REFERENCES. East Sussex Healthcare NHS Trust. optimummedical. Bladder and Bowel Management FORMULARY

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1 East Sussex Healthcare NHS Trust REFERENCES Addison R et al Catheter care: RCN Guidance for Nurses. London. Royal College of Nursing. Available at data/assets/pdf_file/0018/157410/ pdf. British Journal of Urology 85(1): 60-4 Bull E, Chilton CP, Gould AL, Sutton TM (1991) Single-blind, randomised, parallel group study of the Bard Biocath catheter and a silicone elastomer catheter. British Journal of Urology 68(4): Cox ASJ (1987) Effect of a hydrogel-coating on the surface topography of latex-based catheters: An SEM study. Biomaterials 8: Fader M, Patterson L, Brooks R, (1997).A multi centre comparative evaluation of catheter valves. British Journal Nursing 6(7): Getliffe K (1993) Care of urinary catheters. Nursing Standard July (44):31-34 Getliffe K, Dolman M, (2003) Promoting Continence: A Clinical Resource. Bailliere Tindall, London. Getliffe K, Hughes S, Claire M, (2000).The dissolution of urinary catheter encrustation. Loveday HP, Wilson JA, Pratt RJ et al Epic3: National Evidence-Based guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. Journal of Hospital Infection; 86S1: S1-S70. Lowthian P (1998) The dangers of long-term catheter drainage. British Journal of Nursing 7(7): National Institute for Health and Care Excellence Guidance 139. Infection: Prevention and Control of Healthcare-associated Infections in Primary and Community Care. London: National Institute for Health and Care Excellence; Available at Parkin J, Scanlan J., Woolley M. et al (2002) Urinary catheter deflation cuff formation: clinical audit and quantitative in vitro analysis.british Journal of Urology. 90: Pomfret I (1995) Bladder Irrigation. Journal of Community Nursing Dec Ryan-Wooley B (1997). Aids for the Management of Incontinence. London: Kings Fund The European Association of Urology Nurses, Evidence Based Guidelines for Best Practice in Urology Healthcare. Catheterisation, Indwelling Catheters in Adults. Urethral and Suprapubic. Netherlands: The European Association of Urology Nurses. Bladder and Bowel Management FORMULARY For all nurses in the Acute and Community Setting Produced June 2016 To be reviewed August 2018 Community Bladder & Bowel Advisory Service NHS Hastings and Rother CCG NHS Eastbourne, Hailsham and Seaford CCG Produced by the Community Bladder & Bowel Advisory Service, East Sussex Healthcare NHS Trust Produced June 2016 Review date: August 2018 Designed and printed by: optimummedical

2 OBJECTIVE OF GUIDELINES CONTENTS The goal is to simplify prescribing of continence prescription appliance products across East Sussex Bladder and Bowel Service. This will involve good quality, effective products. Choices have been balanced, gauging effectiveness and value for money. The guideline of products has been selected balancing patient requirements, commonly used products and the premise that 80% of patients in the community will find the products selected quite satisfactory for their needs. This is a guideline, therefore patient and carer s clinical needs should be accommodated if the suggested products are not satisfactory. Prescribers and other professionals need to be aware of alternative options for when the baseline formulary is found to not be appropriate. The products have been chosen based on experience and collaboration between the Medicines Management Team, the Bladder and Bowel Service and Community Nurses. URINARY CATHETERS LONG TERM LONG TERM - HYDROGEL COATED LATEX MEDIUM TERM COLLECTION SYSTEMS LEG BAGS BELLY BAGS NIGHT DRAINAGE BAGS CATHETERISATION PACK SUPPORT FOR DRAINAGE BAGS LEG BAG HOLDERS/SUPPORT NIGHT BAG HOLDERS CATHETER VALVES CATHETER MAINTAINANCE SOLUTIONS LUBRICANTS FOR CATHETERISATION SKIN BARRIER FILMS PREP WIPES SHEATHS SHEATH BAGS SHEATH BEST PRACTICE TIPS URINE TESTING COLLECTION PACK BEST PRACTICE IN URINARY CATHETERISATION DECISION FLOW CHART ON DRAINING OF THE CATHETER REFERENCES Bladder and Bowel Management FORMULARY 3

