CATHETER FORMULARY Developed by Marian Di Vito and Amanda Gunner

Transcription

1 CATHETER FORMULARY 2015 Developed by Marian Di Vito and Amanda Gunner 1

2 Your Healthcare Catheter Formulary has been developed to promote consistency in product choice across professionals. The products recommended should be the first choice as they would be suitable for the majority of patients. However, based on clinical assessment and patients individual need an alternative product may on some occasions be used. This guidance does not include Intermittent catheters or specialist products. Please contact Specialist Nurse for advice. CQC DOMAINS Safety: The Your Healthcare Catheter Formulary seeks to provide a safe and evidence based approach to patient catheter care. This formulary guides best practice, but professionals must ensure that undertake individual assessments to make informed choices when selecting catheter s and catheter related equipment and always follow manufacturer s recommendations. Clinical and Cost effectiveness: The choice of catheter in this guidance has been informed by expert opinion and based upon evidence best practice to ensure clinical and cost-effectiveness. All prices quoted are as per Drug Tariff December 2014 Governance: This Guidance ensures standardisation of catheter care for patients in the Kingston community, and provides an audit standard and training tool. The formulary should be used in conjunction with relevant current local policies and procedures documents. Patient focus: The guidance aims to meet most patients requirements. For some patients, who after an assessment, their products requirements are off the Guidance, the healthcare professional should document and justify the choice made and ensure patients receive the most appropriate product for their individual needs. Accessible and responsive Care: The Your Healthcare Catheter Prescription Choice Guidance provides a selection of the most clinical and cost-effective choice of product for most patients, most of the time, and acts as a guide for non-specialists. Your Healthcare Catheter Formulary should be used in conjunction with Your Healthcare s current Catheterisation Policy, Standards and Procedures and Catheter Guidelines documents, and all infection prevention related polices and documents. 2

3 Preventing healthcare associated infections and in particular catheter associated urinary tract infection (CAUTIs) remains a priority for Your Healthcare, and is supported by recommending avoidance of unnecessary catheterisations, and the removal of devices as soon as possible. Catheterisation can be urethral indwelling/intermittent or suprapubic. The initial suprapubic catheterisation and the first suprapubic catheter change must always be done in a secondary care setting. Thereafter, suprapubic catheters can be changed in the community by a competent practitioner. Catheterisation is an invasive procedure and patients with Indwelling Foley catheters have a high incident of urinary tract infections. For effective urinary catheter care and to minimise risks of catheter associated urinary infections the clinician must be familiar with: Catheter selection Drainage options Catheter support systems Meatal cleansing How to maintain a closed system Aseptic Technique Standard Principles of Infection Prevention and Control, Hand hygiene and use of personal protective equipment, and in accordance to Your Healthcare Policies. YH Catheter Formulary has been approved by Kingston Clinical Commissioning Group Medicines Management Committee 3

4 1 st Line RUSCH Teleflex Medical PTFE AquaFlate, PTFE coated latex catheter RUSCH REF Length Balloon CH Standard 2.16 each DP standard 10ml 12 DP standard 10ml 14 DP standard 10ml 16 SHORT TERM FOLEY ( 4 week product licence) PTFE (Polytetrafluoroethylne) Coated latex Indicated in: *Patients with recurrent blockage who have not responded to interventions and require frequent catheter changes whilst the cause is being investigated *Patients requiring 4 weekly catheter changes *Unsuitable for patients with latex allergy BARD REF Length Balloon CH Standard 2 nd Line Bard Ltd PTFE Aquamatic PTFE coated latex catheter 3.01 each D1265AL12 standard 10ml 12 DP standard 10ml 18 Female 2.16 each DP female 10ml 12 DP female 10ml 14 DP female 10ml 16 DP female 10ml 18 1 st Line RUSCH Teleflex Medical PTFE AquaFlate, PTFE coated latex catheter * NOT licensed for suprapubic use * Includes sterile waterfilled syringe for balloon inflation and empty syringe for deflation. 2 nd Line Bard Ltd PTFE Aquamatic PTFE coated latex catheter * NOT licensed for suprapubic use. *Includes sterile waterfilled syringe for balloon inflation but not empty syringe for deflation D1265AL14 standard 10ml 14 D1265AL16 standard 10ml 16 D1265AL18 standard 10ml 18 4

