have regular and frequent Perineal toilets
attended whilst indwelling catheter is in situ, the frequency of which will be
documented in the Nursing Care Plan
 Discard equipment
 Where Chemotherapy precautions are actioned, dispose of urinary output directly
into the Cytotoxic bin
 Leave the patient comfortable with call bell within reach
Document in patients clinical record:

 The patient's response to the procedure
 The urine output on the Bladder Irrigation Chart & fluid balance chart
 The amount, size and frequency of irrigated clot
 The patient's indwelling catheter is patent with no complication during and following
irrigation
 The urinary drainage system is maintained as a sterile drainage system
 The patient's indwelling catheter is irrigated as prescribed by the medical officer
according to the patient's clinical management needs with minimal discomfort and no
complications
 Intake and output are balanced
 The patient is to be monitored with fourth hourly general observations by nursing staff
whilst the indwelling catheter is insitu for signs of sepsis
 The patient is to be monitored for signs of suprapubic distension or discomfort
indicating fluid retention
 The patient’s fluid input and urine output is measured and documented accurately
 Adjust the Patient Accountability and Care Plan to indicate Bladder Irrigation
 In the event of a genitourinary tract infection, infection control will collate and present
data for reporting purposes

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Section 11 – Pre and Post Operative Management of patients undergoing a
Nephrectomy
To provide guidelines for the pre and post operative management of patients undergoing a
Nephrectomy, i.e., surgical removal of a kidney
Alerts:
 On transfer to ward, all observations should be attended in the presence of the PACU
nurse to ensure any abnormalities may be identified and managed as soon as possible.
If the patient meets the MET criteria, activation of MET should occur.
 A full set of Vital signs includes Respiratory Rate, Oxygen Saturations, Temperature,
Blood Pressure, Pulse, Level of Consciousness and Urine Output. A full set of Vital Signs
must be performed every time vital signs are taken in the post transfer from ICU (Refer
to ‘Adult Vital Signs and Early Warning Scores’).
 If respirations are twelve (12) or less per minute or if the patient complains of headache
following spinal or epidural anaesthetic within the first 24 hours, notify the Anaesthetist
or Anaesthetic Registrar immediately and document in the patient’s clinical record.
 Please check surgeon’s preference regarding placement of Statlock, securement of
drains and post operative pain management.
 Determine if the patient is currently on medication and enquire if the patient has
brought any medication to the hospital. If possible, family members must take all
personal medications home after the sighting by the medical officer. If this is not
possible, place the medications in a patient’s own medication green plastic bag, label
and retain in the patient’s own medication cupboard until the patient is discharged-
Patients Own Medication- Management Procedure

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On admission:
Equipment:
 Patient clinical notes and observation charts
 Personal protective equipment (PPE) including safety goggles or shield and clean gloves
 Stethoscope
 Watch with a second hand
 Sphygmomanometer (blood pressure cuff)
 Oxygen saturation monitor
 Thermometer
 Intravenous (IV) pole – mobile
 Emesis bag
 Bedside emergency equipment
Procedure:
 Patient usually attends preadmission clinic (PAC) and is admitted the day before surgery
or at times, on the day of surgery (DOSA). Investigations attended in the PAC are as
follows
 Bloods – UEC, FBC, COAG’s, X – MATCH (2-4 units), LFT’s, and serum ferreting
assessment.
 ECG, CXR, as per hospital policy. Additional bloods, CT, MRI and or bone scan to
determine probability of metastasis to the body and the skeleton. Micro urine (MSU)
 Consent completed reflecting the Consent to Treatment Procedure
 Check reason for admission Inpatient’s clinical record and length of stay as per Request
for Admission form to predict estimated date of discharge (EDD), i.e., commencement
of Discharge Planning.
 Obtain verbal consent
 Explain the process and purpose of the Patient Accountability and Care Plan
 Patient identification and allergy band are checked against clinical notes/ stickers
 Document findings from patient Admission including Risk Assessments and
management plans in clinical records, provide education and pamphlets to patient and
family
 Attend to height, weight and ward urinalysis and document in clinical records, care plan
and Observation Chart
 Obtain baseline observations, Usual systolic BP and MEWS Score
 Provide patient with verbal and CHHS information booklet regarding Patient’s Pressure
Injury, Falls and VTE Risks and management. Document Inpatient Progress notes
findings and actions
 Inform Pharmacist of patient’s admission and request Medication Reconciliation is
completed
 Day before surgery, clear fluids until mid-night. Fast from midnight. Inform Food
Services via DIETPas
 Bowel preparation if ordered
Preoperative:
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Medication Chart
 Usual medications are given at 0600Hrs
Before the patient is transferred from PACU/ICU to the ward:

 PACU/ICU Nursing staff to ensure:
 Receiving ward is aware of and has accepted patients admission
 Patient oxygen delivery system has the patients identification label on it
 Ward Nursing Staff to ensure:
o All emergency equipment is functioning and available, including oxygen and suction
Receiving patient from PACU/ICU

Equipment:
 Don PPE as required
 Patient identification and allergy band are checked against clinical notes/stickers.
Procedure, Correct Patient, Correct Site, Correct Procedure
 Check patient’s airway is clear and observe for effort of breathing (i.e. use of accessory
muscles)
 If airway is compromised place the patient in the lateral position (if not
 Ensure the oxygen is attached to wall oxygen outlet
 Confirm flow rate as ordered (PACU staff responsibility on arrival at ward – checked by
 Ensure equipment has been plugged in and cords are positioned safely under bed or off
the floor
 Transfer of care must reflect Clinical Handover Procedure
 Clarify the operative procedure performed. All actions to reflect Correct Patient,
Correct Site, Correct Procedure
 Discussion of patient medical history and impacting co morbidities should occur whilst
ensuring privacy
 The PACU nurse hands over verbally to the ward nurse at the patient bed side. At the
completion of handover the PACU observation chart should be signed and dated by
both the PACU and ward nurse. Handover should include:
 Review of post operative vital signs, including any interventions required for
stabilisation
 Review the Fluid Balance Chart, check intravenous fluid insitu, received in PACU and
site, and is appropriately secured) Monitor intravenous therapy and record IVT on fluid
balance chart)
 Urinary drainage devices e.g. Indwelling Catheters (IDC), Urostomies, etc (ensure hand
hygiene is attended after contact with these devices)

