Continence Formulary. Continence Products A User Guide

Transcription

1 Continence Formulary Continence Products A User Guide Updated June 2015

2 Introduction This is an update of the Hampshire Community Health Care Continence Formulary The aim of the Continence Formulary is to be a working document with input from Southern Health Continence Service for use across South Eastern Hampshire CCG and Fareham & Gosport CCG. New and current products will be reviewed in an ongoing way to include up to date research. The purpose of the evidence-based Continence Formulary is to provide a list of urinary products that can be used for the majority of patients and as an educational resource. The intention is that this formulary must be used for all new patients and for current patients when a re-assessment is due. It may be that an alternative product which is not in the formulary may need to be provided. In this case the requester will need to prescribe using their own prescription pad or seek advice from continence team. If you have any concerns or need more information, then please contact your Southern Health Continence Advisors. All prices taken from the May 2015 Drug & MIMS Online.

3 Assessment A comprehensive continence assessment is required before considering any continence appliance; the emphasis should be on appropriate treatment. Product selection should be made to meet patient needs on an individual basis as not all products are suitable for all. Ensure catheterisation is used as a last resort and only when at least one of the following have been met; 1. Pre/post operative surgery 2. Monitoring Renal function hourly during critical illness 3. Chronic urinary retention, only if symptomatic and/ or renal compromise 4. Acute urinary retention 5. Allowing bladder irrigation/lavage 6. Bypassing an obstruction 7. For investigative purposes such as urodynamics 8. Instillation of medication e.g. chemotherapy 9. Where it is viewed as better for the patient to use a catheter, such as end of life care, disability, unfit for surgery. Long-Term Catheters Patients should be assessed individually. The optimum time for re-catheterisation should be established. The average period of use is 8-12 weeks. Alternative management options should be considered first in view of the complications associated with long-term catheterisations (Rigby 1998, Sabbuba et al 2002). All catheter balloon sizes within formulary are 10ml. No prefilled catheters were reviewed as they are no longer recommended. Prefilled catheters have a releasing mechanism that inflates the retaining balloon with water, but are more expensive. They may reduce nursing and equipment costs but reported problems include water loss and deflation (Barlow et al 2001). It is important that the correct size catheter is prescribed for the individual. Except in exceptional circumstances, no more than a size 14ch should be used for female urethral catheterisation and no more than a 16ch standard length for a male. For suprapubic catheterisation, use standard length. No less than a size 14ch catheter should be used to avoid insertion and removal trauma. Prescribe 2 initially, but only 1 to be added to repeats. More than 12/year-consider changing to medium term catheter. Product Ch Size Qty Drug Nurses must remember that the risks associated with catheter usage are of a serious nature that increasingly may become more difficult to justify (RCN 2012). This formulary provides guidance to prescribers for first line products. GP Practices should not issue prescriptions retrospectively for any Dispensing Appliance Contractor (DAC) DH3101/12-18 DH2101/12-18 Rusch Sympacath Aquaflate Hydrogel coated latex catheter. Includes syringe prefilled with sterile water and 10ml syringe for catheter removal. Standard length Rusch Sympacath Aquaflate Hydrogel coated latex catheter. Includes syringe prefilled with sterile water and 10ml syringe for catheter removal. Female length Rationale: Cost effective in comparison to other products. Contains pre-filled and 10ml syringe in price.