3 URINARY CATHETERS Careful patient assessment is essential before deciding to catheterise because of the high risk of infection and other complications associated with catheter use. Choice of product depends on: your assessment and diagnosis patient choice local guidelines No one product suits all. To avoid problems such as bypassing, the smallest size that provides adequate drainage should be used. A 5 to 10 ml balloon should be used depending on the catheter chosen, this represents the amount of sterile water required to fully inflate the balloon. Under inflation can distort the angle of the catheter tip, causing bladder spasm. Select the correct length of catheter: female (shorter) length is suitable for ambulant females only and is not recommended for bed or chair-bound people. A standard length catheter is required for use with a Belly bag for both male and female users. LONG TERM CATHETERS (up to 12 weeks) URINARY CATHETERS LONG TERM CATHETERS Assess the patient s needs prior to catheterisation in terms of latex allergy, catheter length (men must be catheterised with standard length catheters only), size of sterile bag or catheter valve and comfort and dignity (Loveday et al, 2013) Select the smallest gauge catheter that will allow urinary outflow (Loveday et al, 2013) Intermittent catheterisation should be used in preference to an indwelling catheter if it is clinically appropriate and a practical option for the patient (NICE, 2012) Decontaminate hands and wear a new pair of clean, non-sterile gloves before manipulating a patient s catheter, and must decontaminate hands after removing gloves (NICE, 2012) Clean the urethral meatus with sterile, normal saline prior to the insertion of the catheter (Loveday et al, 2013) All catheters listed are licensed for both urethral and suprapubic use. Prescribe 2 initially, but only 1 to be added to repeat prescription. More than 12 in a year - consider changing to medium term catheter. L.IN.C MEDICAL CATHETER WITH ACCOMPANYING STERILE WATER AND SYRINGE. 100% SILICONE Please note some of these catheters have a 5ml balloon. Packaged in single units. Prescribe 2 initially but only 1 to be added to repeats. If there are repeated catheter blockages which do not respond to treatments such as catheter maintenance solutions, then consider changing to medium term catheter. Pre-filled balloons are more expensive and have a short shelf-life. Reported problems include water loss and deflation. 100% Silicone (size in bold) G G G G G G G PIP PRODUCT GAUGE/Ch size Standard /Male length 41cm Female length 12ch 14ch 16ch 18ch 12ch 14ch 16ch Thin-walled catheters provide a larger diameter drainage lumen compared to coated catheters (Ryan-Wooley 1987) Basically compatible with urethral mucosa and have encrustation-resistance properties, but lack flexibility. Silicone balloons may allow slow diffusion of water into the bladder and may occasionally deflate in situ (Getliffe 1993) May not be best option for suprapubic use due to cuffing/adhesion on removal (Parkin et al., 2002) Hydrogel coated latex TELEFLEX RUSCH BRILLIANT AQUAFLATE 100% SILICONE CATHETER Includes empty syringe for deflation of previous catheter and a syringe pre filled with sterile water (add size to end of order ) PRODUCT GAUGE/Ch size DA3101 Standard /Male length 41cm DA2101 Female length High compatibility with human tissue. Polymers absorb water to produce a slippery surface which reduces trauma on insertion. There is some evidence to suggest there are fewer episodes of urinary bypassing therefore it may be retained for longer than silicone elastomer-coated catheters (Bull et al 1991, Cox 1987) 4 Bladder and Bowel Management FORMULARY 5

4 TELEFLEX RUSCH BRILLIANT SILFLATE 100% SILICONE CATHETER Includes empty syringe for deflation of previous catheter and a syringe pre-filled with 10% aqueous glycerine solution. This catheter is exactly the same as the RUSCH BRILLIANT AQUAFLATE, except for the solution used to inflate the balloon. All silicone catheters have a tendency to leach water from the balloon, causing the balloon to deflate. If the balloon is not fully inflated the tip of the catheter can angle downwards, hitting the Trigone causing spasm and bypassing. The 10% glycerine added to the sterile water, prevents leaching from the balloon so that it remains fully inflated for the 12 weeks it may stay in the bladder. (add size to end of order ) PRODUCT GAUGE/Ch size DG3101 Standard /Male length 41cm DG2101 Female length CLINISUPPLIES PROSYS FOLEY LONG TERM CATHETER WITH A 10ML INTEGRAL BALLOON 100% SILICONE 