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 IDC to be anchored with Statlock unless the surgeon specifically requests Statlock not to
used as per Urinary Catheter Management Procedure
 Urine output is to be recorded hourly for 48 hours postoperatively
 Check any drains insitu e.g. wound drains and output (ensure hand hygiene is attended
after contact with these devices). Drainage bags to be changed and output documented
on FBC and Inpatient progress notes daily at midnight
 Check output of nasogastric tube for drainage or feeding. Ensure orders are clearly
documented in the notes as to purpose, use and position of tube (ensure hand hygiene
is attended when in contact with these devices)
 Ensure all output is documented on Fluid Balance Chart
 Medications administered and documented on medication chart review
 Any intravenous medications ordered and given (e.g. antibiotics, antihypertensive)
 Observe the wound dressing for ooze or blood loss. Note colour, amount and odour (if
any), reinforce wound if required. Do not remove theatre dressing
 Any pain management devices including Patient Controlled Analgesia (PCA), Epidurals,
Pain Busters, Continuous Opioid infusions, regional local anaesthetic infusions, etc and
single shot analgesia technique without pain management device i.e. single shot local
anaesthetic block or intrathecal/epidural morphine single dose administration for post
operative pain relief (refer to appropriate Pain Management Unit procedures)
 Perform and document a full set of Vital signs and Modified Early Warning Score
(MEWS)
 All observations are to be recorded on the Modified Early Warning Score (MEWS) charts
and appropriate adjunct charts (i.e. neurovascular, neurological, PCA, Epidural,
Intrathecal/ epidural morphine etc)
 Ensure all of the above are completed prior to PACU nurse leaving ward area and
patient care is accepted
 Complete Patient Care and Accountability Plan and action appropriately
patients response
 Offer and attend to bed bath
 Dress in personal nightwear if desired
 Offer and attend to mouth care, replacing dentures if applicable
 Position the patient in accordance to post operative instructions
 Ensure that the call bell is within reach and
 Lower bed and bed rails to maintain patient safety if required. Note: where patients are
 Educate and encourage deep breathing and leg exercises
 Ensure 2/24 Pressure area care and skin integrity checks and repositioning performed
(off affected side)
 Document all observations on the appropriate charts, e.g. MEWS, fluid balance chart, in
the Patient clinical record and escalate if required according to MEWS and MET criteria
patients response
Ward management:
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Ward Nursing Staff:

 Ensure Privacy
 Explain the process and purpose of the dressing change
 Obtain verbal consent for any interventions
General/ Epidural/ Spinal Anaesthetic:

Perform and document a Full set of Vital Signs and Modified Early Warning Score (MEWS):
 On return to ward, then
 Half hourly for two hours (30mins x two hours), if MEWS ≥ 4 continue half hourly (See
‘Adult Vital Signs and Early Warning Score SOP’) (excluding Day Surgery Unit)
 When MEWS <4, hourly for four (4) hours (60 mins x four hours), then
 Fourth hourly for a minimum of 48 hours
 Where an Epidural is in situ patient assessment is performed Following the guidelines of
the Epidural (Adult and Paediatric ) Chart and Insert Documents and Procedure
 The Patient Accountability and Care Plan must be commenced within the postoperative
period
 Risk Assessments for Pressure Injury, Falls, VTE, Mobility/Manual Handling and
Discharge must be completed, actioned and documented in the patient progress notes
within the postoperative period as reflected in the Patient Accountability and Care
Planning Procedure
Ward Management Day 1:

 Check patient clinical records for medical orders
 Remains NBM until reviewed by medical team, if dietary status changed, inform Food
Services via DIETpas and update bed card
 Commence diet and fluids as ordered (continue to monitor tolerance of diet)
 Maintain IV Fluids
 Maintain hourly urine output measures
 Document drain output and change drainage bag at midnight
 Maintain strict Fluid Balance Chart
 Ensure second hourly pressure area care and skin integrity checks are offered and
performed
 Maintain fourth hourly vital signs
 Maintain observations as required with Epidural/ PCA
 Assist patient with sponge in bed
 Attend perineal/ penile care
 Observe the wound dressing for ooze or blood loss fourth hourly
 Sit patient out of bed
 Reapply TEDs
 Notify physiotherapist
 Continue discharge planning with Discharge Liaison Nurse (DLN) and allied health team
as appropriate

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 May progress to Free Fluids to Light Diet if passed flatus and approved by medical staff
 Inform Food Services of changes via DIETpas and update Bed Card
 Maintain observations as required with Epidural/PCA- may be removed if tolerating
fluids at the discretion of the APS. Motor Block observations maintained for 24 hours
post removal of Epidural
 Assist patient with shower
 Attend Perineal/ penile care
 Observe the wound for swelling, ooze and/ or redness fourth hourly. Dress as per
medical orders
 Encourage patient mobilisation with stand by assistance
 Continue discharge planning
 Consecutive post operative days continue as Day 2, drains will be shortened and/ or
removed at the discretion of medical officer. Patient usually discharged on day six to
eight depending on progress
Discharge planning:
 Ensure Medical Officer (MO) has documented discharge Inpatient clinical record
 Ensure discharge medications are scanned to pharmacy
 Inform patient of usual discharge procedure, i.e., transfer to Discharge Lounge by 1000
on the day of discharge
 CNC to refer to the Discharge Liaison Nurse for wound care and/or staple removal at
daily MDT meeting

Section 12 – Management of patients undergoing a Percutaneous
Nephrolithotomy
To provide guidelines for the pre and post operative management of patients undergoing a
Nephrolithotomy, i.e., surgical removal of a kidney stones via a percutaneous tract using
laparoscopic equipment
On transfer to ward, all observations should be attended in the presence of the PACU nurse
to ensure any abnormalities may be identified and managed as soon as possible. If the
patient meets the MET criteria, activation of MET should occur.
A full set of Vital signs includes Respiratory Rate, Oxygen Saturations, Temperature, Blood
Pressure, Pulse, Level of Consciousness and Urine Output. A full set of Vital Signs must be
performed every time vital signs are taken in the post transfer from ICU (Refer to ‘Adult
Vital Signs and Early Warning Scores’).

