Community Continence Product Formulary Community Continence Service

Transcription

1 Worcestershire Health and Care NHS Trust Community Continence Product Formulary Community Continence Service April 2017 Please contact Continence Service at 1

2 This Formulary has been prepared by the community continence service in consultation with community hospitals, infection control, district nurses, nursing homes and patient forum. There is an evidence based rationale for product selection. 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 criteria has 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 eg 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. 2

3 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 only and is not intended to restrict patient choice. Prescriptions must not be issued retrospectively Prices correct as of November 2016 from Drug Tariff. (DOH November 2016) 3

4 Contents Page Catheterisation Pack / Lubricating Gel 5 Urinary Catheters 6 Catheter Valves 9 Catheter Drainage bags 10 Night Bags 11 Catheter Accessories 13 Catheter Maintenance 13 Urinary Sheaths 15 Skin Barrier Film / Cream 17 Urinals 18 Prescribing Summary 19 References 20 4

5 Catheterisation Pack Facilitates aseptic non touch technique (ANTT) to reduce risk of catheterassociated urinary tract infections. (CAUTI) Promotes and standardises best practice using a two layer system, layer 1 catheter removal kit, layer 2 catheter insertion kit. Cost effective catheterisation pack as supplied in one packet reducing nursing time and FP10 costs. Prosys Vesica Community Catheterisation Pack (catheter and lubricating gel not included) Order code Product Pack size Unit price Vescp-01 Vescp-02 Catheterisation pack (slide tap leg bag) Catherisation pack LT (lever tap leg bag) Lubricating Gel for Catheterisation Provides a protective layer to ensure smooth passage of a catheter, reducing potential injury to the urothelium and subsequent risk of possible urethral damage. It can facilitate pain free insertion. Helps to reduce the risk of associated infection. One to be used at each catheter change. For urethral catheter insertion: 6mls female, 11mls male. Licensed for suprapubic use where appropriate: 6ml to be used. Be aware of the potential for an anaphylactic reaction to chlorhexidine. DO NOT USE in patients with a known allergy to chlorhexidine (MHRA warning, 2012). 5

6 Hydro-Caine Gel Order code Product Pack size Unit price HYD-006 Hydro-Caine Gel 6ml 1.10 HYD-011 Hydro-Caine Gel 11ml 1.15 Urinary Catheters Patient assessment, monitoring and ongoing support is essential to prevent urinary tract infections and improve quality of life for those patients who have a urinary catheter. All patients should have a catheter passport which is completed and kept up to date. Aim to remove catheter as soon as possible following insertion, and review continuing need. Also aim to use the smallest size that provides adequate drainage to avoid problems such as bypassing. Select the correct length and type of catheter; Standard/male- for males/ females & also suitable for suprapubic catheterisation. Female - for females only Use the correct amount of sterile water to fully inflate the balloon as per manufacturer s instructions (usually 10ml). Under-inflation can distort the angle of the catheter tip, causing bladder spasm. Choice of product depends upon: 1. Assessment & diagnosis 2. Patient choice 3. Local guidelines If problems persist i.e. frequent re-catheterisations, bypassing, blocking, contact the community continence service for advice/support. Intermittent self catheterisation is considered the gold standard treatment and should be used in preference to an indwelling catheter if it is clinically appropriate and is a practical option for the patient. Please refer these patients to the continence service for individual assessment where appropriate. 6

7 A prescription must be generated and authorised by the prescriber prior to any ordering/delivery of catheters, this will prevent excessive quantity and frequency of ordering. Types of Catheters Long term (up to twelve weeks) Packaged in single units. Prescribe two initially and from then on only one to be prescribed at a time. Catheters listed are licensed for both urethral/suprapubic use. If catheter life is less than four weeks i.e. requiring recurrent recatheterisation, consider a medium term catheter. Rusch Sympacath Aquaflate Hydrogel coated latex catheter (includes empty syringe for deflation of previous catheter and a syringe prefilled with sterile water). Standard/Male Order code Product Gauge/CH/size Unit price DH Standard/Male DH Standard/Male DH Standard/Male DH Standard/Male Female Order code Product Gauge/CH/size Unit price DH Female DH Female DH Female

