Procedure for removal and reinsertion of a supra pubic catheter

Transcription

1 Procedure for removal and reinsertion of a supra pubic catheter Equipment required collect prior to procedure Perform this procedure as an aseptic technique to minimise the risk of introducing Clean the trolley (or equivalent). Refer to National Infection Prevention and Control Manual. Assemble the equipment on the bottom shelf while the top shelf acts as a clean working surface (if available). Clean disposable apron Alcohol hand rub Catheterisation pack Catheter appropriate size, length and material, check expiry date One pair of procedure gloves Two pairs of sterile nitrile gloves One sachet of normal saline Sterile water and one 10ml syringe and needle if not already supplied with catheter Appropriate drainage bag or catheter valve (refer to Continence Products section from the Adult Protocol) Lubrication must be prescribed. Check for contraindications before using an anaesthetic gel (refer to Lothian Joint Formulary). A single use sachet of 5g plain lubricating gel may be used when an anaesthetic gel is contraindicated. Bed protection Disposal bag Continence Care Service Page 1 of 5 April 2015

2 If routine/planned change, encourage personal hygiene (shower or bath). Ensure privacy. Explain and discuss the procedure with the patient. Obtain and document informed consent in nursing notes. Allow time for questions. Adjust the height of the bed (if possible) and assist the patient into the supine position. Place the procedure pad under buttocks and leave the patient covered. Ensure the bedside lighting is good. Wash your hands (refer to hand hygiene in National Infection Prevention and Control Manual). Put on a disposable apron. Using an aseptic technique prepare the equipment. Remove the outer packing, place the catheterisation pack on the top shelf and open the drapes. Remove the outer packaging from the remaining items, placing them within the sterile area of catheterisation pack. Fold back the patient s bedclothes, preserving dignity at all times. Wash your hands (refer to hand hygiene in National Infection Prevention and Control Manual). Put on procedure gloves. To promote privacy and maintain dignity. To obtain informed consent and co-operation. As a legal requirement. To alleviate anxiety. To aid procedure. To maintain dignity. To enable the supra pubic site to be clearly seen. To allow access to cystostomy. To minimise the risk of cross To minimise the risk of introducing Continence Care Service Page 2 of 5 April 2015

3 Perform routine catheter site cleansing. Attach a syringe to the inflation channel of the catheter and allow spontaneous deflation of the balloon. Prepare to remove the catheter by placing two fingers of gloved hand on either side of the catheter as close to cystostomy as possible. Withdraw slowly and firmly rotating the catheter at the same time to help loosen any adhesions. Observe the condition of the catheter and document any abnormalities. Note the length and angle the catheter was previously inserted. Dispose of the used catheter and drainage system (refer to National Infection Prevention and Control Manual). Remove gloves and apply two applications of alcohol gel to hands and rub well into hands. Apply the first pair of sterile gloves. Clean around the cystostomy site with sterile swabs and normal saline. Clean away from the site of insertion with each swab. Use once only and discard. Apply plain lubricating gel to 7-8cm of the insertion end of the catheter taking care to avoid clogging the eyelets with the gel. Remove gloves. Apply two applications of alcohol gel to hands and rub well into hands. Put on the second pair of sterile gloves. To minimise the risk of To deflate the balloon and help to prevent ridges forming on the catheter balloon that may cause discomfort/spasm on catheter withdrawal. To facilitate easy removal of the catheter. If resistance is encountered refer to catheter problem solving guide. May indicate problems such as encrustation. This guides the angle and how far to insert the new catheter. To minimise cross infection and to promote a safe environment. To minimise the risk of introducing To cleanse the area and reduce the risk of introducing infection into the bladder. Clogged eyelets may prevent urine drainage. To minimise the risk of Continence Care Service Page 3 of 5 April 2015

4 Place the sterile fenestrated drape over the patient leaving the pubic area exposed. A sterile valve or drainage bag should be attached to the catheter at this point. Insert the new catheter via cystostomy into the bladder 2-3cm further than it was before and not more and observe for urine drainage. Avoid inserting the catheter too far. To promote clean work area and maintain dignity. To help reduce trauma and patient discomfort. To prevent the catheter tip irritating the bladder wall and preventing the catheter entering the urethra resulting in potential trauma. Ensure the catheter is draining urine prior to inflating the balloon with sterile water as per manufacturer s instructions. Once the balloon is fully inflated withdraw the catheter slightly. Obtain a sterile urine specimen if a symptomatic UTI is suspected. Dry area with swabs. Leave cystostomy exposed with no dressing unless an infection is present. Dispose of equipment according to local policy then wash your hands (refer to National Infection Prevention and Control Manual). To ensure the inflated balloon is in the correct position. To obtain a sterile urine specimen for culture and sensitivity. To reduce the risk of secondary infection and skin irritation. To make the patient comfortable. To reduce trauma/skin excoriation around cystostomy. To promote a safe environment and reduce the risk of cross Continence Care Service Page 4 of 5 April 2015

5 Post procedure care Document information in the patient urinary catheter passport. Ensure the method of supporting the catheter and catheter bag is appropriate (refer to Continence Products section from the Adult Protocol). Ensure catheter care is ongoing: Shower or wash the insertion site daily with warm water and soap (avoid strongly perfumed soaps, talcum powder and creams) Clean the catheter itself starting from the insertion site and working towards the distal end Encourage a normal fluid intake of 1½-2 litres daily (unless contraindicated) Ensure the patient and/or carer knows how to care for the catheter and is aware of possible catheter problems and contact details. Patient information is available if required. Details are all relevant to future management. To reduce trauma, irritation and patient discomfort. To prevent obstruction of urine from the bladder. To reduce the risk of To reduce the risk of urinary tract infection and constipation. To increase the patient and/or carer s knowledge and confidence in caring for the catheter. Continence Care Service Page 5 of 5 April 2015