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If respirations are twelve or less per minute or if the patient complains of headache
following spinal or epidural anaesthetic within the first 24 hours, notify the Anaesthetist or
Anaesthetic Registrar immediately and document in the patient’s clinical record. Please
check surgeon’s preference regarding placement of Statlock, securement of drains and post
operative pain management.
Nephrostomy drainage catheter

 Do not instil more than 10 ml of Sodium Chloride 0.9% at one time (See NSW Agency for
Clinical Innovation. ACI Urology Network 2012, p. 8).
 Flush the tube very slowly. Do not apply force as over distension of the renal pelvis
could cause renal tissue damage.
On admission:
Equipment:
 Patient clinical notes and observation charts
 Personal protective equipment (PPE) including safety goggles or shield and clean gloves
 Stethoscope
 Watch with a second hand
 Sphygmomanometer (blood pressure cuff)
 Oxygen saturation monitor
 Thermometer
 Intravenous (IV) pole – mobile
 Emesis bag
 Bedside emergency equipment
Procedure:
1. Patient usually attends preadmission clinic (PAC) and is admitted the on the day of
surgery (DOSA). Investigations attended in the PAC are as follows
2. Bloods – UEC, FBC, COAG’s, X – MATCH (two to four units)
3. ECG, CXR, KUB (kidneys, Ureters and Bladder-confirm position of calculi) X-ray as
required
4. Additional bloods, CT, MRI as required
5. Micro urine (MSU)
6. Consent completed reflecting the Consent to Treatment Procedure
7. Check reason for admission Inpatient’s clinical record and length of stay as per Request
for Admission form to predict estimated date of discharge (EDD/PDD), i.e.,
commencement of Discharge Planning.
8. Explain the process and purpose of the Patient Accountability and Care Plan
9. Patient identification and allergy band are checked against clinical notes/ stickers
10. Document findings from patient Admission including Risk Assessments and
management plans in clinical records, provide education and pamphlets to patient and
family
11. Attend to height, weight and ward urinalysis and document in clinical records, care plan
and Observation Chart

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12. Obtain baseline observations, Usual systolic BP and MEWS Score

13. Provide patient with verbal and CHHS information booklet regarding Patient’s Pressure
Injury, Falls and VTE Risks and management. Document Inpatient Progress notes
findings and actions
14. Inform Pharmacist of patient’s admission and request Medication Reconciliation is
completed
15. Day before surgery, Nil by Mouth from Midnight or as per Urologist’s orders
Preoperative:
Medication Chart
 Usual medications are given at 0600
Before the patient is transferred from PACU to the ward:

PACU Nursing staff to ensure:
 Receiving ward is aware of and has accepted patients admission
 Patient oxygen delivery system has the patients identification label on it
Ward Nursing Staff to ensure:

 Patient bed area has been cleaned
 All emergency equipment is functioning and available, including oxygen and suction
Receiving patient from PACU:

1. Don PPE as required
2. Patient identification and allergy band are checked against clinical notes/stickers.
Procedure, Patient Identification and Procedure Matching Policy and Procedure
3. Check patient’s airway is clear and observe for effort of breathing (i.e. use of accessory
muscles)
4. If airway is compromised place the patient in the lateral position (if not
5. Ensure the oxygen is attached to wall oxygen outlet
6. Confirm flow rate as ordered (PACU staff responsibility on arrival at ward – checked by
7. Ensure equipment has been plugged in and cords are positioned safely under bed or off
the floor
8. Transfer of care must reflect Clinical Handover Procedure
9. Clarify the operative procedure performed. All actions to reflect Procedure Matching
Policy and Procedure
10. Discussion of patient medical history and impacting co morbidities should occur whilst
ensuring privacy

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11. The PACU nurse hands over verbally to the ward nurse at the patient bed side. At the
completion of Handover the PACU observation chart should be signed and dated by both
the PACU and ward nurse. Handover should include:
12. Review of post operative vital signs, including any interventions required for
stabilisation
13. Review the Fluid Balance Chart, check intravenous fluid insitu, received in PACU and
site, and is appropriately secured) Monitor intravenous therapy and record IVT on fluid
balance chart)
14. Urinary drainage devices e.g. Indwelling Catheters (IDC), Urostomies, Nephrostomy
tubes etc (ensure hand hygiene is attended after contact with these devices)
15. IDC to be anchored with Statlock unless the surgeon specifically requests Statlock not to
used as per Urinary Catheter Management Procedure
16. Maintain Nephrostomy tube patency as per Drain Management Procedure
17. Nephrostomy to be anchored with Statlock device
18. Urine output is to be recorded hourly for 48 hours postoperatively
19. Check flank for swelling, bruising or ooze and ensure adequate pain relief
20. Check any drains insitu e.g. wound drains and output (ensure hand hygiene is attended
after contact with these devices). Drainage bags to be changed and output documented
on FBC and Inpatient progress notes daily at midnight
21. Check output of nasogastric tube for drainage or feeding. Ensure orders are clearly
documented in the notes as to purpose, use and position of tube
22. Ensure all output is documented on Fluid Balance Chart
23. Medications administered and documented on medication chart review
24. Any intravenous medications ordered and given (e.g. antibiotics, antihypertensive)
25. Observe the wound dressing for ooze or blood loss. Note colour, amount and odour (if
any), reinforce wound if required. Do not remove theatre dressing
26. Pain management devices such as Patient Controlled Analgesia (PCA), to be managed as
per appropriate PCA procedures
27. All observations are to be recorded on the Modified Early Warning Score (MEWS) charts
and appropriate adjunct charts (i.e. neurovascular, neurological, PCA, Epidural,
Intrathecal/ epidural morphine etc)Ensure all of the above are completed prior to PACU
nurse leaving ward area and patient care is accepted
28. Complete Patient Care and Accountability Plan and action appropriately
29. Record in the patient's clinical record all post-operative nursing care provided and the
patients response
30. Offer and attend to bed bath
31. Dress in personal nightwear if desired
32. Offer and attend to mouth care, replacing dentures if applicable
33. Position the patient in accordance to post operative instructions
34. Ensure that the call bell is within reach and
35. Lower bed and bed rails to maintain patient safety if required. Note: where patients are
36. Educate and encourage deep breathing and leg exercises
37. Ensure 2/24 Pressure area care and skin integrity checks and repositioning performed
(off affected side)
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38. Document all observations on the appropriate charts, e.g. MEWS, fluid balance chart, in
the patient clinical record and escalate if required according to MEWS and MET criteria
39. Record in the patient's clinical record all post-operative nursing care provided and the
patients response
Ward Nursing Staff:

