1. Urinary Catheters & Problem Solving William Ryan Nurse Advisor

2. Aim of Presentation
Cover common issues related to Indwelling Urinary Catheters (IDC & SPC)
Always consider why is the catheter in-situ?
Is it required?
Is there an alternative?
Documentation!!!!

3. Intermittent Catheterization
The GOLD STANDARD of artifical drainage of the bladder (Barton 2000;Bardsley and Kaighin,2008)
To prevent risk of over-distension
Generally the procedure is carried out 4-5 times/24hours (Barton 2000; Robinson,2007)
Number of times may need adjusting depending on residual (less then 100mls)
Should be considered for patients attending A&E with ROU as an immediate or planned alternative method of bladder emptying instead of an IDC. Not suitable for all patients!

4. Advantages Reduced risk of infection (Bakke & Digranes,1991)
Improvement in urinary symptoms & bladder health – maintains bladder tone
Offers opportunity to be self caring
Regain personal control over bladder function
Allows easier & more spontaneous sexual relations
Reduced need for equipment / appliances – easier to choose clothing – mobility less hindered

5. Advantages contd Less risk of problems associated with
indwelling catheters
Helps maintain positive body image
(Addison 2001)
“Ready to go”, saves time & more cost effective
Improved quality of life and independence

6. To Begin!
Indwelling Catheters!

7. Bypassing Kinked Tubing Constipation Infection Detrusor Instability
Trigone Irritation (Catheter Size? Traction?)
Encrustation (Struvite)
Debris & Mucous 7

8. No Drainage Kinked Tubing, Constipation, Debris & Encrustation
Renal Impairment - Anuria
(Cessation of urine production) 8

9. Infection
CAUTI (Catheter Associated Urinary Tract Infections) account for 45% of all hospital acquired infections
Dougherty, L. and Lister, S. (2004) The Royal Marsden Hospital Manual of Clinical Nursing Procedures
22.5% of Healthcare Associated Infections or
nosocomial Infection are UTIs of those 56.2% Catheter
related
(2006 prevalence survey of HCAI)
Patients do die from urinary sepsis (Stewart 1998)

10. Managing / Reducing Risk of Infection
Aseptic Technique When Catheterising
Maintain Closed System
Hygiene
- Meatal Cleansing / Bathing etc
- Wash Hands/Wear PPE Aprons when carrying out catheter care
- Daily washing of catheter
Adequate Fluid Intake
Frequency of drainage bag changes and use of night drainage systems 10

11. Encrustation
What is encrustation and how do we deal with it?

12. Encrusted catheters
Normal catheter
Encrusted catheter 12

13. Encrustation of the catheter from deposits of mineral salts is a complication in approximately 50% of all long-term catheterised patients.   Encrustation on catheter surface can cause trauma to the urethra during catheter removal. The risks associated with CMS use may be outweighed by increasing catheter life SARI 2011

14. Process of Encrustation
BACTERIA (Proteus, E-Coli, Klebsiella)
Produce
UREASE
Spliting Urinary Urea into
AMMONIA
CARBON DIOXIDE
Change in pH ( )
Alkaline Urine
Note: The process of encrustation described is simplified.
MINERAL PRECIPITATION
ENCRUSTATION 14

15. Stickler, D. J. 1996. Biofilms, catheters, and urinary tract infections.
Eur. Urol. Update Ser. 5:1-8.

16. Assess
Inspect retrieved catheter – Visual examination of tip and cut catheter along its length to determine cause of catheter failure. Document findings – photograph if possible.

17. Unblocking / Checking Patency
The traditional manner in which ‘washouts have been performed is using 50-60ml syringe attached to the catheter. The plunger is alternately depressed and withdrawn to facilitate drainage and removal of debris. This may be potentially damaging to the tissues because of the considerable force exerted. (Getliffe & Dolman, 1997)

18. Urotainer Solutions Uro-Tainer Twin SUBY-G (3.23% Citric Acid)
Uro-Tainer Twin SOLUTIO-R (6% Citric Acid)
SODIUM CHLORIDE (0.9%) 18

19. When to use Uro-Tainer Prophylactic Treatment for known “BLOCKERS”
To Clear an Encrusted Catheter
Prior to Catheter Removal
To Remove Debris, Mucous, Haematuria from the Bladder
To instil Prescribed Drugs 19

20. Using Uro-Tainer Assessment of the Problem Promotes Patient Comfort
Prolongs Catheter Life (within manufacturers guidelines)
Patients and/or carers may be taught self administration 20

21. Note:
Catheter Maintenance Solutions are not bladder washouts. Do not provide a therapeutic effect Are Class 1 (Sterile) Medical Devices

22. Autonomic Dysreflexia
Contraindication
Autonomic Dysreflexia
Autonomic dysreflexia (also known as autonomic hyperreflexia) is one of the
most serious conditions affecting people with spinal cord injury at or above the
6th thoracic vertebrae.
Develops secondary to any noxious stimulus below the level of injury.
Nerve impulses cannot pass normally to the brain, therefore, the body
produces exaggerated abnormal nerve signals that cause problems above
and below the spinal injury.

23. TREAT AS A MEDICAL EMERGENCY
Symptoms range from mild to sever and patients may present with one or more of
the following:
Pounding headache
Flushing and/blotching above the level of spinal injury
Slowed heart rate
Profuse sweating above the level of injury
Palpitations
Goosebumps
Blurred vision or seeing spots
Stuffy nose
Feeling of impending doom, anxiety or apprehension
Elevated blood pressure.
TREAT AS A MEDICAL EMERGENCY

26. Antimuscarinic medications block the messages that initiate bladder contractions and reduce frequency of bladder emptying.
These can be very effective in managing an overactive bladder but risk causing a dry mouth as common side effect.
Source: MS Trust UK