5 LONG TERM FOLEY (12 week product licence) Indicated in: Patients not presenting with recurrent blockages or other related catheter complications LATEX Material SILICONE Material *Unsuitable for patients with latex allergy *First choice catheter whenever possible *Latex Free *Wider lumen versus coated latex catheter same Charriere *Rigid and uncomfortable specially for females and urethra catheterisation 1 st Line RUSCH Teleflex Medical Sympacath hydrogelcoated latex catheter. * Licensed for urethral and suprapubic use. *Includes sterile water-filled syringe for balloon inflation and empty syringe for deflation. 2 nd Line Bard Ltd Biocath Aquamatic hydrogel coated latex catheter *Licensed for urethral and suprapubic use. *Includes sterile water-filled syringe for balloon inflation but not empty syringe for deflation. *Potential formation of balloon cuff on deflation making removal difficult 1 s Line L.I.N.C. Medical *100% silicon catheter with integral balloon *Licensed for urethral and suprapubic use. *Includes glycerine filled syringe for balloon inflation and empty syringe for deflation. 2 n Line RUSCH Teleflex Medical *Brilliant Silflate, allsilicon catheter *Licensed for urethral and suprapubic use. *Includes glycerine filled syringe for balloon inflation and empty syringe for deflation. 5

6 Latex Hydrogel coated Foley Catheter Long-Term Use (12 week product licence) LONG TERM FOLEY PRODUCTS 100% All-silicone Foley Catheter Long-Term Use ( 12 week product licence) 1 st Line RUSCH Teleflex Medical Sympacath hydrogel-coated Latex catheter. 2 nd Line Bard Ltd Biocath Aquamatic hydrogel coated latex catheter 1 st Line L.I.N.C. Medical 100% silicon catheter with integral balloon 2 nd Line RUSCH Teleflex Medical Brilliant Silflate, 100 % allsilicon catheter RUSCH REF Length Balloon CH BARD REF Length Balloon CH L.I.N.C. REF Length Balloon CH RUSCH REF Length Balloon CH Standard 6.12 each Standard 8.36 each Standard 5.50 each Standard 7.07 each DH standard 10ml 12 D standard 10ml G standard 5ml 12 DG standard 10ml 12 DH standard 10ml 14 D standard 10ml G standard 5ml 14 DG standard 10ml 14 DH standard 10ml 16 D standard 10ml G standard 10ml 16 DG standard 10ml 16 DH standard 10ml 18 D standard 10ml G standard 10ml 18 DG standard 10ml 18 Female 6.12 each Female 8.40 each Female 5.50 each DH female 10ml 12 D female 10ml G female 5ml 12 Female 7.07 each DH female 10ml 14 D female 10ml G female 5ml 14 DG female 10ml 12 DH female 10ml 16 D female 10ml G female 10ml 16 DG female 10ml 14 DH female 10ml 18 D female 10ml 18 Supraflo Open Tip 10.95each DG female 10ml G standard 5ml 12 DG female 10ml G standard 5ml G standard 10ml 16 6

7 DRAINAGE SYSTEM ADVICE The maintenance of a closed drainage system reduces the risk of symptomatic urinary infections ( 7 day product licence) Intermittent drainage catheter valves Benefits *Maintenance of bladder tone and capacity *Reduction of UTI s from flushing effect *promotion of normal bladder function day/night *improves patient self-esteem and body image Risks *Retention of urine *Can aggravate existing conditions (fluid retention, respiratory problems, cardiac problems) *Can aggravate existing urological conditions (Hydronephrosis, kidney disease) *Teleflex lever tap 2.00 each * Manfred Sauer CVS, Smartflow valve pack of *Great Bear, 10540A, Libra Lever tap pack of Drainage Bags Benefits *Good for patients that cannot manage a valve *Weight of bag potentially makes it less likely for patients to forget emptying the bag *Vast choice of sizes, types and emptying taps Risks *Loss of bladder capacity after 6-12 months of use *If bag not appropriately support can cause, bleeding, discomfort and damage to the urethra and/or bladder neck *Overfilling of bag can aggravate existing urological conditions *Circulatory problems or leg ulcers if leg straps are too tight *disruption to cardiac rhythm with increased nocturnal polyuria 7

8 LEG BAGS (7 day product licence) 1 st Line LINC 2 nd Line Teleflex Sterile bag, with night drainage connector and pair straps each bag, pack of 10 bags each Sterile bag, with night drainage connector and Velcro, pack of 10 bags 2.37 each Latex free. Needle free sample port. T tap & L lever tap Needle free sample port. Slide tap & Lever tap 500ml direct inlet tube LM500SD T 22.O3 500ml 10cm inlet tube LM500MD T 22.O3 500ml 30cm inlet tube LM500LD T 22.O3 500ml adjust/scissors LM500AD T 22.O3 500ml Slide tap 10cm ml Slide tap 30cm ml Lever tap 10cm ml Lever tap 30cm ml adjust/scissors LM500AD L 22.O3 500ml direct inlet tube LM500SD L ml 10cm inlet tube LM500MD L ml Belly Bag, includes belt B1000 ( 28 day product licence) each N.B: S =SLIDE TAP L = LEVER TAP T= T TAP PLEASE NOTE: other sizes of leg drainage bags are also available from the manufacturers. Please consult the latest drug tariff for coding. 8