 Explain the process and purpose of the dressing change
 Obtain verbal consent for any interventions
General/Epidural/Spinal Anaesthetic
Perform and document a Full set of Vital Signs and Modified Early Warning Score (MEWS):
 On return to ward, then
 Half hourly for two hours (30mins x two hours), if MEWS ≥4 continue half hourly (Refer
to Vital Signs and Early Warning Score Procedure)
 When MEWS <4, hourly for four hours (60 mins x four hours), then
 Fourth hourly for a minimum of 48 hours
 The Patient Accountability and Care Plan must be commenced within the postoperative
period
 Risk Assessments for Pressure Injury, Falls, VTE, Mobility/Manual Handling and
Discharge must be completed, actioned and documented in the patient progress notes
within the postoperative period as reflected in the Patient Accountability and Care
Planning Procedure

 Update diet when reviewed by medical team, if dietary status changed, inform Food
Services via DIETpas and update Bed card
 Monitor tolerance of diet
 Maintain IV Fluids
 Maintain hourly urine output measures
 Maintain strict Fluid Balance Chart
 Ensure second hourly pressure area care and skin integrity checks are offered and
performed
 Maintain observations as required with PCA
 Attend perineal/ penile care
 Observe the wound dressing for ooze or blood loss fourth hourly
 Sit patient out of bed
 Reapply TEDs
 Notify physiotherapist
 Continue discharge planning with Discharge Liaison Nurse (DLN) and allied health team
as appropriate
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 Monitor tolerance to diet and progression to full diet
 Inform Food Services of changes via DIETpas and update Bed Card
 Maintain observations as required with PCA- may be removed if tolerating fluids at the
discretion of the APS.
 Attend Perineal/ penile care
 Observe the wound for swelling, ooze and/ or redness fourth hourly. Dress as per
medical orders and as per Drain Management Procedure
 Encourage patient mobilisation with stand by assistance
 Continue discharge planning
 Document drain output-amount, consistency, colour, odour etc
 Change drainage bag at midnight
 Medical Officer may order a Nephrostogram to confirm the patency of the urinary tract
post-operatively
 Depending on Nephrostogram results the Medical Officer may request the
Nephrostomy tube to be clamped for six to eight hours prior to removal
 When Nephrostomy tube clamped-observe patient for pyrexia and flank pain
 Contact the Medical Officer if either occur
Consecutive post operative days continue as Day 2, drains will be removed at the discretion
of medical officer
Discharge planning:
 Ensure MO has documented discharge Inpatient clinical record
 Ensure discharge medications are scanned to pharmacy
 Inform patient of usual discharge procedure, i.e. transfer to Discharge Lounge by 1000
on the day of discharge
 CNC to refer to the Discharge Liaison Nurse for wound care of Nephrostomy tube site
care post removal of Nephrostomy tube at daily MDT meeting
 Follow-up appointment is usually four to six weeks in the Outpatient Urology Clinic or in
the VMO’s private rooms, please clarify this before patient is discharged
 Educate the patient regarding the VMO’s post-operative instructions – no strenuous
activity for four to six weeks until reviewed. Ensure adequate fluid intake i.e. two litres
per day

Section 13 – Management of patients admitted with Pre-Existing
Continent Urinary Reservoirs/Neobladder during routine hospital
admissions

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Purpose
To provide information on the clinical management of patients who are admitted into
Canberra Hospital with a pre existing Continent Urinary Reservoir / Neobladder, to ensure
care is consistent for each individual patient.
A Continent Urinary Reservoir, also known as a Neobladder, is a procedure in which a false

bladder has been developed from a section of the patients’ bowel. The bladder is continent
due to the positioning of the opening in the abdominal wall. The patient is required to self
catheterise several times each day in order to release the stored urine. Continent Urinary
Reservoirs / Neobladder can also be known as Studor, Kock’s, Indianan or a Charleston
Pouch.
Procedures:
Patients who are admitted to Canberra Hospital with a pre-existing Continent Urinary
Reservoir require individualised management of the reservoir for the duration of the
inpatient admission.
On admission of the patient it will be necessary to:

 Obtain a review by the Surgical Urology Registrar to initiate and formalise the treatment
plan of the individual reservoir
 Inform the Stomal Therapist of the patients admission
Senior nursing staff from the Urology Ward are available 24 hours per day to provide further
advice and guidance relating to Continent Urinary Reservoirs if required.