10ml pre-filled syringe of water. For urethral and suprapubic use. Large eyes at the tip of catheter to promote better drainage and help those patients that tend to block. LONG TERM CATHETERS - HYDROGEL COATED LATEX Suitable for urethral and supra pubic catheterisation TELEFLEX RUSCH SYMPACATH AQUAFLATE HYDROGEL COATED LATEX CATHETER - Includes empty syringe for deflation of previous catheter and a syringe pre-filled with sterile water (add size to end of order ) PRODUCT GAUGE/Ch size DH3101 Standard /Male length 41cm DH2101 Female length BARD BIOCATH HYDROGEL COATED LATEX CATHETER Pre-filled with sterile water. (add size to end of order ) P RODUCT GAUGE/Ch size D2264 Standard /Male length 41cm D2268 Female length PIP PRODUCT PCF12F PCF12M PCF14F PCF14M PCF16F Long Term Use, Female 2 Way 10ml Long Term Use, Male 2 Way 10ml Long Term Use, Female 2 Way 10ml Long Term Use, Male 2 Way 10ml Long Term Use, Female 2 Way 10ml GAUGE/Ch size COLOPLAST FOLYSIL OPEN ENDED SILICONE CATHETER This catheter can be used for urethral or suprapubic use and may offer an alternative for those patients experiencing problems with repeated by passing and blockage. There is no tip to the end of this catheter creating an additional drainage channel. Includes pre-filled syringe. PRODUCT GAUGE/Ch size AA8C12 Standard length only AA8C14 Standard length only AA8C16 Standard length only AA8C18 Standard length only PCF16M PCF18F PCF18M Long Term Use, Male 2 Way 10ml Long Term Use, Female 2 Way 10ml Long Term Use, Male 2 Way 10ml L.IN.C MEDICAL SUPRAFLO OPEN TIP CATHETER PIP PRODUCT GAUGE/Ch size G Standard length with 5ml balloon G Standard length with 5ml balloon G Standard length with 10ml balloon Bladder and Bowel Management FORMULARY 7

5 MEDIUM TERM CATHETERS (use up to 4 weeks only) Suitable for urethral and suprapubic use. PTFE-coated latex (Polytetraflouroethylene) PTFE (commonly known as Teflon) is permanently bonded to latex. PTFE is inert providing a smooth outer surface, reducing incidence of irritation and rejection. However there may be a greater susceptibility to encrustation (Getliffe and Doman 2003). TELEFLEX RUSCH AQUAFLATE PTFE COATED LATEX FOLEY CATHETER Includes empty syringe for deflation of previous catheter and a syringe pre-filled with sterile water (add size to end of order ) PRODUCT GAUGE/Ch size DP3101 Standard /Male length 41cm DP2101 Female length BARD PTFE COATED LATEX CATHETER Includes empty syringe for deflation of previous catheter and a syringe pre-filled with sterile water Only one of these catheters comes with a pre-filled balloon (add size to end of order ) OPTIMUM MEDICAL UGO LEG BAGS (Community) Fabric backing 1 pair of Ugo Fix Leg Bag Straps in every box. Designed to be used with either an indwelling urethral or suprapubic catheter. Short, easy-to-remember names for quick and easy re-ordering. Purpose measured soft silicone outlet tubing for kink free link drainage ensuring patients can move around in bed without blocking or damaging the tubing. PIP Product Bag vol. Tube length Tap design 1C/500/ST/L Ugo 1C 500ml Short Tube Lever Tap Box of C/500/LT/L Ugo 2C 500ml Long Tube Lever Tap Box of C/500/ST/T Ugo 3C 500ml Short Tube T tap Box of C/500/LT/T Ugo 4C 500ml Long Tube T tap Box of C/350/DI/L Ugo 5C 350ml Direct Inlet Lever Tap Box of C/350/ST/L Ugo 6C 350ml Short Tube Lever Tap Box of C/750/ST/L Ugo 7C 750ml Short Tube Lever Tap Box of C/750/LT/L Ugo 8C 750ml Long Tube Lever Tap Box of PRODUCT GAUGE/Ch size D1265LV Standard /Male length 41cm D1265AL Standard length pre-filled balloon T tap Lever tap Ugo Leg Bags with a lever tap are ideal for those with impaired dexterity. DO169LV Female length CLINISUPPLIES PROSYS LEG DRAINAGE BAGS COLLECTION SYSTEMS PIP PRODUCT Size Box Qty. DRUG TARIFF LEG BAGS P350S Prosys Leg Bag Short Tube (10cm) with non latex gloves and velcro straps. Slide Tap 350ml Do not add antiseptic or antimicrobial solutions to urinary drainage bags (Addison et al, 2012) Never wash urine bags and re-connect them in any care setting (Addison et al, 2012) Urine samples must be obtained from a sampling port using aseptic technique (NICE, 2012) P350L P500S Prosys Leg Bag Long Tube (30cm) with non-latex gloves and velcro straps. Slide Tap Prosys Leg Bag Short Tube (10cm) with non latex gloves and velcro straps. Slide Tap 350ml