Types
What is Intermittent Self Catheterisation or ISC?
When you introduce a straight single-use catheter long enough to drain the bladder. When the bladder is empty, you immediately withdraw this type of catheter.
A patient has a CAUTI after a week of having a catheter change. Name 4 interventions that are performed for correct treatment?
*Check patients catheter not blocked/ kinked/ pulling/ positioned correctly and using correct stat lock/ straps/ leg bag not full
* Check patient not constipation
* Observations: Temp (>38C), pulse and Blood pressure (check not hypotensive)
* Change the catheter using ANTT
* Obtain a CSU from a new/ clean leg bag and send for urine culture to microbiology
* Start antibiotics if symptomatic (2 or more symptoms rigors/ chills, low back pain)
* Consider use of analgesia (paracetamol /ibuprofen) to relive pain
* Consider admission to hospital if patient has fever and chills or new onset hypotension
* Review patient daily and if no improvement or patient deteriorates - admit to hospital.
What 5 checks you should always do BEFORE inserting a catheter?
* Check equipment is in date
* Ensure you have consent from the patient to perform procedure
* Ensure you have all of the necessary materials
* Ensure a sterile field and aseptic non touch technique used throughout
*Ensure patients dignity, privacy maintained throughout procedure.
*Hand Hygiene and PPE
What is the definition of urinary catheterisation?
Providing a continuous flow of urine in patients who are unable to control micturition or those with obstructions
Hospital-acquired urinary tract infections (UTIs) are often related to poor hand washing and:
A. Poor urinary output
B. Improper catheter care
C. Use of urinary drainage bags
D. Poor perineal care
B. Improper catheter care
How long can a Supra pubic catheterisation be left in situ?
A. 7 days
B. 28 days
C. 42 days
D. 70- 84 days
B. 42 days (6 weeks)
When can you use bladder maintenance solutions?
A: As a pre-emptive intervention to maintain the patency of the catheter and reduce encrustation.
B: To assist with unblocking catheters after they have been in for a week.
C: To assist with management of a CAUTI
D: Only when they are prescribed for the patient.
A: As part of a pre-emptive intervention to maintain the patency of the catheter and reduce encrustation.
and
D:Only when they are prescribed for the patient.
When a catheter blocks how may times can the balloon be re-inflated to make it drain?
A: Twice
B: Once
C: Never
D: Depends on manufacturers instructions
C: Never- the catheter is for single use only therefore the balloon can only be inflated once when it is inserted.
What is a CAUTI and when does this occur?.
A CAUTI is - A Catheter Associated Urinary Tract Infection - It occurs when bacteria in a catheter bypass the body's defence mechanism (such as the urethra and the passing of urine) and enters the bladder.
How long can a belly bag remain in situ when used with a supra pubic catheter?
A. 24hrs - 48hrs
B. 72hrs - 1 week
C. 3 weeks
D. 1 week - 2 weeks
C:Up to 3 weeks
Name 4 advantages/ disadvantages of use of a urethral catheter?
Advantages of Urethral Route
*Does not need a surgical insertion
*Relatively simple procedure
*May be used for both intermittent and indwelling catheters
*May be removed for episodes of sexual activity
*Allows easy measurement of residual urine
Disadvantages of Urethral Route
*May damage urethra.
*Problems with leakage, by-pass and expulsion common (Pomfret, 2015).
*Higher risk of symptomatic urinary infection (NICE, 2015)
*50% of patients with urethral catheters are prone to blockage (Morris, Stickler 2017)
Name 3 interventions nurses can take in order to prevent CAUTIs in patients with short- and long-term indwelling catheters?
*Staff education
*Aseptic non touch insertion technique of catheter
*Urethral meatal care
*Securement, use of a closed drainage system and stabilising device
*Pre-emptive bladder irrigation or maintenance
* Monitor frequency of catheter change
What size chariere catheter should a male patient use with prostate problems?
A: 12ch Foley catheter
B: 12 -16ch Foley catheter
C: 16-18ch Tierman tip catheter
D: 22ch All silicone catheter
B: 12 -16ch Foley or
c: 16-18ch Tierman Tip catheter if problematic.
How long does it take for bacteria to develop in a catheterised patient?
A: 1 week
B: 72hrs
C: 24-48hrs
D: Immediately
C: 24-48hrs
Which statement demonstrates how to collect a Mid Stream Urine (MSU) specimen from a patient who does NOT have a catheter?