Implementation
All staff working in the Urology ward to read and sign Procedure Register. CNC and CDN to
monitor Register to ensure all staff are aware of appropriate care for patients undergoing
Urology procedures every 12 months.
Staff will be told where to access this Procedure as part of their Ward Orientation

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Related Policies, Procedures, Guidelines and Legislation
Policies and Procedures

Perineal/ Penile Care SOP
Healthcare Associated Infections Procedure
Health Waste Management Policy
Health Nursing and Midwifery Continuing Competence Policy
Patient Identification-Surgical Safety Checklist SOP
Patient Identification and Procedure Matching procedure
Health Consent and Treatment Policy
Health Consent and Treatment Procedure
Wound Management Procedure
Post-operative Handover and Observations-Adult Patients (first 24 hours) SOP
Epirubicin Chemotherapy use in Urological Surgery SOP
Chemotherapy Care of the Adult Patient eviQ
Legislation
Health Practitioner Regulation National Law (ACT) Act 2010
Health Records (Privacy and Access) Act 1997
Health Regulation (Maternal Health Information) Act 1998
Human Rights Act 2004
Privacy Act 1988
Guardianship and Management of Property Act 1991
Medical Treatment (Health Directions) Act 2006
Powers of Attorney Act 2006

Search Terms
Urology, catheter, urine, urinary reservoirs, neo-bladder, Percutaneous nephrolithotomy,

nephrectomy, indwelling catheter, suprapubic, catheterisation, void, Urinary drainage bag,
TURP, transurethral prostatectomy, bladder irrigation, IDC, SPC,

References
The Joanna Briggs Institute, 2008, Canberra Hospital Procedure Manual 2008, 27 July 2006,
pp 207-208
GMCT Urology Network-Nursing, Catheters (Male and SPC), September 2008, p 20

Prevention of Indwelling Catheter Associated Urinary Tract Infections, Dailly, Sue, Nursing
Older People 23.2, March 2011

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Bard StatLock® Universal Plus Stabilization Device. https://www.bardaccess.com/statlock-

other-universal-plus.php Accessed 13 November 2013.
NSW Agency for Clinical Innovation. ACI Urology Network – Nursing. Nursing Management
of Patients with Nephrostomy Tubes. Guidelines and Patient Information Templates. 2012.
Siddiq M and Darouiche R. Infectious complications associated with percutaneous
nephrostomy catheters: Do we know enough? International Journal of Artificial Organs.
2012;35(10):898-907.
The Australian Council on Healthcare Standards (ACHS). [Homepage of ACHS] [Online] – last
updated 19 April 2011. Available: www.achs.org.au/ [6 July 2011].
NS485 Madeo M, Roodhouse AJ (2009) Reducing the risks associated with urinary catheters.
Nursing Standard. 23, 29, 47-55. Date of acceptance: February 11 2009.
Tucker, S.M., Canobbio, M.M., Paquette, E.V. and Wells M.J. (2000) Patient Care Standards:
Collaborative Planning and Nursing Interventions, 7th Edition
Monahan, Mosby (2010) Manual of Medical-Surgical Nursing, 7th Edition
Le, V. The Joanna Briggs Institute (2011) Bladder Irrigation Post Transurethral Resection of
the Prostate
Mikel L. Gray, PhD, Securing the Indwelling Catheter- American Journal of Nursing,
December 2008
Australian Infection Control Association-Position Statement, “Preventing Catheter
Associated Infections Inpatients”, November 2010
Timby, B. Fundamentals of Nursing: Nursing Skills and Concepts. 9th ed Lippincott, Williams
and Wilkins. 2008
Jones, S. et al Care of urinary catheters and drainage systems. Nursing Times; 103:42. 2007
Getliffe K & Dolman M, Promoting Continence, A Clinical Research Resource, Bailliere.2006
NHS Quality Improvement Scotland, Best Practice Statement June, Urinary Catheterisation &
Catheter Care.2007
National Institute for Clinical Excellence June 2003, "Infectious Control: Prevention of
healthcare-associated infection in primary and community care" Standard 1.2.5.1, 1.2.5.7,
1.2.5.3, Clinical guideline 2,
Guidelines for prevention of Catheter –Associated Urinary Tract Infections. CAUTI

Guidelines. 2009

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Wasson, D., (1998-2002), Perspectives–Transurethral Resection of the Prostate,

http: 11perspectivesinnursing.org/vin3/wasson.html
Tucker, S.M., Canobbio, M., Paquette, E. V., & Wells, M. F., (2000), Patient Care Standards –
Collaborative Planning and Nursing Interventions, pp633–635.
Bladk, J., & Matassarin–Jacobs, E., (1997), Medical–Surgical Nursing – Clinical Management
for Continuity of Care, 5th edition, pp 2350–2363.
The Joanna Briggs Institute, Canberra Hospital – Acute Care Practice Manual 2008, supra-
pubic catheter site dressing, 5.2.2007, p195-197
‘World Health Organisation (WHO) Guidelines on Hand Hygiene in Healthcare.
Farrell, M., Smeltzer, S & Bare, B., (2005) Smeltzer & Bare’s Textbook of Medical-Surgical
Nursing, Lippincott Williams & Wilkins Pty. Ltd, Australian & New Zealand Edition, pp 1360-
1361

Attachments
Attachment A: Stat Lock – Foley Stabilisation Device

Attachment B: Insertion of Urinary Catheter Sticker
Attachment C: How to care for your Urinary Catheter
Attachment D: Troubleshooting guide for urinary catheters
Attachment E: Source of information and/ or suppliers for urinary catheter equipment
Attachment F: Catheter selection
Disclaimer: This document has been developed by ACT Health, <Name of Division/ Branch/Unit> specifically for
its own use. Use of this document and any reliance on the information contained therein by any third party is
at his or her own risk and Health Directorate assumes no responsibility whatsoever.
Date Amended Section Amended Approved By

Eg: 17 August 2014 Section 1 ED/CHHSPC Chair

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Attachment A: Stat Lock – Foley Stabilisation Device

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Attachment B: Insertion of Urinary Catheter Sticker
Sticker available on order through Corporate Express

ID 18838521
ACT Hth Ins of Urinary Cath Lbls Roll 500

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Attachment C: How to care for your Urinary Catheter

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Attachment D: Troubleshooting guide for urinary catheters
TROUBLESHOOTING GUIDE FOR URINARY CATHETERS