8 Prosys All-Silicone Foley Catheter (includes empty syringe for deflation of previous catheter and a syringe prefilled with sterile water). Standard/Male Order code Product Gauge/CH/size Unit price PCF12M10 Male PCF14M10 Male PCF16M10 Male PCF18M10 Male Female Order code Product Gauge/CH/size Unit price PCF12RF10 Female PCF14RF10 Female PCF16RF10 Female PCF18RF10 Female Coloplast Folysil Open Ended Silicone Catheter may offer an alternative for those patients experiencing problems with repeated bypassing and blockage. There is no tip to the end of this catheter creating a flat end which may assist drainage. Standard/Male Order code Product Gauge/CH/size Unit price AA7412 Standard/Male AA7414 Standard/Male AA7416 Standard/Male AA7418 Standard/Male Medium term catheters (up to four weeks) Packaged in single units. Prescribe two initially and from then on only one to be prescribed at a time. Catheters listed are licensed for both urethral/suprapubic use. 8

9 PTFE Coated latex (Polytetrafluoroethylene). Rusch AquaFlate PTFE Coated Latex Foley Catheter (includes empty syringe for deflation of previous catheter and a syringe prefilled with sterile water). Standard/Male Order code Product Gauge/CH/size Unit price DP Standard/Male DP Standard/Male DP Standard/Male DP Standard/Male Female Order code Product Gauge/CH/size Unit price DP Female DP Female DP Female Catheter Valves For use with indwelling catheters only. These provide a discrete alternative to drainage bags. Their use helps to imitate normal bladder function by allowing the bladder to fill and empty, maintaining normal capacity and tone. They allow the catheter balloon to be lifted from the bladder wall decreasing the risk of bladder wall erosion and trauma to the bladder neck. (RCN guidelines, 2012) To be considered 2-3 weeks prior to trial without catheter to regain bladder function and tone. Catheter valves should be changed every 5-7 days. No more than one packet (5) should be prescribed every month. 9

10 Contraindications: Reduced bladder capacity No bladder sensation Cognitive impairment Poor manual dexterity Renal impairment Post Radical Prostatectomy Prosys Catheter Valves Order code Product Pack size Unit price PCV3942 Prosys catheter valves ( 9.50 per Catheter Drainage Bags Leg Bags Leg bags may be worn in different positions on the leg i.e inside thigh/calf, which is an individual choice and which will determine the length of the inlet tube. Leg bags should be changed every 5-7 days. (Manufacturer s recommendation as detailed in DoH Drug Tariff Nov 2016) Maintaining a closed drainage system (i.e not removing the leg bag when attaching a night bag) reduces the risk of infection. The leg bag must remain connected to the catheter and linked to the night bag if additional drainage capacity is required overnight. 500ml bags have been listed below, as this is the most common size used. Other volume leg bags are available. 10

11 No more than one box of ten should be issued on alternate months (6 x10 boxes per year). LINC- Flo Leg Drainage Bag (with T-tap) Order code Product Size Unit price LM500SD-T LM500MD-T LM500LD-T LINC-Flo direct inlet tube, T-tap LINC-Flo 10cm inlet tube, T-tap LINC-Flo 30cm inlet tube, T-tap 500ml x 10 per box 500ml x 10 per box 500ml x 10 per box 2.21 ( per 2.21 ( per 2.21 ( per LINC- Flo Leg Drainage Bag (with lever tap) Order code Product Size Unit price LM500SD-L LM500MD-L LM500LD-L LINC- Flo direct inlet tube, lever tap LINC- Flo 10cm inlet tube, lever tap LINC-Flo 30cm inlet tube, lever tap 500ml x 10 per box 500ml x 10 per box 500ml x 10 per box 2.21 ( per 2.21 ( per 2.21 ( per Night Bags Non Drainable Night Bags (single use) Suitable for night time use for the collection of urine from indwelling catheters or urinary sheaths. The position of the bag should be below bladder level to enhance drainage. Night bags should be directly connected to the leg bag to maintain a closed system. Night bags should be used in conjunction with a catheter stand, available from Clinisupplies. (not available on FP10) 11