A. Hold a cup firmly against the urethra while collecting the sample.
B. Cleanse back to front with the antiseptic wipe before peeing in the cup.
C. First, pee a small amount of urine in the toilet and then collect the rest in the cup.
D. To drink a lot of fluids to keep the urine diluted before peeing into the cup.
C. First, pee a small amount of urine in the toilet and then collect the rest in the cup.
Name 4 alternative products can be used instead of catheterisation. Predominately used for incontinent men who still have complete and spontaneous bladder emptying.
1: Sheath/ Conveen
2: Bioderm
3: External aids - AFEX Urinary System/
4: Penile Pouch
5: Urinals/Beambridge medical urinals/ funnels/ Uribags/
6: Last resort - Containment aids/ PADS
What type of interventions could be given through patient education on urinary habits?
*Perineal hygiene (cleansing while taking a bath)
*Maintaining adequate fluid intake 1.5 - 2l
*Maintaining elimination habits to prevent constipation
*Promote complete bladder emptying/ bladder drill - using a valve
*Regular toileting/ emptying of the leg bag when 2/3rds full
Name 5 checks you should always do after the catheter has been properly inserted?
* Ensure that the catheter is draining clear urine into closed system leg bag/ night bag prior to inflating the balloon
* Inflate the balloon with sterile water/ solution in accordance with manufacturers instructions.
* Anchor the catheter tube with a fixation device (G strap/ stat lock, leg straps, leg bag holder)
* Ensure the patient is cleaned, made comfortable and not in any pain
* Document and record details of catheterisation in patients notes and catheter passport
In accordance with NICE guidelines November 2018 when would you change an indwelling catheter with CAUTI symptoms?
A: Immediately
B: Within 48hrs after starting antibiotics
C: If the catheter has been in place for more that 1 week/ 7 days
D: Don't change - just give antibiotics.
C: If the catheter has been in place for more that 1 week/ 7 days.
N.B: Catheters should be removed rather than changed where possible.
The correct way to collect a catheter specimen of urine is?
A. Wash hands and apply PPE prior to obtaining a sample from a new leg bag
B. Clean portal on the leg bag with antiseptic wipe
C. Use a red topped bottle to collect the urine sample in and label correctly
D. All of the above.
D. All of the above.
Name 4 types of catheters that can be used for urinary catheterisation to aid drainage of urine and their duration of use.
1: Silicone elastomer coated latex, Hydrogel coated latex, Hydrogel coated 100% silicone, All silicone, Hydrogel coated silicone - up to 12 weeks
2: Polytetrafluoroethylene (PTFE), Silver alloy - up to 28 days
3: Uncoated latex (Scott) -up to 7 days
4: Plastic hydrophilic, Silicone hydrophilic, Plastic nelaton tipped, Discrete compact - Single use only
In accordance with NICE guidance 2015 all patients should have a clinical reason for catheterisation.
What is the acronym that is used to determine the clinical reason for this?
HOUDINI
H……….Haematuria -visible
O………Obstruction - urinary
U...........Urology surgery (post op)
D...........Decubitus ulcers – open sacral or perineal wound in an incontinent patient
I………..Input/output fluid monitoring
N...........Not for resuscitation (palliative care)/comfort care
I………..Immobility due to physical restraint, e.g. Unstable fracture
Name 3 important nursing interventions when inserting a catheter?
*Making sure you use the correct chariere size catheter
*Ensure you complete the catheterisation using an aseptic non touch technique
*A catheter can only be used once for insertion
*The catheter balloon can only be used in accordance with manufacturer's instructions and inflated once.
Name 3 pathogens or bacteria that increase the risk of Catheter Acquired Urinary tract infections
1:Escherichia Coli (E.coli)
2: Meticillin Resistant Staphylococus Aureus (MRSA)
3: Extended spectrum beta lactamase producing E.coli (ESBL)
UTI is the most common healthcare acquired infection, accounting for 19% of all healthcare-associated infections, with around half of these infections due to an indwelling urinary catheter (Health Protection Agency 2012). In some people, catheter-associated UTI can lead to a more serious systemic infection (urosepsis).
Constipation and Elimination changes that result from obstructing the flow of urine in the urinary collecting system may cause which of the following? (Select all that apply.)
A. Blood clots
B. Dehydration
C. Renal damage
D. Urinary retention
E. Urinary tract infection (UTI)
C. Renal damage
D. Urinary Retention
E. Urinary tract infection (UTI)