PROBLEM POSSIBLE CAUSE WHAT TO DO
Check Plumbing Is the catheter or tubing kinking - check bag
CATHETER LEAKAGE
and/or valve connections, check line and
(Bypassing) connection of tubing. Use catheter securing
device.
Faecal Impaction / Assess, alleviate and prevent by review of
Constipation bowel management.
Catheter too large A urethral catheter that is greater than 18Fg
may need to be gradually downsized.
o Women IDC: 12 -14Fg/10ml balloon
o Men IDC: 14- 16Fg /10ml balloon
o SPC: 16 -18
Balloon too large A 5-10ml balloon is advised. Authorisation
from an Urologist is required for long-term
use of a catheter with a 30 ml balloon, given
it may contribute to bladder neck erosion.
Catheter blockage If a catheter is blocked and has been insitu
for >2 weeks it may be replaced and
documented on Urinary Catheter
Management Chart. Determine the blocking
agent and consult with Medical Officer re
indications for antibiotic therapy or refer for
a urological review.
Bladder spasm See BLADDER SPASM
Bladder spasm Consider concentrated urine – increase fluids
BLADDER PAIN
Bladder Distension Assess and action as per NO URINE
DRAINING
Traction on Catheter Secure with tape or strap
Bladder infection - See INFECTION
Symptomatic
Balloon too large or 5-10 ml balloon advised (as per
Catheter too large manufacturer’s recommendations
IDC – less than 18Fg advised
BLADDER SPASM Traction on Ensure catheter is not under tension.
(Cramps) catheter with Recommend use of catheter strap.
movement
Faecal Impaction / Alleviate and prevent. Review bowel
Constipation management.
Bladder infection See INFECTION

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Overactive bladder Discuss use of anticholinergic medication
with Medical Officer. Consider use of topical
oestrogen for urethritis in females
New Catheter in Spasms should settle within 24-48 hours,
situ Reassure patient they should resolve.
BLEEDING Trauma Ensure catheter is not under tension, check
securement devices. Some clients may
experience a small amount of bleeding
following SPC change.
Infection See INFECTION
Persistent Urgent referral to medical officer / Urological
Haematuria consult
NO URINE Kinked tubing Check for correct lie and connection of
DRAINING +/- tubing
urinary leakage Low fluid intake Recommend fluid intake of between 2-3
litres daily unless otherwise stated by
Medical Officer.
Drainage bag above Lower bag, ensure bag is below bladder level
bladder level to assist gravity.
Catheter is blocked If a catheter is blocked and has been insitu
with mucous or for >2 weeks it may be changed.
debris Catheter Flush:
o may be indicated if a client has a history
of blocked catheter
o is prescribed by a medical practitioner
and requires a treatment order
o is a short term management option only
and the cause of the blockage should be
investigated. A Urology review must be
in place. (See Catheter Flushing SOP)
NO DRAINAGE OF Check as above. o Check for palpable bladder i.e. blocked
URINE AFTER
catheter. Check the catheter position in
SEVERAL HOURS
the bladder by deflating the balloon and
slightly rotate and push catheter in.
o Check for sediment and document
characteristics.
o Replace catheter.
o If anuria is identified (urinary output of
less than 100-250mls in 24 hours),
immediately refer client to nearest local
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hospital emergency department.
INFECTION o Review catheter management; ensure
closed link system is being maintained.
Clients with symptomatic catheter related
infection should be treated as per local
prescribing procedure or the latest version
of the Therapeutic Guidelines: Antibiotic if
not available
o Concerns regarding persistent infective
symptoms should be referred to a Medical
Officer.
PAIN AND Bladder and/or o Alleviate urethral traction trauma and
DISCOMFORT urethral irritation potential for pressure necrosis; secure
AROUND THE catheter with catheter retaining strap.
CATHETER, o Liaise with Medical Officer.
BLEEDING, ITCHING o See INFECTION
AND SORENESS o Discuss with medical officer possible use of
topical oestrogen for urethritis (in post-
menopausal women) with Medical Officer.
Allergy to catheter Change catheter type
material
Hyper granulation o Prevent catheter traction and alternate the
of supra pubic site side the catheter is taped to on a weekly
due to pulling or basis.
tension. o Keep stoma clean and dry.
o Silver nitrate treatment may be required
(See Wound Care Manual).
Infection of stoma Arrange for wound swab, treat as required
(See Wound Care Manual)
Catheter balloon o Insert new catheter. Nelaton catheter to
CATHETER FALLS
deflates keep site open until Foleys available
OUT
prematurely o Check balloon of dislodged catheter for
Balloon faulty faults.
Balloon intact o Anchor inadequate, or trauma at transfer
URINE IS CLOUDY, Infection See INFECTION

OFFENSIVE
Low fluid intake Recommend fluid intake: 2-3 litres daily
SMELLING
unless otherwise stated by Medical Officer.

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Difficult removal Ridging of deflated o Allow balloon to spontaneous deflate
balloon or o Select appropriate catheter materials: all-
hysteresis’ silicone catheters have a tendency to cuff,
consider all-silicone catheter with
integrated balloon (Releen In-Line Foley
catheter or hydrogel coated catheter
(Bard Biocath). Consider latex allergy
status of clients.
o Where cuffing is suspected, consider
instilling 1ml of sterile water back into the
balloon (after complete deflation).
Consider the use of anaesthetic gel prior
to the removal of the catheter.
Difficult removal Bladder Spasm o Apply lubricate to stoma site.
o A fair degree of pull may be required,
holding the catheter close to stoma, apply
consistent firm pressure whilst supporting
the abdomen with the non-dominant hand
until the catheter releases.
Anxiety o Encourage relaxation, allay anxiety
UNABLE TO INSERT Spasm of o Apply anaesthetic gel (Lignocaine 2%) to
SPC tract/bladder stoma site.
o Place catheter in stoma, apply firm constant
pressure to catheter whilst waiting release
of spasm.
o Insert Nelaton intermittent catheter to
maintain tract, then remove and quickly
insert usual catheter, or try smaller size
Foley catheter.
o Report to medical practitioner,
antispasmodic/muscle relaxant therapy may
be required.
o Where unsuccessful, send patient to hospital
within 30 to 45 minutes for management.
o Re-attempt at correct angle. Always observe
Not following tract the angle of tract during catheter removal.
NO DRAINAGE Catheter /balloon o Advance catheter a little further. Once in the
AFTER CATHETER bladder SPC should not be advanced more
not in bladder
INSERTION than 10 cm in total.
o Check/consider the tip of catheter is not
located in the urethra.