9 2 litre Bags/ NIGHT BAGS 1 st Line STERILE licence for single use only 1 st Line STERILE 7 day licence/drainable bag (if not disconnected, recommended for bedbound patients) LINC-Flo: Single use, Sterile 2 litre overnight drainage bag with 100cm inlet tube and non-return valve (formerly 2 litre overnight drainage bag with non-return valve twist off tap individually wrapped, LM2LS 26p each Teleflex: Sterile 2 litre bag with integral hanger (Lever tap) 1.06 each Teleflex: Sterile 2 litre bag integral hanger (Slide tap) 1.06 each 2nd Line STERILE 7 day licence/drainable bag (if not disconnected, recommended for bedbound patients) LINC-Flo: Sterile 2 litre drainable bag, needle free sample port,120cm tube, non-return valve, antibacterial filter and integral handle Lever tap TZ02-L and & T-Tap LTZ each NON-STERILE BAGS To be used with Uro-sheaths SINGLE USE licence LINC-Flo, Single use, non-sterile 2 litre overnight drainage bag with 100cm inlet tube and non-return valve LM2LNS 21p each TELEFLEX: Single use, 2 litre non- sterile bag with single use drainable tap: p each 9

10 LUBRICATION GEL NICE (2003) guidelines states that: An appropriate lubricant from a single-use container should be used during catheterisation to minimise trauma and infection in male and females. There is not evidence to support the use of anaesthetic gel during female or male indwelling catheterisation. Your Healthcare recommends the use of sterile gel with NO lidocaine/antiseptic as first line. Following individual assessment the nurse assessor can use discretion to use anaesthetic gel during catheterisation to minimise trauma and discomfort (Pratt et al 2007). Lidocaine is POM and must be individually prescribed and used cautiously in patients with impaired cardiac conditions, hepatic insufficiency and epilepsy (BNF, 2014). Cathejell mono sterile gel with NO lidocaine/antiseptics 8.5g code: CJM p each 12.5g code: CJM p each Cathejell Lidocaine sterile gel with WITH lidocaine 8.5g code: CJL each 12.5g code: CJL each 10

11 PLEASE REFER TO MANUFACTURERS INSTRUCTION FOR USE Catheter Maintenance Solutions (CMS) The Department of Health Infection: prevention and control of healthcare-associated infections in primary and community care (2012) guidance suggests that maintaining a closed drainage system by avoiding unnecessary disconnections, is still the most effective intervention to prevent CAUTI and related complications. In long-term catheterised patients biofilm formation, encrustation and catheter blockage are the causes of catheter related UTI s. The disconnection of the closed drainage system to administer a CMS can increase the risk of bacteria ascending into the bladder through the catheter lumen causing CAUTI. There is not enough evidence that the use CMS prevent blockages and/or restore catheter drainage (Ansell, 2013). Your Healthcare advocates a holistic assessment to identify the cause of the problem before administering CMS. However, when a CMS is needed the use of a bladder infusion kit may reduce the risk of infection. Bladder infusion Kit (to administer solutions via needle free sample port using aseptic technique) Order Code MCI 701 per 10 (Linc Medical) 1.99 each 11

12 First line use OptiFlo CATHETER MAINTENANCE SOLUTIONS 3.50 each OptiFlo G 3.23% Citric Acid, magnesium oxide 50mL CSG50 To prevent and reduce encrustation formation and for regular instillation in patients known to be suffering from regular blockages Not recommended to dissolve encrustation once it has occurred OptiFlo R 6.0% Citric Acid, magnesium carbonate 50mL CSR50 To dissolve severe encrustation and achieve catheter drainage OptiFlo S 0.9% Saline 50mL CSS50 Removal of small blood clots, debris or mucus Not recommended for regular catheter blockage from encrustation 12

13 If you require further information regarding this Formulary please contact : Marian Di Vito Continence Nurse Specialist Surbiton Helath Centre, Ewell Road, Surbiton, Surrey KT6 6EZ t: w: Continence Service Your Healthcare CIC Special thank you to Nicky Harrap Primary Care Pharmacist, Kingston Clinical Commissioning Group, for her contribution to the development of this formulary. 13