12 Nursing/residential homes should always use a single use, non drainable night bag attached to a leg bag. Non drainable night bags are preferred option as single use reduces the risk of infection. Prosys Non-sterile 2 Litre Night Bag Order code Product Pack size Unit price PSU2 ProSys Non-sterile 2 litre night bag with single use drainable tap 2L x 10 per pack 0.30 ( 3.04 per No more than three boxes of ten should be issued monthly Sterile Drainable Night Bags For community bed bound patients it may be appropriate for a sterile drainable 2 litre bag to be connected directly to the catheter. (Not recommended for nursing/residential home patient due to cross infection) Drainable night bags should be changed every 5-7 days. (Manufacturer s recommendation, DoH Drug tariff Nov 2016) Prosys Sterile 2 Litre Drainable Night Bags (includes one pair of nonlatex gloves) Order code Product Pack size Unit price P2000 Prosys with slide outlet tap 2L x 10 per pack 1.20 ( per P2000-LT Prosys with lever outlet tap 2L x 10 per pack 1.20 ( per No more than one box of ten should be issued on alternate months (6x10 boxes per year) 12

13 Catheter Accessories It is extremely important that both the catheter and leg bag is well supported to reduce traction and trauma to the bladder neck/urethra. The Ugo Fix strap is used as a retaining strap which secures the tubing or catheter firmly and comfortably against the leg acting as a shock absorber for all indwelling catheters. Prosys leg bag sleeves and Bard Urisleeves can be used as an alternative to, or alongside, leg straps. They are particularly good if patients have frail skin or problems with straps digging into or rubbing against legs, as they distribute the weight of the bags more uniformly. A pack of 5 Ugo Fix straps should last four to six months. A pack of 4 Prosys sleeves or Urisleeves should last four to six months. Order code Product Pack Size Unit price 3002 Ugo Fix catheter straps short 45cm 3003 Ugo Fix catheter straps medium 80cm PLS 3881 Prosys leg bag sleeve small (24-40cm) PLS 3904 Prosys leg bag sleeve medium (36-50cm) PLS 3928 Prosys leg sleeve large (40-65cm) Bard Urisleeve leg bag holder extra large (65-95cm) (unit price 2.50) (unit price 2.76) (unit price 1.88) (unit price 1.88) (unit price 1.88) (unit price 2.01) Catheter Maintenance Solutions Catheter maintenance solutions should be used as a treatment plan and not as routine for every patient. 13

14 Their use must be based on clinical need and after an appropriate assessment. Solutions should only be considered for short term use to prevent encrustation in indwelling catheters, or to dissolve crystal formation prior to the removal of a catheter to prevent urethral trauma. They are treatment preparations for dissolving encrustation only, and should only be prescribed for 4 weeks, then reviewed. They are not to be used routinely or to attempt to unblock a nondraining catheter. It is good practice to cut open the catheters on removal, from those patients where blocking is problematic to see if the lumen is blocked by sediment deposit. The total amount of material dissolved when two solutions are used sequentially is significantly better than using just a single solution. (Getliffe 2000) Types of solutions Sodium chloride (S) Sodium chloride may be helpful for removing blood clots and mucus. Citric acid 3.23% (G) will dissolve encrustation. It is recommended that two instillations should be used sequentially. The agitation property of this product should be used with care. Citric acid 6% (R) will dissolve crystals and is twice the strength of the G solutions. It is recommended that two instillations should be used sequentially. The agitation property of this product should be used with care. 14

15 Order code Product Volume Unit price CSG50 Optiflo G (3.23% Citric Acid Suby G) CSR50 Optiflo R (6.0% Citric Acid Solution R) CSS50 Optiflo S (0.9% saline) Uro-Tainer Twin Suby G (3.23% Citric Acid) Uro-Tainer Twin Solution R (6.0% Citric Acid ) 50mls mls mls x 30mls x 30mls 4.81 Urinary Sheaths Can offer a valuable alternative method of urinary incontinence management for men. It is important to accurately assess for type and size of sheath using manufacturers measuring device. Sheaths can be worn for up to 24hrs. Over ordering more than one box of thirty per month may indicate poor fit - refer to Community Continence Service for advice. Style 1: Standard Style 2: Pop-on Style 3: Wideband 15

16 Conveen Optima Sheath Order code Product Gauge/CH size Unit price Conveen Optima short 21mm 1.72 ( per Conveen Optima short 25mm 1.72 ( per Conveen Optima short 30mm 1.72 ( per Conveen Optima short 35mm 1.72 ( per Clear Advantage Spirit Sheath Order code Product Gauge/CH size Unit price 5243 Clear Advantage Spirit, style Clear Advantage Spirit, style Clear Advantage Spirit, style Clear Advantage Spirit, style Clear Advantage Spirit, style Clear Advantage Spirit, style Clear Advantage Spirit, style Clear Advantage Spirit, style Clear Advantage Spirit, style Clear Advantage Spirit, style Clear Advantage Spirit, style Clear Advantage Spirit, style Clear Advantage Spirit, style 3 24mm 28mm 32mm 36mm 40mm 24mm 28mm 32mm 36mm 40mm 24mm 28mm 32mm 16