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No urine in bladder Dehydration o Give extra fluids.
o Ensure drainage before inflating balloon.
o Advise increased fluids prior to planned
o catheterisation.

Check Plumbing Is the catheter or tubing kinking - check bag
CATHETER LEAKAGE
and/or valve connections, check line and
(Bypassing) connection of tubing. Use catheter securing
device.
Catheter too large A urethral catheter that is greater than 18Fg
may need to be gradually downsized.
o Women IDC: 12 -14Fg/10ml balloon
o Men IDC: 14- 16Fg /10ml balloon
o SPC: 16 -18
Balloon too large A 5-10ml balloon is advised. Authorisation
from an Urologist is required for long-term
use of a catheter with a 30 ml balloon, given
it may contribute to bladder neck erosion.
Catheter blockage If a catheter is blocked and has been insitu
for >2 weeks it may be replaced and
documented on Urinary Catheter
Management Chart. Determine the blocking
agent and consult with Medical Officer re
indications for antibiotic therapy or refer for
Bladder spasm See BLADDER SPASM
Bladder spasm Consider concentrated urine – increase fluids
BLADDER PAIN
Bladder Distension Assess and action as per NO URINE
DRAINING
Traction on Catheter Secure with tape or strap
Bladder infection - See INFECTION
Symptomatic
Balloon too large 5-10 ml balloon advised (as per
or Catheter too manufacturer’s recommendations
large IDC – less than 18Fg advised

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BLADDER SPASM Traction on Ensure catheter is not under tension.
(Cramps) catheter with Recommend use of catheter strap.
movement
Faecal Impaction / Alleviate and prevent. Review bowel
Constipation management.
Bladder infection See INFECTION
Overactive bladder Discuss use of anticholinergic medication
with Medical Officer. Consider use of topical
oestrogen for urethritis in females
New Catheter in Spasms should settle within 24-48 hours,
situ Reassure patient they should resolve.
BLEEDING Trauma Ensure catheter is not under tension, check
securement devices. Some clients may
experience a small amount of bleeding
following SPC change.
Infection See INFECTION
Persistent Urgent referral to medical officer / Urological
Haematuria consult
NO URINE Kinked tubing Check for correct lie and connection of tubing
DRAINING +/- Low fluid intake Recommend fluid intake of between 2-3
urinary leakage litres daily unless otherwise stated by
Medical Officer.
Drainage bag Lower bag, ensure bag is below bladder level
above bladder to assist gravity.
level
Catheter is blocked If a catheter is blocked and has been insitu
with mucous or for >2 weeks it may be changed. Determine
debris the blocking agent and consult with Medical
Officer re indications for antibiotic therapy or
Catheter Flush:
o may be indicated if a client has a history
of blocked catheter
o is prescribed by a medical practitioner
and requires a treatment order
o is a short term management option only
and the cause of the blockage should be
investigated. A Urology review must be in
place. (See Catheter Flushing SOP)
NO DRAINAGE OF Check as above. o Check for palpable bladder i.e. blocked
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URINE AFTER catheter. Check the catheter position in
SEVERAL HOURS the bladder by deflating the balloon and
slightly rotate and push catheter in.
o Check for sediment and document
characteristics.
o Replace catheter.
o If anuria is identified (urinary output of
less than 100-250mls in 24 hours),
immediately refer client to nearest local
hospital emergency department.
INFECTION o Review catheter management; ensure
closed link system is being maintained.
Clients with symptomatic catheter related
infection should be treated as per local
prescribing procedure or the latest version of
the Therapeutic Guidelines: Antibiotic if not
available
o Concerns regarding persistent infective
symptoms should be referred to a Medical
Officer.
PAIN AND Bladder and/or o Alleviate urethral traction trauma and
DISCOMFORT urethral irritation potential for pressure necrosis; secure
AROUND THE catheter with catheter retaining strap.
CATHETER, o Liaise with Medical Officer.
BLEEDING, ITCHING o See INFECTION
AND SORENESS o Discuss with medical officer possible use of
topical oestrogen for urethritis (in post-
menopausal women) with Medical Officer.
Allergy to catheter Change catheter type
material
Hyper granulation o Prevent catheter traction and alternate the
of supra pubic site side the catheter is taped to on a weekly
due to pulling or basis.
tension. o Keep stoma clean and dry.
o Silver nitrate treatment may be required
(See Wound Care Manual).
Infection of stoma Arrange for wound swab, treat as required
(See Wound Care Manual)

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Catheter balloon o Insert new catheter. Nelaton catheter to
CATHETER FALLS
deflates keep site open until Foleys available
OUT
prematurely o Check balloon of dislodged catheter for
Balloon faulty faults.
Balloon intact o Anchor inadequate, or trauma at transfer
URINE IS CLOUDY, Infection See INFECTION

OFFENSIVE
Low fluid intake Recommend fluid intake: 2-3 litres daily
SMELLING
unless otherwise stated by Medical Officer.
Difficult removal Ridging of deflated o Allow balloon to spontaneous deflate
balloon or o Select appropriate catheter materials: all-
hysteresis’ silicone catheters have a tendency to cuff,
consider all-silicone catheter with
integrated balloon (Releen In-Line Foley
catheter or hydrogel coated catheter
(Bard Biocath). Consider latex allergy
status of clients.
o Where cuffing is suspected, consider
instilling 1ml of sterile water back into the
balloon (after complete deflation).
Consider the use of anaesthetic gel prior
to the removal of the catheter.
Difficult removal Bladder Spasm o Apply lubricate to stoma site.
o A fair degree of pull may be required,
holding the catheter close to stoma, apply
consistent firm pressure whilst supporting
the abdomen with the non-dominant hand
until the catheter releases.
Anxiety o Encourage relaxation, allay anxiety