ml The bags may be worn in different positions on the leg. The intended position i.e. thigh or calf will determine the length of the inlet tube. The bags should remain connected for approximately 5-7 days. More frequent change is normally unnecessary and breaks the closed system, thereby increasing risk of infection. Non-sterile bags are not to be used with indwelling catheters but are available for use with penile incontinence sheaths. No more then 1 box of 10 should be issued alternate months - 6x10 per year. P500S-LT P500L P500L-LT Prosys Leg Bag Short Tube (10cm) with non latex gloves and velcro straps. Lever Tap Prosys Leg Bag Long Tube (30cm) with non-latex gloves and velcro straps. Slide Tap Prosys Leg Bag Long Tube (30cm) with non-latex gloves and velcro straps. Lever Tap 500ml ml ml continued on next page 8 Bladder and Bowel Management FORMULARY 9

6 P750S P750L BELLY BAGS TELEFLEX RUSCH BELLY BAG PRODUCT Pack size B ml (short outlet tube) B1000P 1000ml (short outlet tube) with sample port B1000CT Prosys Leg Bag Short Tube (10cm) with non latex gloves and velcro straps. Slide Tap Prosys Leg Bag Long Tube (30cm) with non-latex gloves and velcro straps. Slide Tap Positioned on the abdomen. Urine drains into the bag by means of residual bladder pressure. 1 litre capacity. Does not require a night drainage bag. For additional drainage (more than 1 litre over night) a PSU2 connector can be used to attach a ProSys single use night bag. Can be left in place for 28 days. No more than 2 belly bags should be issued alternate months. 1000ml with extra long (60cm) outlet tube easier emptying for someone in a wheelchair. 750ml ml P10LS Prosys Leg Straps OPTIMUM MEDICAL UGO 2L DRAINAGE BAGS Ugo 9 and Ugo 10 to be used with Ugo Leg Bags (non sterile). Ugo 12 and Ugo 13 to be attached directly to a catheter (sterile). Short, easy-to-remember names for quick and easy re-ordering Ugo 9 and Ugo 10 provided in tamper-resistant, protective, resealable bags PIP PROD. 9/NS/SU/DO Ugo 9 10/NS/SU/DO Ugo 10 11/S/SU/DO Ugo 11* 12/S/D/L Ugo 12 13/S/D/T Ugo 13 Tap design Non Drainable (tear corner to drain) Non sterile Single Use T Tap (can only drain once) Non sterile Single Use T Tap (can only drain once) Lever Tap (continuous drainage) Sterile pouch aged T Tap (continuous drainage) Sterile pouch aged Clinical use Single use link drainage only Single use link drainage only Attaching directly to catheter or single use link drainage Attaching directly to catheter for up to 7 days with needle free sample port Attaching directly to catheter for up to 7 days with needle free sample port Bag of Bag of Box of Box of Box of PBBCO1 Belly Bag PSU2 connector - product available direct from CliniSupplies Tel: Free * For patients using a Ugo Catheter Valve overnight. NIGHT DRAINAGE BAGS A link system should be used to facilitate overnight drainage, to keep the original system in tact (NICE, 2012) These bags are suitable for night time use for the collection of urine from indwelling catheters or incontinence sheaths. They are generally used in conjunction with a bag hanger (not available on FP10) some companies will supply free of charge. The position of the bag should be below bladder level to enhance drainage but not more than 30cm below as the negative pressure created may cause a suction effect to the bladder mucosa, which may block the catheter (Lothian 1998). Night bags should be directly connected to the leg bag to maintain a closed system. DRAINABLE NIGHT BAGS Not recommended for use in residential or nursing homes. These bags are not intended for single use and may be reused for up to 7 days. Good hygiene control should be used to avoid infection risks (refer to manufacturers guidance) Best practice suggests rinsing through using tap water only, and replace dust cap. Comprehensive patient and carer user guide is supplied with all Ugo Urology products, including detailed information about how to use and care for them. To request a copy you can ugo@optimummedical.co.uk. CLINISUPPLIES PROSYS 2 LITRE DRAINAGE BAGS PIP PRODUCT Size Box Qty. DRUG TARIFF PSU Prosys Single Use Drainable Bag 2ltr P Prosys Sterile Drainable Bag 2ltr P2000-LT Prosys Sterile Drainable Bag + Lever Tap 2ltr P Prosys Non-Drainable Bag 2ltr Bladder and Bowel Management FORMULARY 11