4 All Silicone Long-term Catheters All catheters are licensed for urethral and suprapubic use. Due to increasing numbers of people with latex allergies, all silicone products are advised as first choice products (Woodward 1997). Product Ch Size DA3101/12-18 DA2101/12-16 AA71/12-18 AA75/12-16 Brilliant AquaFlate 100% All Silicone. Contains syringe prefilled with sterile water and 10ml syringe for catheter removal. Licensed for suprapubic use. Brilliant AquaFlate 100% All Silicone. Contains syringe prefilled with sterile water and 10ml syringe for catheter removal. Licensed for urethral and suprapubic use. Female length. Folysil All Silicone catheter Licensed for urethral and suprapubic use. Standard length. NO PRE-FILLED SYRINGE Folysil All Silicone catheter Licensed for urethral and suprapubic use. Female length. NO PRE-FILLED SYRINGE Qty Drug Rationale: Cost effective and licensed for both urethral and suprapubic catheterisation. Intermittent Catheters (ICS) Due to the need for individual, specialist assessment, these products are only available for prescribing by the Continence Team or Secondary care. Open-ended catheters Licensed for long-term use and are available as an alternative for those patients experiencing problems with sediment blockage and urinary infection. The catheter differs, as the tip is open-ended allowing for additional drainage. NO PRE-FILLED SYRINGE. Product Ch Size AA74/12-18 Folysil All Silicone Open-ended catheter Licensed for urethral and suprapubic use. Standard length. Qty Drug Rationale: Significant cost efficiency and licensed for both urethral and suprapubic use. Catheter Valves It is recommended to change catheter valves every 5-7 days. Pull or tap product options allow for personal preference and dexterity. Can be used in open position and attached to bag for night time use. Contra indication: Renal impairment, Ureteric Reflux, Reduced bladder capacity, no bladder sensation, cognitive impairment, insufficient manual dexterity to operate catheter valve. Not to be used following radical surgery (bladder/prostate) for at least eight weeks. For more complex bladder surgery and bladder tumours seek advice from consultant as catheter valves may not be appropriate. No more than 1 packet (5) should be prescribed every month. Product Name Quantity Drug CVS Smartflow Catheter Valve Manfred Sauer JECV Jade Euro-Med S (sterile) Euro catheter Valve. Tap Action T180 Bard Flip-Flo Catheter Valve

5 Belly bags No more than 1 box of 10 should be issued alternate months 6 x 10/yr. Suitable for patients who are wheelchair-dependent, or dislike other drainage options. Product Size Qty Drug The Belly bag can be left in situ for up to 28 days and uses a twist tap action to limit urine leakage post-drainage. A night bag can be attached. No more than 1 pack (containing 2 belly bags) should be issued alternate months - 6/year. Product Size Qty Drug B 1000 Belly bag. Twist control tap. Sterile 1000ml P0337 Belly bag Replacement belt Rationale: One option available as patented product with no alternatives. Leg Bags The sterile bags listed below are suitable for the collection of urine from indwelling catheters or sheaths. Leg bags are designed for daytime use and vary in sizes and can be worn in different positions (thigh, knee and calf). Straps are included in each pack and are generally either latex or foam with Velcro fasteners. Bags may stay in place for 5-7 days. Night bags should be attached to leg bags for night time drainage. Do not break the system. Considering the contra-indications, would a catheter valve be more appropriate? See catheter valve section. Sheaths Leg bags for sheaths do not have to be sterile and certain bags can have their tubes cut to length to ensure it is not excessively long which may cause kinking but must be long enough if the patient uses a wheelchair. (Please refer to manufacturer s guidance) Sterile bags should only be ordered if non-sterile products have been discounted. For patients wearing trousers consider long tube. Catheters Sterile leg bags must be used. The position of the bag should be below the bladder level to enhance gravity induced drainage, but no more than 30cm below as the negative pressure created may cause a suction effect to the bladder mucosa, which may increase the likelihood of catheter blocking (Lowthian 1998) SVCG Careline + Sterile leg bag with slide action tap, with sterile gloves. Short tube LVCG Careline + Sterile leg bag with slide action tap, with sterile gloves. Long tube SVCG Careline + Sterile leg bag with slide action tap, with sterile gloves. Short tube LVCG Careline + Sterile leg bag with slide action tap, with sterile gloves. Long tube SVCG Careline + Sterile leg bag with slide action tap, with sterile gloves. Short tube LVCG Careline + Sterile leg bag with slide action tap, with sterile gloves. Long tube. P500S-LT P500L-LT PS350S PS350L PS500S PS500L PS750S PS750L Prosys Sterile leg bag with lever tap Short Prosys Sterile leg bag with lever tap Long Prosys Sterile leg bag with slide action tap Short Prosys Sterile leg bag with slide action tap Long Prosys Sterile leg bag with slide action tap Short Prosys Sterile leg bag with slide action tap Long Prosys Sterile leg bag with slide action tap Short Prosys Sterile leg bag with slide action tap Long 350ml ml ml ml ml ml ml ml ml ml ml ml ml ml

