SARASOTA MEMORIAL HOSPITAL NURSING PROCEDURE
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1 SARASOTA MEMORIAL HOSPITAL TITLE: ISSUED FOR: NURSING PROCEDURE PUREWICK FEMALE EXTERNAL CATHETER USE AND MANAGEMENT PROCEDURE (cat17) Nursing DATE: REVIEWED: PAGES: 1/17 4/18 1 of 6 RESPONSIBILITY: RN, LPN, Patient Care Tech, Multi-skilled Tech, Licensed Physical Therapist, Licensed Occupational Therapist, Licensed Physical Therapy Assistant (LPTA), Mobility Techs PS1094 PURPOSE: DEFINITIONS: 1. To define the procedure for initiation of urinary incontinence management with accurate urine output measurement through implementation of the PureWick System. 1. PureWick System: A non-invasive device, consisting of a wick and standard wall suction which has the capacity to capture 100% of urine into a suction canister. The PureWick System can be used on adult females with urinary incontinence as an alternative to a Foley Catheter. 2. Wick: A flexible female external catheter with cloth material on one side and silicone on the other. Wicks are disposable. 3. Wall-suction: The vacuum supply for patient equipment. The wick is designed to connect to the hose leading to the wall-suction canister with vacuum set at 40mmHg. 4. Suction canister: The fluid container attached to the wallsuction which collects the urine. KNOWLEDGE BASE: 1. Latex Precautions: The wick contains dry natural rubber which may cause an allergic reaction in staff and patients who have a latex sensitivity. Purewick should not be used with patients who are allergic to latex. Staff who is allergic to latex should take appropriate precautions when handling the product. 2. A physicians order is not needed to apply PureWick. 3. When a female patient has urinary incontinence, PureWick urine management should be implemented. 4. PureWick can be used in conjunction with Flexi-Seal if patient has loose stools. 5. The wick can be used for collecting clean catch urine.
2 PAGE: 2 of 6 6. Indications a. Managing urinary incontinence in adult females as an alternative to a Foley catheter b. Post-surgical/post procedural short-term immobility c. Aiding in the prevention/healing of pressure injuries d. Obtaining a clean catch urine sample e. Providing accurate urine output for incontinent females f. Prevention of falls associated with toileting g. PREVENTION OF CAUTI 7. Contraindications a. Urinary retention b. Vaginal bleeding c. Patients who are uncooperative or agitated d. Patients who get out of bed without supervision e. Patients who have bowel incontinence with frequent stools f. Do not use for Male patient g. Do not use with patient on a bed pan at the same time 8. Precautions a. Do not use if the patient is uncomfortable with the PureWick b. Never insert the wick into the vagina, anal cavity or any other body cavity c. Do not use barrier cream on the perineum. It will clog the wick. (Barrier cream is OK to use on the sacrum) d. Do not use with a diaper. 9. Patient Assessment and Monitoring a. The wick can be maintained 24 hours a day. Assessment of patient for skin irritation or discomfort should be done at least once a shift (i.e. when changing of the wick). Wick should be changed once a shift or when visibly soiled. Discontinue wick if blood visible. b. Canister and tubing should be changed when known to be contaminated (such as tubing falling to the floor) or when visibly soiled with stool. c. Assessment of urine capture success should be made prn throughout the shift. If urine is escaping the wick, refer to the troubleshooting section d. PureWick should be removed for any testing or procedures off the nursing unit and a NEW PureWick should be reapplied after patient returns to the nursing unit e. The canister can be emptied or changed without removing the wick by first disconnecting the tubing and then emptying the contents of the canister into the toilet if there is no visible blood present. Connect the tubing back to the canister and verify
3 PAGE: 3 of 6 the suction is on. f. If there is visible blood in the canister, discontinue the use of the wick and dispose of the canister in the biomedical waster per SMHCS Policy 00.IFC.12. EQUIPMENT: PROCEDURE: SPECIMEN COLLECTION: 1. To implement a PureWick system, obtain the following supplies from Central Stores (ext.1367) if not available in nursing unit clean supply room. a. PureWick wicks b. Wall suction gauge c. Suction canister d. Suction tubing e. Canister Privacy cover (optional) f. Gloves 1. Identify patient, assess for latex allergy/sensitivity and indications for PureWick system use. Explain procedure to patient and/or family. 2. Perform hand hygiene and don clean gloves. 3. Position an incontinence pad under the patient s buttocks. 4. Remove the wick from the plastic bag. 5. Connect the wick tubing to the suction tubing. 6. With the patient lying on her side or back, separate legs, gluteus and labia each time wick is placed or removed. 7. Hold the wick vertically with the connection to the suction tubing on top and the cloth surface facing the patient s perineum. 8. Gently tuck the bottom end of the wick between the patient s buttocks and the middle-upper end between her labia. The cloth surface of the wick should be snugly positioned between the labia and close to the urethra. The top of the white part of the wick should reach just above the pubic bone. 9. Remove gloves and perform hand hygiene. Don clean gloves. 10. Set wall vacuum at 40mmHg (low setting) continuous suction and observe for urine capture. Increasing wall suction past 40mmHg is usually not necessary. 11. Proper positioning of the wick should be verified with every position change. 12. Disposable fishnet panties may be used to assist with holding the PureWick in place if needed. Collecting a Clean Catch Urine Specimen using PureWick: Equipment: a. ALL NEW - PureWick, Tubing and Canister set-up b. Commercial clean-catch kit that contains: Castile Soap Wipes (2 per package); Sterile specimen container with lid; and Two (2) vacutainers (ECC has three vacutainers urine chemistry tests are collected in the pearl top)