7 CATHETERISATION PACK Two layer system (layer1: catheter removal kit. Layer 2: catheter insertion kit) Facilitates aseptic non touch technique to reduce risk of catheter associated urinary tract infections (CAUTI) RICHARDSON HEALTHCARE CATH-IT Catheter Application/Removal Pack (Catheter or gel not included) PRODUCT Pack size Catheter procedure -gloves S/M Catheter procedure -gloves M/L SUPPORT FOR DRAINAGE BAGS LEG BAG HOLDERS / SUPPORT Movement induced trauma can lead to urinary tract infection and tissue necrosis. (EAUN, 2012) Best practice suggests catheters are secured to avoid trauma. (NICE, 2012) It is extremely important that the leg bag is well supported so that there is no pulling on the catheter that could cause urethral trauma. Leg bag holders or sleeves provide much better support than leg straps, which may be provided with the leg bag. Leg bag holders are manufactured from soft, latex free fabric and encase the leg bag to hold it against the patient s leg. May be worn on the thigh or calf NB please measure to ensure correct fit. These products are washable and 1 should last 6 months. No more than 2 ets should be issued every year. Should not be on repeat screens. OPTIMUM MEDICAL UGO FIX GENTLE (CATHETER CLIP) Gentle re-adhesive pad with silicone technology Easy to apply, remove and reposition No skin preparation required before application and suitable for re-application over the same area of skin No sticky residue Revolving clip for natural movement PIP Description Ugo Fix Gentle (catheter clip) Box of OPTIMUM MEDICAL UGO FIX CATHETER STRAP Fully adjustable and can be cut to fit Silicone technology for extra firm grip to skin Reusable and washable (provided with laundry bag to maintain optimum performance for longer) PIP Description Extra short up to 35cm Short up to 45cm Medium up to 80cm Long up to 130cm Extra Long up to 180cm Box of Box of Box of Box of Box of Where the can be secured Prior to fitting it is important that you measure around the leg or abdomen and use the correct length. Using the on upper leg Using the on abdomen Using the on the leg bag tubing Using the at the catheter bifurcation 12 Bladder and Bowel Management FORMULARY 13

8 How to use the How to position your Ugo Fix Sleeve 1 2 Before securing the tubing/catheter 1 2 Place the strap around either the upper leg or abdomen in the desired position with the two silicone lines facing down on the skin. Ensure the strap is not too tight and the Ugo Fix strip is positioned where easily accessible. Securing the tubing/catheter Lift the Ugo Fix strip and (a) wrap it over and under the tubing and then (b) through the eyelet. 1 2a 2b Pull the Ugo Fix Sleeve over your foot and position on your thigh or calf. Ensure the coloured strip is at the top and on the outside of the sleeve, and that the sleeve is facing forwards. Slide your leg bag into the front pouch through the opening at the top. Do not disconnect your leg bag from your catheter to fit your Ugo Fix Sleeve. Push the drainage tap from your leg bag through the hole at the bottom of the sleeve. Adjust your Ugo Fix Sleeve to ensure optimum drainage and comfort. You can now empty your leg bag without removing it from the Ugo Fix Sleeve. UGO FIX LEG BAG STRAPS Ensure the Ugo Fix strip is in the desired position and has a firm hold of the tubing, then secure in place on the strap using the Velcro tab. Finally ensure the catheter is not pulling when stood up and that you are able to move around comfortably with it in place. 3 4 PIP Description Ugo Fix Leg Bag Straps NIGHT BAG HOLDERS 10 pairs one 75cm and one 45cm OPTIMUM MEDICAL UGO FIX SLEEVE (LEG BAG HOLDER) Maintaining a sterile, continuously closed urinary drainage system is central to the prevention of catheter-associated infection. The risk of infection reduced from 97% with an open system to 8-15% when a sterile closed system was employed as standard practice. (NICE, 2012) No need to disconnect leg bag from catheter when changing sleeve External seam to protect skin and increase comfort Colour d for easy re-ordering Reusable and washable (provided with a laundry bag to maintain optimum performance for longer) Urinary drainage bags should be positioned below the level of the bladder, and should not be in contact with the floor (NICE, 2012) Not available on Drug Tariff. May be obtained by contacting following companies. Manufacturer- will provide holder free of charge Optimum Medical Ugo Stand with Dignity Available with or without dignity cover Tel. number Clinisupplies ProSys Bed bag stand (flat ) PIP Description Ugo Fix Sleeve Small 24cm-39cm Box of Ugo Fix Sleeve Medium 36cm-55cm Box of Ugo Fix Sleeve Large 40cm-70cm Box of Ugo Fix Sleeve Extra Large 65cm-90cm Box of Call Bladder and Bowel Management FORMULARY 15