6 Leg bags for Sheaths Product Size Qty Drug 5165 Conveen Security + Non-sterile leg bag 50cm tube length Conveen Security + Non-sterile leg bag 30cm tube length Conveen Security + Non-sterile leg bag 50cm tube length. 350ml ml ml Drainable night bags Suitable for single patient use. The drainage bags are connected to the leg bag and are used in conjunction with a stand. The position of the bag should be below the bladder level to enhance gravity induced drainage, but no more than 30cm below as the negative pressure created may cause a suction effect to the bladder mucosa, which may increase the likelihood of catheter blocking (Lowthian 1998). Bags require changing every 5-7 days. Product Size Qty Drug adj Comfort Non-sterile leg Bag 45cm inlet. Swing tap. 600ml Flexicare F4 Drainable night drainage bag Slide action tap. Sterile. 2000ml adj Comfort Non-sterile leg Bag 45cm inlet. Slide action tap. 500ml Flexicare F4 Drainable night drainage bag Lever action tap. Sterile. 2000ml Rationale: Adjustable bags not included as the cost of sterile scissors increases the cost considerably. Needle free sample port for CSU collection reduces the possibility of needle-stick injury. Night bags Suitable for all patients unless bed bound where a drainable bag may be used. Non-drainable night bags are policy for all residents in a care home setting due to the cross-contamination risk of infection. No more than 3 boxes should be issued every month-3x10/month. Product Size Qty Drug Simpla S2 Urine drainage bag Standard connector PSU2 Prosys Single Use Non-sterile night drainage bag Click Close outlet. 2000ml ml IDCG 46-20IDCG Careline + E4 Drainable night drainage bag, with sterile gloves. Slide action tap. Sterile. Careline + E4 Drainable night drainage bag, with sterile gloves. Lever action tap. Sterile 2000ml ml Rationale: Both companies products are cost efficient and link with leg bag products without additional costs. Stands Most companies providing continence products offer a stand for night drainage bags. However, not all are free and cost varies. Product Contact for orders Qty Drug Simpla Catheter stand. Flat pack. Plastic. PBS001 CliniSupplies Triple Purpose Stand. Plastic Free Free to patients using Prosys bags. Contact Brett on Free Rationale: Coloplast Simpla S2 is a cost effective option and has a perforated strip which reduces spillage. Rationale: Coloplast Simpla stand is freely available and with universal hanging punch-holes is the preferred choice. However, the Flexicare option is more durable and would be a sensible purchase for Residential and Nursing home residents.

7 Leg bag holder/support Used as an alternative to leg straps to secure a leg urine drainage bag to the patient s leg. The sleeve has an opening for the tap for ease of emptying. The patient s leg should be measured to ensure the correct fit. These products are washable and 1 pack should last 6 months No more than 2 packets should be issued every year Should not be on repeat screens. Product Size Qty Drug Conveen Aquasleeve. Small 24-33cm Conveen Aquasleeve. Standard 33-39cm Conveen Aquasleeve. Medium 40-46cm Conveen Aquasleeve. Large 47-64cm Conveen Aquasleeve. Extra Large 65cm Rationale: choice due to selection options and cheaper across the board. Quality as good as other more expensive products. Catheter Maintenance Solutions These should be considered for short-term use to treat indwelling catheters blocked by encrustation or on removal to dissolve crystal formation. After removal, cut catheter lengthwise to observe any crystal formation. Blockers are defined as patients who frequently and repeatedly develop encrustation on their urinary catheters, resulting in a shorter catheter life. The higher the urine alkalinity, the greater the chance of encrustation developing. The catheter maintenance solution should flow into the catheter by gravity by elevating the bag to above bladder height allowing the tip of the catheter to be bathed. B. Braun ph indicator documentation sheets and test strips are available free Uro-tainer Twin. Citric acid 3.23% Suby G Uro-tainer Twin. Citric acid 6% Solution R 2x30 ml x30 ml Support Straps Uro-tainer NaCl (sodium chloride) 0.9% 100 ml The G-Strap Catheter and Tube Holder are designed as a re-useable strap and can be washed several times before disposal. The strap secures catheters and tubing and acts as a shock absorber, minimising risk of urethral trauma. The G-Strap is latex-free. Rationale: Two sequential administrations of a small volume is more successful than a single larger administration (Getcliffe 2000). NaCl to be used by agitation for the removal of blood clots or debris Simpla G-Strap Adult 45cm Simpla G-Strap Abdominal 80cm Rationale: Cost efficient as reduces the risk of urethral damage and potential clinical intervention.