4 PAGE: 4 of 6 c. Patient Identification Labels for specimens d. Gloves Procedure: a. Positive patient identification is required prior to specimen collection/labeling. Refer to SMH Policy (01.PAT.09) Patient Identification: Inpatient/ Outpatient. b. Perform hand hygiene and don gloves. c. Remove used PureWick and discard in regular trash. d. Remove gloves, perform hand hygiene and don clean gloves. e. Clean peri area using Castile Soap Wipes: Separate the labial folds with the thumb and forefinger. Wipe inner labial folds front to back with a single motion with one towelette. Wipe down through the center of labial folds with remaining towelette. f. Remove gloves, perform hand hygiene and don clean gloves. g. Apply NEW PureWick, Tubing and Canister set-up as described on page 3 PROCEDURE and allow patient to void. h. Transfer 30-50ml of urine from canister into the sterile collection container and cap it securely. Avoid touching the inside of the collection canister, sterile container or lid. i. Peel the yellow sticker off the collection cup to transfer urine into the vacutainer tubes (Urinalysis and urine C & S are to be sent in the vacutainers). Replace the yellow sticker back on the lid of the collection cup so it covers the sharp. NOTE: The collection cup with the sharp CANNOT to be sent to the Lab. Place the collection container lid into a red bag in the patient s room and discard in the large red sharps box in the Soiled Utility Room. NOTE: In the event a special urine specimen such as Chlamydia or gonorrhea is ordered, collect the urine in a sterile cup (not the collection cup with the sharp) and label it. The urine cup cannot be sent via the pneumatic tube system. j. Label the vacutainer(s) at bedside per policy 01.LAB.12 for the urinalysis and/or urine C & S. k. Perform Final Check verification for EACH specimen collected by reading out loud the last 3 digits of the patient s visit number on the specimen label and then reading out loud the last 3 digits of the patient s visit number on the patient ID band. l. Send specimens to the laboratory within 90
5 PAGE: 5 of 6 minutes. A requisition will still print for urine C & S. Place the specimen(s) into a biohazard bag along with the requisition in the bag pocket. If the vacutainers are being sent via the pneumatic tube system, the biohazard bag must be placed in a sealed bubble bag prior to placing them in the tube. m. Perform hand hygiene EXCEPTIONS: PATIENT AND FAMILY EDUCATION: EXPECTED OUTCOME: TROUBLESHOOTING: None 1. Explain the procedure to the patient. A video explaining wick positioning is available at 1. Provide an alternative to urinary catheter insertion. 2. Prevent urinary tract infections by eliminating the need for urinary catheter placement. 3. Keep the incontinent female patient dry. 4. Provide air flow and cooling of the perineum to aid in the healing of skin problems. 1. Wicks are capable of capturing 100% of urine. If a large amount of urine is escaping the wick, the reason is typically due to: a. Improper placement a. The wick must be snugly positioned between the labia with the bottom end between the buttocks. b. Be certain that the top of the wick reaches just above the pubic bone. b. Wall-suction is not set correctly a. Set the wall suction at 40mmHg. Higher settings are not necessary and not recommended. b. Before connecting the wick, feel the end of the suction tubing to verify the presence of a mild vacuum. c. There is a vacuum leak a. Be certain the lid is firmly on the canister. b. Verify that the canister pour spout is tightly closed. c. Check the tubing connection at the canister and the wick. The connectors must be firmly pushed together. d. The vacuum canister is full a. Empty the canister e. The tubing is blocked a. Be certain there are no kinks in the tubing DOCUMENTATION: Electronic Medical Record Documentation 1. Flowsheet: Assessment Reassessment (RN, LPN) a. Urinary Assessment Documentation
6 PAGE: 6 of 6 1) Route Select PureWick 2. Flowsheet: Hygiene/Activity (PCT, MST) a. Hygiene 1) PureWick applied/changed REFERENCES: Bardmedical.com, PUREWICK Female External Catheter Retrieved February 8, 2018 from PUREWICK Female External Catheter Retrieved February 8, 2018 from AUTHORS: Elizabeth Brott, MSN, RN, CNOR, Nursing Quality Mahira Moreira, MSN, RN, CCRN, PCCN, Critical Care Jordan Solich, BSN, RN, NPD, 7WT Melissa Shelton, PhD, RN, CNE, Nursing Quality Program Coordinator Sherry Wolabaugh, Manager, Infection Prevention & Control Sue Drake, RN, CIC, Infection Prevention & Control APPROVAL: CAUTI Steering Committee, February, 2018 Clinical Practice Council, 4/5/18
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