17 9363 Clear Advantage Spirit, style Clear Advantage Spirit, style 3 36mm 40mm It is recommended that one box of thirty should be sufficient per month Conveen Prep Wipes (provide a barrier for protection and adhesion to skin) Order code Product Pack Size Unit price Single use protective film wipes p ( per If the above product is unsuitable please contact the Continence Service for samples of alternative products. Skin Barrier Film/Cream (See also Worcestershire NHS Wound Management Formulary) Provide protection from body fluids, including wound exudate. Protection from tapes and dressings. Apply film to clean, dry skin. Apply cream very sparingly after every third episode of incontinence. (NB Cream is not no-sting) Film will aid adhesion of tapes and adhesive dressings, creams will not prevent dressings from sticking. The absorbency of incontinence pads is not affected by the use of this product. Sorbaderm can be used up to the expiry date on the product once opened - do not discard after 28 days. A 92g tube should be sufficient for 3 months treatment. 17

18 Order code Product Pack Size Unit price 3026 Sorbaderm barrier cream 3028 Sorbaderm barrier cream 3020 Sorbaderm No-sting film barrier Spray 3021 Sorbaderm No- sting Foam Applicators (sterile) 3022 Sorbaderm No- sting Foam Applicators (sterile) 2g sachets x ( 6.66 per box) 92g ml ml x ( 4.45 per box) 3ml x ( 7.20 per box) Urinals These may be used for patients who have functional incontinence. These should be used as part of their treatment or management plan. There is a 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 the Continence Service. 18

19 Continence Prescribing Quantity Summary Appliance Lubricating gel Indwelling catheter for long term use Indwelling catheter for medium term use Duration ONE per indwelling catheter change Up to 12 weeks. Consider medium term catheter if catheter life is less than 4 weeks Usual Monthly Quantity ONE per THREE months Notes 6ml size female 11ml size male Prescribe 2 catheters for the first prescription Up to 4 weeks ONE per month Prescribe 2 catheters for the first prescription Catheter valves Change every 5-7 days FIVE (= 1 box) per month Leg bags Change every 5-7 days TEN (= 1 box) on ALTERNATE months Night bags (nondrainable) Night bags (sterile; drainable) Leg bag sleeves Catheter straps Penile sheaths Change every night single use Change every 5-7 days change up to every 24hrs THIRTY (= 3 boxes of 10) per month TEN (=1 box) on ALTERNATE months FOUR (=1 box) should last 4-6 months FIVE (=1box) should last 4-6 months THIRTY (= 1box) per month For use with indwelling catheters Recommended for use in care homes to reduce the risk of cross-infection. Do not attach directly to catheter Limited use- Community bedbound patients only Washable and reuseable Washable and reuseable Over-ordering may be due to poor fit refer to continence service 19

20 Developed in partnership with: NHS South Worcestershire Clinical Commissioning Group NHS Redditch and Bromsgrove Clinical Commissioning Group NHS Wyre Forest Clinical Commissioning Group References Clinisupplies-freephone For prosys bed bag stand Department of Health - Drug Tariff April 2016 Getliffe K Hughes S Claire M (2000) The dissolution of urinary catheter encrustation British Journal Of Urology 85(1).: 60-4 Guide To Urine Drainage Systems - Coloplast NICE Clinical Guidelines 139 (2012) Prevention and Control of Heatlhcare associated infections in primary and community care NICE Clinical Guidelines 171 (2013) - Urinary incontinence in women - management RCN Guidelines (2012) Catheter care RCN guidance for Nurses Turner B Dickens N (2011) Long Term Urethral catheterisation Nursing Times Vol 21 no Worcestershire Wound Care Formulary (2015) Hydro-Caine Gel - Frequently Asked Questions: MHRA Drug alert (Oct 2012) All medical devices and medicinal products containing chlorhexidine - Risk of anaphylactic reaction due to chlorhexidine allergy for information Produced Feb 2017 Review Feb