8 Local anaesthetic and lubricant Cathejell lidocaine is a sterile local anaesthetic and lubricant for urethral mucosa. It can prevent injury to the urethra and as a consequence reduces the subsequent risk of urethral damage and must be used for catheterizing both male and female patients. It facilitates the reduction in pain on insertion and helps reduce the risk of associated infection. 1g gel contains 20 mg of Lidocaine Hydrochloride and 0.5 mg of Chlorhexidine Dihydrochloride. Risk of anaphylaxis from anaesthetic - refer to local anaphylaxis policy. *Should not be on repeat screen. CJL08501 Cathejell Lidocaine C 8.5g CJL12501 Cathejell Lidocaine C 12.5g Product Ch Size D236512S-22S Urinary Sheaths Bardex IC Aquafil Foley with Silver Alloy Coating Qty Drug The sheath drainage system is the device most commonly used by males for the management of moderate/severe urinary incontinence (MDA 2000). However, the sheath can also be the cause of great anxiety and discomfort if incorrectly fitted. The assessment of bladder function, correct fitting and sizing of sheaths are essential. It is also important that those using sheaths are given clear guidance of application by staff. The appliance should be changed daily to allow for pressure relief and personal hygiene. There are many urinary sheath options available and research suggests that relying on the products and systems manufactured by one company may not achieve the results required for patient dignity and comfort (Bath et al 1999, Watson & Kuhn 1990). * Generally 1 packet of 30 should be adequate for 1 month. Synthetic Standard Length Rationale: Most cost efficient as available as single units. Silver-Coated Catheters Silver coated catheters have been developed and are suitable for patients who are prone to urinary tract infections as the silver coating provides an increase in anti-bacterial protection. Though not suitable for urine that contains proteus or pseudomonas. They should only be initiated by the continence team or secondary care. Basic research and development, validation and in-use evaluations have shown benefits (DoH 2004). However, all research has evaluated short-term use (Bandolier 1998) and therefore not relevant to primary care use. The Bard Bardex IC Silver Alloy coated foley catheter is licensed for urethral and suprapubic use for 28 days as the effectiveness is reduced after this time P-Sure Sheath Manfred Sauer P-Sure Sheath Manfred Sauer P-Sure Sheath Manfred Sauer P-Sure Sheath Manfred Sauer P-Sure Sheath Manfred Sauer P-Sure Sheath Manfred Sauer P-Sure Sheath Manfred Sauer P-Sure Sheath Manfred Sauer 24mm mm mm mm mm mm mm mm

9 Urinary Sheaths (continued) Style 1 Standard Length Urinary Sheaths (continued) Style 3 Extra wide adhesive 1243 Rochester Clear Advantage with Aloe silicone sheath, Style 1 24mm Rochester Clear Advantage with Aloe silicone sheath, Style 3 24mm Rochester Clear Advantage with Aloe silicone sheath, Style 1 29cm Rochester Clear Advantage with Aloe silicone sheath, Style 3 28mm Rochester Clear Advantage with Aloe silicone sheath, Style 1 32mm Rochester Clear Advantage with Aloe silicone sheath, Style 3 32mm Rochester Clear Advantage with Aloe silicone sheath, Style 1 36mm Rochester Clear Advantage with Aloe silicone sheath, Style 3 36mm Rochester Clear Advantage with Aloe silicone sheath, Style 1 40mm Rochester Clear Advantage with Aloe silicone sheath, Style 3 40mm Style 2 Shorter Length (Pop-On) Rationale: Non-latex to minimise allergy reactions. Cost efficient as number of combinations Rochester Clear Advantage with Aloe silicone sheath, Style Rochester Clear Advantage with Aloe silicone sheath, Style Rochester Clear Advantage with Aloe silicone sheath, Style Rochester Clear Advantage with Aloe silicone sheath, Style Rochester Clear Advantage with Aloe silicone sheath, Style 2 24mm mm mm mm mm

10 Urinals / Urine directors There is a wide range of products available on FP10. Patients will require assessing for the appropriateness of using urinals, due to many factors including hand dexterity, eye sight and co-ordination. For further advice and support please contact Southern Health Continence Service. Product Directions Manufacturer Product / PIP code Female Bridge Urinal with tap Lady funnel - Female Urine directors / positioners Saddle Urinal Lady Jug Female Bridge Urinal with tap Helpful for ladies with restricted movements/ mobility problems or to assist carer Useful for ladies in wheelchairs Patients need to be sitting for effective use Useful for ladies who void large amounts of urine as a 2litre drainage bag can be attached to the urinal. Useful for ladies who are unable to sit on the toilet to pass urine and can be attached to a 2 litre urine drainage bag Helpful for ladies with mobility problems or to assist carer For ladies who void large amounts of urine. Must be used with the lady sitting on the edge of the bed or chair. Beambridge Medical Beambridge Medical Beambridge Medical Beambridge Medical 6.18T PIP PIP PIP PIP Qty Drug Urine directors / positioners Male Male draining jug with tap Male Pocket Urinal Female Pocket Urinal Male Funnel Useful for men with retracted penis or difficulty in directing flow Helpful for males with mobility problems Can be used to aid toileting where there is difficulty managing a urinal by attaching a 2 litre drainage bag Available in 4 sizes Helpful with patients with mobility problems For men who void large volumes of urine a 2 litre drainage bag may be used to accommodate larger volumes of urine Useful for men when travelling Small enough to put in pocket Advise re washing using soapy water, do NOT use disinfectant or bleach. Advise re turning urinal inside out to wash & dry Advise re-checking rubber lining is not perished to avoid accidents. Useful for women when travelling Small enough to put in pocket Advise re washing using soapy water, do NOT use disinfectant or bleach. Advise re turning urinal inside out to wash & dry Advise re-checking rubber lining is not perished to avoid accidents. Beambridge Medical Male funnel Male funnel mini Youth funnel Adult funnel Beambridge Medical Manfred Sauer Manfred Sauer Product code M (PIP code) T URIbag male URIbag F