9 CATHETER VALVES B BRAUN URO-TAINER TWIN. The solution is divided into a twin delivery system allowing for two sequential administrations. In patients for whom it is appropriate, a catheter valve can be used as an alternative to a drainage bag (NICE, 2012) May be helpful in retaining bladder tone. (Fader et al 1997) Allows drainage of urine from a catheterised bladder without the need for a permanently attached drainage bag. The catheter valve must be released regularly to prevent over distension of the bladder. Should only be considered for those patients or carers who have sufficient manual dexterity to operate the valve. Contraindications: reduced bladder capacity, no bladder sensation, cognitive impairment, poor manual dexterity and renal impairment. Catheter valves should be changed every 5-7 days. No more than 1 et (5) should be prescribed every month PIP PRODUCT Bladder Infusion Kit Citric acid 3.23% Suby G - 2 x 30mls (prevent or dissolve urinary salts & encrustation) Citric acid 6% Solution R - 2 x 30mls (should not be used for more than 2 weeks and only when 3.23% solution has failed) Pack size / 4.51 each / 4.51 each OPTIMUM MEDICAL UGO CATHETER VALVE Safety lever feature to prevent accidental opening Universal stepped connector for secure fitting to all catheter materials Lever handle designed to ensure easy single handed operation Please refer to page 11 (Ugo 11 sterile singe use 2L drainage bag) for overnight drainage. PR PIP Description CATHETER MAINTAINENCE SOLUTIONS These should be considered for short term use to treat indwelling catheters blocked by encrustation or on removal of the catheter to dissolve crystal formation. They should not be considered as an option for routine catheter maintenance. Getliffe et al (2000) suggest that two sequential instillations of a small volume are more effective than a single administration. Monitoring urine ph will help identify the need for, and the type of solution required Ugo Catheter Valve Box of Citric acid should only be used for those patients who have a consistently high ph of 7.4 and above (Pomfret 1995). It is good practice to cut open catheters on removal, from those patients where blocking is problematic to see if the lumen is blocked by sediment deposit. If a catheter maintainence solution is indicated more than weekly please use a bladder infusion kit to reduce the number of times the system is opened and reduces the cost of replacing the leg bag. Information for product below. The Bladder Infusion Kit is a device that enables the instillation of a catheter maintenance solution without the need to disconnect the patients leg/night bag therefore eliminating the need to break the closed catheter link system. The device enables the catheter maintenance solution to be instilled into the catheter and bladder via the needle free port of the catheter bag Ideally, if a catheter maintainence solution is required then best practice is to administer the instillation weekly at bag change. Order MCI/701 LUBRICANT FOR CATHETERISATION Use lubricant from a sterile single use container to minimise urethral discomfort, trauma and the risk of infection (Loveday et al, 2013) Disposable syringes of sterile lubricant and/or local anaesthetic for instillation, can reduce injury to the urothenium and subsequent risk of possible urethral damage. It can also facilitate pain free instrumentation and help reduce the risk of associated infection. One to be used at each catheter change - prescribe same quantity as catheters. Recommended for use in both male and female patients (not usually necessary for suprapubic catheterisation). Must not be used in patients with known hypersensitivity to the active ingredients or in patients with significant damage or bleeding urethral mucosa. CLINIMED (lubricant with anaesthetic) PIP PRODUCT Pack size Instillagel 6ml (female) Instillagel 11ml (male) Bladder and Bowel Management FORMULARY 17

10 SKIN BARRIER FILMS NOTE: the prophylactic use of a skin barrier film is not necessary for the majority of patients with urinary incontinence. SORBADERM SKIN BARRIER FILM/CREAM PIP Code PRODUCT Pack size Sorbaderm 92g tube (should last 3 months) single Sorbaderm 28ml spray bottle single 5.99 Sorbaderm products (durable barrier cream and film) are reserved for selected patients who experience skin problems. The use of Sorbaderm is to: Protect skin from body fluids including wound exudate. Sorbaderm Cream should be applied very sparingly (size of a 10 pence coin) after every third episode of incontinence as a preventative on intact skin (N.B. Cream is not no-sting). Over application leads to the skin feeling waxy. If waxy skin occurs then do not apply further cream since there is already sufficient present. Sorbaderm Film product is indicated for both intact but primarily for broken irritated skin since it is waterproof. Sorbaderm can be used up to the expiry date on the product once opened therefore no need to discard after 28 days. A 92g tube should be sufficient for 3 months treatment. PREP WIPES For use with penile sheaths. The wipes provide a barrier which protects the skin and also aids adhesion, extending the life of the sheath. GREAT BEAR SOFT SKIN MEDICAL BARRIER WIPE PIP PRODUCT Pack size 10381B GB Soft Skin Medical Barrier Wipe GREAT BEAR ADHESIVE REMOVER PIP PRODUCT Pack size 10380A Adhesive Remover (50ml can) SHEATHS Can offer a valuable alternative method of urinary incontinence management in men. It is important to accurately assess for type and size of sheath along with the appropriate drainage system. It is recommended that sheaths are changed on a daily basis to relieve pressure and allow for skin hygiene. Generally 1 of 30 should be sufficient per month. ROCHESTER CLEAR ADVANTAGE SHEATH WITH ALOE Size Pack size mm mm mm mm ROCHESTER FREEDOM TRANSFIX 100% clear silicone sheath PIP PRODUCT Pack size TF mm TF Style 2: 29mm Shorter length, suitable TF for retracted penis 36mm TF mm CONVEEN OPTIMA latex free self adhesive sheath PRODUCT Pack size mm mm Standard length mm mm mm mm Shorter length mm mm Bladder and Bowel Management FORMULARY 19

11 SHEATH BAGS COLOPLAST SIMPLA PROFILE LEG BAG PRODUCT Pack size Simpla non sterile leg bag - anti kink - 500ml, 25cm tube Simpla non sterile leg bag - anti kink SHEATH BEST PRACTICE TIPS ALWAYS MEASURE BEFORE FITTING A SHEATH Ensure that your patient washes with a silicone soap, not moisturising soap and they dry thoroughly. Always refer to the manufacturers guidelines. Please watch this video about the Conveen Optima for further information: URINE TESTING COLLECTION PACK Newcastle Urine Collection Pack (single use). Each contains 2 urine collection pads, a 5 ml syringe and a specimen container. Available from NHS Supply Chain catalogue/oracle Also available to purchase from Redland Health Care tel: Price on request approximately 68p each BEST PRACTICE IN URINARY CATHETERISATION Review need for catheter at each change and remove as soon as possible Refer to catheter guidelines/trouble shooting guide on intranet Intermittent Self Catheterisation should be adopted in preference to an indwelling catheter Check for latex allergy Males must be catheterised with STANDARD (40cm) length Use smallest gauge possible that will allow urinary flow Use aseptic technique (do not double glove ) Hand hygiene, wear apron and gloves when touching catheter Maintain closed system. Drainage bags licensed for 5-7 days Consider use of catheter valve if appropriate Consider use of fixation device Refer to Bladder and Bowel Advisory Service for advice and support if necessary at the below address: BLADDER & BOWEL ADVISORY SERVICE Bexhill Hospital Holliers Hill Bexhill on Sea East Sussex TN40 2DZ These guidelines have been endorsed by the Meds Management team and put together by Sue Jenner and Tracey Perkins. DON T FORGET TO USE A CATHETER PASSPORT! 20 Bladder and Bowel Management FORMULARY 21

12 DECISION FLOW CHART ON DRAINING OF THE CATHETER 22 Bladder and Bowel Management (Adapted from; European Association of Urology Nurses, Evidence Based Guidelines for Best Practice in Urology Healthcare. Catheterisation, Indwelling Catheters in Adults. Urethral and Suprapubic.) FORMULARY 23