1. Catheter Care – Problem Solving Presented by Cheryl Hammond Clinical Nurse Specialist

2. Objective To maintain urinary drainage and reduce the risk of trauma and infection.

3. Educate the patient  Discuss catheter care - hygiene - securing catheter - supporting drainage bag - catheter not kinked or twisted - drainage bag emptied regularly - advise on fluid intake and prevention of constipation - importance of a closed system

4. Catheter by-passing  Check tubing is not twisted or kinked  Catheter secured  Check patient not constipated  Check size of catheter is correct  Check balloon inflated correctly

5.  Check if bag needs emptying  Check for infection  Check catheter not blocked  Consider possibility of bladder spasm or irritation

6. Catheter blocked  Check catheter in correct position  Check drainage bag, below bladder level and empty if full  Check tubing not kinked or blocked

7. Catheter by-passing due to bladder spasm  Decrease known bladder irritants i.e. caffeine and alcohol.  Decrease size of catheter  Check balloon size  Check bag is secured and empty bag.

8. Possible infection  Maintain closed system  Follow hand hygiene guidelines  Position bag below bladder level  Drainage bag should be off the floor  Catheter secured correctly

9. Risk factors  Patient been in hospital last 12 months  Patient taken antibiotics in last 6 months  Over 65 years of age  Diabetes  Chemotherapy  Taking steroids  Chronic wounds

10. Possible encrustation  Inspect for encrustation in the catheter lumen and on outer surfaces of the tip and the balloon.  Monitor PH of urine, urine is normally acidic.  Monitor time of catheter life and when blockage

11. Unable to deflate the balloon  Check for kinked tubing  Relieve in constipation  Try a different syringe and leave in place.  Try and dislodge debris blocking the deflation channel by milking the catheter along its length.  Never cut the catheter or inflation valve  Never attempt to burst the balloon by over inflating it..

12. References Bond P and Harris C (2005) Best practice in urinary catheterisation and catheter care, Nursing Times, 101 (8) 54-58. Freeman C (2009) Why more attention must be given to catheter fixation, Nursing Times, 105 (29) Fraczyk L Godfrey H (2004) Current practice of antibiotic prophyalaxis for catheter procedures, British Journal of Nursing, 13 (10) 610-617. Getliffe K and Dolman M (2007) Catheters and containment products, 10, 259- 307; Promoting Continence A Clinical and Research Resource. Holtam B (2004) Blocked indwelling urethral catheters ; Evaluating the evidence, Journal of Community Nursing, 18, 3. Howell AB, Foxman B (2002) Cranberry juice and adherence of antibiotic resistant uropathogens, Journal of the American Medical Association, 287, 3082-3 Madeo M and Roohouse AJ (2001) Reducing the risks associated with urinary catheters, Nursing Standard, Supplement, 3-13. Promfret I (2007) Urinary catheter problems 2, Journal of Community Nursing, 21, (7) 23-25. Robinson J (2006) Selecting a urinary catheter and drainage system, British Journal of Nursing, 15 (19), 1045-1050. Royal College of Nursing (2012) Catheter Care, RCN guidance for nurses. Turner B and Dickens N (2011) Long term urethral catheterisation, Nursing Standard, 25 (24) 49-56