11 Manufactures contact details Bard Ltd, Forest House, Brighton Road, Crawley, West Sussex, RH11 9BP Beambridge Medical, 46 Merrow Lane, Burpham, Guildford, Surrey, GU4 7LQ B. Braun Medical Ltd, Thorncliffe Park, Sheffield, S35 2PW CliniSupplies Ltd, Unit 11 Crystal Way, Elmgrove Road, Harrow, Middlesex, HA1 2HP Coloplast Ltd, Peterborough Business Park, Peterborough, PE2 6FX Flexicare Medical Ltd, Cynon Valley Business Park, Mountain Ash, Mid-Glamorgan, CF45 4ER Jade-Euro-Med Ltd, Unit 14, East Hanningfield Industrial Estate, Old Church Road, East Hanningfield, Chelmsford, Essex, CM3 8BG Manfred Sauer UK Ltd, Unit 3 io Centre, Lodge Farm, Northampton, NN5 7UW ProSys International Ltd, 60 Cottenham Park Road, Wimbledon, London, SW20 0TB Rochester Medical Ltd, 10 Commerce Way, Lancing, West Sussex, BN15 8TA Teleflex, Stirling Road, Cressex Business Park, High Wycombe, Buckinghamshire, HP12 3ST Unomedical Ltd (A ConvaTec Company), Harrington House, Milton Road, Ickenham, Middlesex, UB10 8PU Useful Documents Southern Health Urinary Catheter Care Guidelines V2 (SH CP 123) Sept 14 Southern Health Infection Prevention & Control Policy V3 (SH CP 10) Sept 13 Appendix H - Catheter Care Leaflet, Looking after your catheter - A guide for patients and carers These documents can be downloaded at the link below: References Bath, J., Fader, M., Patterson, L. (1999) Urinary sheaths and bags: making an informed choice, Primary Health Care, Vol 9, No 7, page Medical Devices Agency (2000) Self-adhesive sheaths for men using sheath systems: an evaluation, IN6, Medical Devices Agency, London. Watson, R., Kuhn, M. (1990). The influence of component parts on the performance of urinary sheaths systems. Advanced Nursing, Vol 15, No 4, page Getliffe, K. (2003) Catheters and Catheterisation. In Getliffe K, Dolman M 2nd Ed Promoting Continence: A Clinical Research Resource. pp Bailliere Tindall Oxford. Hatch, L. (2005) Urology News, Vol 9 No 3 pp Lapides J, Ananias CD, Silber SJ, Lowe BS (1972) Clean Intermittent Self Catheterisation in the treatment of urinary tract disease, Journal Of Urology 107, 3, pp Pilloni; Stefania; Krhut; Jan; Mair; Dora; Madersbacher; Helmut; Kessler; Thomas M. (2005) Age and Ageing. 34 (1) pp Shah J, Leach G (2001) Urinary Continence 2nd Ed Oxford Health Press Rigby, D. (1998) Long-term catheter care, Professional Nurse Study Supplement, Vol 13. Sabbuba, N., Hughes, G., Stickler, D. (2002) The migration of Proteus Mirabilis and other urinary tract pathogens over Foley catheters, British Journal of Urology International, Vol 89, page Barlow, A et al (2001) Continence Prescribing Guidelines: Southern Derbyshire Prescribing Guide, Southern Derbyshire PCTs. Woodward, S. (1997) Complications of allergies to latex urinary catheters, British Journal of Nursing, Vol 6, No 14, page Health Protection Agency (2004) Bardex IC silver coated hydrogel catheters, Health Protection Agency, [ONLINE] Bandolier (1998) Urinary catheters, Bandolier, Vol 58, No 3, page 1-4, [ONLINE] Lowthian, P. (1998) The dangers of long-term catheter drainage, British Journal of Nursing, Vol 7, No7, page PrescQIPP Continence Formulary Booklet RCN Guidelines (2012) Catheter care RCN guidance for Nurses Department of health Drug tariff April 2015 MIMS Online Accessed May 2015

12 Bibliography Addison, R. (2000) Risk assessment in suprapubic catheterisation, Nursing Standard, Vol14, No 14, page Joanna Briggs Institute, (2000) Management of Short Term indwelling Urethral Catheters to Prevent Urinary Tract Infections, Best Practice, Vol 4, No 1, ISSN , page 1-6. Stewart, E. (1999) Urinary catheters: selection, maintenance and nursing care, Nursing and Residential Care, Vol 1, No 2. Talja, M., Korpela, A., Jarvi, K. (1990) Comparison of urethral reaction to full silicone hydrogel-coated and siliconised latex catheters, British Journal of Urology, Vol 66, page Thames Valley University, (2000) National evidence-based guidelines for preventing hospital-acquired infections associated with the use of short-term indwelling catheters in acute care, Thames Valley University, London. Updated by South Eastern Hampshire - Medicines Management Team Jessica Collins Medicines Management Technician CommCen Building, Fort Southwick, James Callaghan Drive, Fareham, PO17 6AR Main office Tel: Southern Health Continence Advisory Team Marion Houghton BEM BSc (Hons)RN Continence Nurse Specialist Alison Wileman Project Nurse Specialist -Continence Clinical Hub: Southern Health NHS Foundation Trust Fairway House Parklands Hospital Aldermaston Road Basingstoke RG24 9RH Tel: Date of next review May 2017

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