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UNABLE TO Spasm of o Apply anaesthetic gel (Lignocaine 2%) to
INSERT SPC tract/bladder stoma site.
o Place catheter in stoma, apply firm
constant
pressure to catheter whilst waiting release
of spasm.
o Insert Nelaton intermittent catheter to
maintain tract, then remove and quickly
insert usual catheter, or try smaller size
Foley catheter.
o Report to medical practitioner,
antispasmodic/muscle relaxant therapy
may
be required.
o Where unsuccessful, send patient to
hospital
within 30 to 45 minutes for management.
o Re-attempt at correct angle. Always
Not following tract observe
the angle of tract during catheter removal.
NO DRAINAGE Catheter /balloon o Advance catheter a little further. Once in
AFTER CATHETER the
not in bladder
INSERTION bladder SPC should not be advanced more
than 10 cm in total.
o Check/consider the tip of catheter is not
located in the urethra.
No urine in bladder Dehydration o Give extra fluids.
o Ensure drainage before inflating balloon.
o Advise increased fluids prior to planned
o catheterisation.

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Attachment E: Source of information and/or suppliers for urinary catheter equipment

Continence Aids Payment Scheme (eligibility criteria applies)
ACTES ACT Equipment Scheme

If client is eligible for CAPS and has used their allowance they may be eligible for
assistance
G.P. MEDICAL
30 Colbee Court, Phillip, 2606 ACT Ph. 6282 0059
INDEPENDENT LIVING CENTRE
24 Parkinson St. Weston, 2600, ACT

Ph. 6205 1900
Fax (02) 62051906
Provides information and advice about products.
INDEPENDENCE SOLUTIONS
6 Holker St. Newington, NSW, 2127
Customer service number: 1300 788 855
Fax: 1300 788 811
BRIGHT SKY ( proceeds support ParaQuad NSW programs)

6 Holker St (corner of Avenue of Africa)
Newington NSW 2127
Phone 1300 88 66 01 Fax 1300 88 66 02
Email: orders@brightsky.com.au
Webstore: www.brightsky.com.au
LOCAL PHARMACIES may order relevant equipment for clients
MOBILITY MATTERS PTY LTD
33-35 Townsville St. Fyshwick
Ph. 6239 1381

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Attachment F: Catheter selection

Catheter Materials Recommended Advantages Disadvantages
Usage
Polyvinyl Chloride (PVC) Short term use Large internal diameter Uncomfortable
only, maximum 7 allows good drainage for long-term use
days postoperatively Rigid and
inflexible
Intermittent
PVC non balloon catheterisation
Polytetrafluoroethylene Short term, up to Smoother on external If left in situ for
(PTFE) or Teflon coated 28 days surfaces for insertion – too long Teflon
with latex core reduces tissue damage coating may wear
thin
More resistant to
encrustation Unsuitable for
clients allergic to
latex
Silver-alloy coated Catheter Protective against Not so effective
expected to be in bacteriuria when used at 14 days - not
situ for up to 14 for 5days proven for long
days term
effectiveness
Silicone Long term up to Wide lumen for ‘Cuffing’ of
All silicone BARD 12 weeks drainage. Suitable for balloon can occur
clients with latex on deflation and
All silicone CLINY
allergy can be more
difficult to
remove
suprapubically
Releen 100% Silicone Long term up to Reduced
12 weeks urethritis/inflammation
of urethra.
Wide lumen – reduced
encrustation.
Integrated balloon –
less ridging
Hydrogel coated latex Long term use up More compatible with Does contain
Biocath® Foley Catheter to 12 weeks body tissue, less latex – unsuitable
trauma. May resist for clients allergic
colonisation of bacteria to latex
and reduce infection

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Silicone elastomer- Long term use up May help to reduce Unsuitable for
coated latex (silicone to 12 weeks potential for clients allergic to
bonding to outer and encrustation latex
inner surfaces)
Hydrogel coated Long term use up Suitable for clients with Rigid; may be
silicone to 12 weeks latex allergy uncomfortable
for clients
Lubri-sil™ (BARD)

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Urology - Catheter Insertion and Management, Bladder Irrigation, Nephrectomy and Trans Urethral Prostatectomy (TURP)

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CHHS16/008

Canberra Hospital and Health Services

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Section 12 – Management of patients undergoing a Percutaneous Nephrolithotomy..........44

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This document applies to:

 Observed the procedure

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Community Based Patients:

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8. Catheter flushing is a prescribed procedure using a small amount of fluid to maintain

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Section 2 – Insertion of Female Indwelling Catheter (IDC)

18. Separate the labia with free hand

Note: Do not use force

Stabilisation of Urinary Catheters:

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 Peel away paper backing and place on skin (See Attachment A)

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9. Position fenestrated drape to provide sterile field

After this time you may:

17. Attach sterile drainage bag

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4.1 Insertion of Suprapubic Catheter

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 Alcohol based hand rub (ABHR)

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16. Attend hand hygiene by either hand washing or using ABHR

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5. Don clean gloves

11. Don clean gloves

Alert: Maintain a closed drainage system as much as possible so as to prevent infection. Do

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4.2 Changing Suprapubic Catheter: Inpatient

If symptomatic urinary tract infection is suspected and patient is not on antimicrobial

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4.3 Removal Suprapubic Catheter

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4.4 Management of Supra Pubic Catheter: Community Based Patient

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Care of the Suprapubic Catheter:

Supply of catheter equipment:

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 Procedural under pad

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Section 6 – Catheter Flushing for Adult Community based patient

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TOV with IDC Pathway:

TOV with SPC Pathway:

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Medical authorisation is required prior to TOV:

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The purpose of this section is to provide clinical care so as to: