MY CATHETER PASSPORT. sample A HOW TO GUIDE & NOTEBOOK FOR WOMEN

Transcription

1 Royal United Hospitals Bath NHS Foundation Trust MY CATHETER PASSPORT A HOW TO GUIDE & NOTEBOOK FOR WOMEN Please keep this guide safe as it contains important information about you and your catheter

2 MY DISCHARGE CHECKLIST To be completed by patient/carer and the nurse. If there is anyone else that you would like to be involved with learning how to manage your catheter, please let the nurse know. As soon as you know that you will be leaving hospital with a catheter you will be learning how to look after the catheter and its accessories that are designed for your comfort and safety. Use this checklist to guide your learning and tick each section off as you become comfortable with the activity. When you are comfortable with all the points, please sign and date at the bottom with your nurse. I know how to attach my catheter to a: Leg bag.. and then to a night bag Valve tap.. and then to a night bag I know how to secure the bag to my leg and make it comfortable with a retaining strap I know how to empty my leg bag / night bag / use a valve I know how often I should change my leg bag / valve and night bag I know how to dispose of my old bags / valves I have enough supplies and know how to order more: I have my Starter Pack bag I have my upright night stand and retaining strap I have been registered with a Home Delivery service (if going home) I have been referred to my District Nurse team (if going home) I know who to call if I have a problem (see page 6) 1

3 I know why I have a catheter. It is because/for: Temporary healing I am unable to pass water I am incontinent and this has been assessed by a specialist For my comfort Being infection-free is important to me: I know how and when to wash my hands and why this is important I know how and why I have to wash around the catheter entry site I know when my catheter next needs changing. See Page 3 (date)... Anything else? Please add anything else in the box below - Patient / carer: Nurse: Signed Date... Signed Date... Ward / Hospital: What Now? Please complete the following sections: Key Information About My Catheter (overleaf) Key Information About Me (pages 5-6) 2 MY DISCHARGE CHECKLIST E CHECKLIST

4 KEY INFORMATION ABOUT MY CATHETER If you don t know the answer to one or more of these questions, please contact your nurse or doctor. If your catheter is temporary: I will no longer need a catheter from: (date) My Trial Without Catheter is booked for: (date) What type of catheter do I have? I have a Latex / PTFE / PVC / coated catheter (these can safely be left in the bladder for up to 28 days) I have an All Silicone or Hydrogel catheter (these can safely be left in the bladder for up to 12 weeks) For all catheter users: Size of catheter (these are normally Ch but can be larger) What date was my current catheter inserted? How frequently do I normally have my catheter changed? (if applicable) (for further changes, please note them in your Urinary Catheter Record Book. Your catheter changes will be arranged by your District Nurse.) 3

5 CONTENTS 1 My Discharge Checklist 3 Key Information About My Catheter 4 Contents 5 Key Information About Me 6 Who to Call If I Need Help? 7 Introduction 8 Getting Your Supplies 9 My Catheter Diary 13 What Is A Catheter? 14 How Is It Held Inside The Bladder? 15 Effective Hand Washing 17 Living With A Catheter 19 Looking After My Relationships 20 Drainage Options 22 Catheter Retaining Strap 23 Attaching/Changing My Valve 25 Attaching/Detaching My Leg Bag 27 Attaching My Night Bag To My Valve 28 Detaching My Night Bag From My Valve 29 Attaching My Night Bag To My Leg Bag 30 Detaching My Night Bag From My Leg Bag 31 Drainage Of Night Bags 32 Coming To Terms With My Emotions 33 Catheter Changes & Bladder Spasms 34 What Should I Do If...? 37 My Catheter Diary 38 More Information / References 4 First Day At Home Arrange my supplies (see page 8) Attach my night bag (see pages 27 & 29) Write my diary (see page 9) Know who to contact with concerns (see page 6) KEY INFORMATION ABOUT MY CATHETER

6 KEY INFORMATION ABOUT ME Name: Address: County: Post code: Addressograph sticker: NEXT OF KIN Name: Contact details: CARER OR LOCAL FRIEND (optional): Name: Contact details: 5

7 GP PRACTICE INFORMATION: Doctor: Practice name & address: Contacting your District Nurse team is dependent on which area your GP Practice is located. Please see the table below: Where is your GP based? Bath & North-East Somerset South Gloucestershire North & West Wiltshire Somerset HOSPITAL INFORMATION Bladder & Bowel Service for Bath & NE Somerset residents: Urology Specialist Nurse: (Reception ) KNOWN ALLERGIES? (including Latex as some catheters are made with this) Yes No Not known If yes, what am I allergic to? How does the allergy affect me? During working hours Contact District Nurses via your GP Practice Contact District Nurses via your GP Practice Outside of normal working hours Call Call 111 and ask for the out-of-hours District Nurses 6 KEY INFORMATION ABOUT ME

8 INTRODUCTION Welcome to My Catheter Passport. More than likely, you have been given this booklet during the last few days before your discharge from hospital. By speaking to other catheter-users and their carers, we know that learning to live with a catheter is likely to require some changes to your everyday life. To make this change easier, we have designed this booklet with features which we hope will help you. Be it the step-by-step guides or the Catheter Diary, we hope the information gives you the confidence to live your life as you would wish to lead it. WHAT NEXT? Before you leave hospital, fill out the My Discharge Checklist. Your hospital nurse will work through the points with you - now is a good time for a re-cap from the nurse if there is anything you are unsure about. Once you have finished the Checklist, please fill out the sections Key Information About Me and Key Information About my Catheter (at the front of this booklet). This will be essential information for you, your carer, your District Nurse and GP. 7

9 GETTING YOUR SUPPLIES When you are In Hospital. When you get home. 1 4 You will leave hospital with a Starter Pack, an upright night stand and a retaining strap. This is enough supply for one week only. 2 The ward staff will register you with a Home Delivery Company which will deliver more supplies to your home within 2-3 days. This is enough supply for 2-3 weeks. If you leave hospital outside of normal working hours then YOU or YOUR DISTRICT NURSE will need to call the Home Delivery Company to register with them. See the free phone telephone number in/on your Starter Pack to do this. 3 Before you go home, check that you have your Starter Pack and that you have been registered or have the number to register yourself. 8 The ward staff will have referred you to a District Nurse to arrange for your regular ongoing supplies. This first supplies order should be organised as soon as possible as it can take 2 weeks to arrive. 5 Your District Nurse will arrange the prescription for this order with your GP and will set up repeat prescriptions for you. See your Checklist on Page 1 to see if you have already been referred to your District Nurse. If you have not heard from your District Nurse within 3 days of returning home, please ring your GP Surgery to arrange this. 6 Consider what drainage options are best for you have a look on pages 20 & 21. Contact your District Nurse to discuss any options and re-order. Please note that the designs and brand names may differ between hospital and home. GETTING YOUR SUPPLIES

10 MY CATHETER DIARY My First 3 Days at Home I was discharged from hospital on: (date)... To help you to come to terms with living with your catheter, you may find it useful to record your progress, practically and emotionally, by jotting down your thoughts in this Catheter Diary. We suggest you complete the diary for the first 3 days after leaving hospital, just before you have your first catheter change and (if you still have one) at about 6 months. You may like to record any particular incidents good or bad. We have put together a prompt sheet called ANY QUESTIONS on the next page to help you fill out the diary. This includes some of the things we know catheter users experience and sometimes need extra help with. The What Next? section is designed to encourage you to take the next step in your journey with the catheter. It might be to build the confidence to go swimming with your catheter or simply to try a new accessory to make your life easier. Take the opportunity to discuss any of the points you raise in your diary with your District Nurse or GP so they can help you or point you in the direction of a number of charities with expertise in this area. Day One From a practical point of view, how am I managing with my catheter? I can attach my leg bag but I m struggling to attach my night bag From an emotional point of view, how do I feel about the catheter? What Next? Set a goal for tomorrow. I don t feel that I can go out because I m worried that my leg bag shows Have a practice with attaching my leg bag and night bag spares I would like to have a clothes trying-on session with my best friend EXAMPLE 9

11 MY CATHETER DIARY My First 3 Days at Home Day One What Next? From a practical point of view, how am I managing with my catheter? From an emotional point of view, how do I feel about the catheter? Day Two From a practical point of view, how am I managing with my catheter? Set a goal for tomorrow. What Next? Set a goal for tomorrow. From an emotional point of view, how do I feel about the catheter? 10 MY CATHETER DIARY

12 ANY QUESTIONS? Here are some things that catheter users and their closest family and friends tell us that they sometimes need extra help with. Just jot the ones down that affect you - in your Catheter Diary. How do I keep clean with my catheter? What exercises can I do with my catheter in? What can I wear now? My catheter is leaking I am worried about going out and about Eating and Drinking? Is there an alternative to me having a catheter? Emotions, relationships and sex I am having problems at night When will my catheter come out? How do I manage my supplies & medications? My catheter is causing me pain Maybe you are worried or concerned about having a shower, going swimming or even the romantic side of your relationship? Maybe it s something we haven t mentioned here if so, write it in one of the blank shapes above. Please discuss any of your worries with your nurse or with any of the knowledgeable self-help or user groups on the back page. 11

13 My First 3 Days at Home Day Three From a practical point of view, how am I managing with my catheter? What Next? Set a goal for tomorrow. From an emotional point of view, how do I feel about the catheter? A Day of Your Choice What Next? From a practical point of view, how am I managing Set a goal for tomorrow. with my catheter? From an emotional point of view, how do I feel catheter? about the 12 MY CATHETER DIARY

14 WHAT IS A CATHETER? A catheter is a soft hollow tube, which is passed into the bladder to drain urine. Catheters are sometimes necessary for people who, for a variety of reasons, cannot empty their bladder in the usual way i.e. passing urine into a toilet or urinal. Please do not try to remove the catheter yourself as this should only be removed or changed by a healthcare professional. SHORT TERM (i.e PTFE) CATHETER A short term catheter can stay in the body for up to 28 days. This end attaches to the drainage bag or valve This is used by the nurse to inflate and deflate the catheter balloon LONG TERM (i.e ALL SILICONE) CATHETER A long term catheter can stay in the body for up to 12 weeks. This end attaches to the drainage bag or valve This end sits in the bladder The balloon is inflated after the catheter is put into the bladder This is used by the nurse to inflate and deflate the catheter balloon This end sits in the bladder 13

15 HOW IS THE CATHETER HELD INSIDE THE BLADDER? A WOMAN WITH A CATHETER IN SITU BLADDER CATHETER Your catheter has a balloon device which when inflated prevents the catheter from falling out. The drainage of urine is totally dependent on gravity. Therefore, the tubing and the drainage system must always be below the level of your bladder. The end of the catheter that sits in your bladder has two holes (eyelets) that allow the urine to drain. The urine then passes down the rest of the catheter into your leg bag OR out, when you open your catheter valve. THE POSITION OF THE CATHETER IN THE BLADDER BALLOON LEG BAG BLADDER 14 CATHETER CATHETER EYELET WHAT IS A CATHETER?

16 EFFECTIVE HANDWASHING Effective hand hygiene is very important when dealing with your catheter. Please always follow the instructions below. It is essential that the highest standards of hygiene are maintained at all times. You must wash your hands prior to handling your catheter or drainage bag/valve. Use an unperfumed soap. Whatever the product used, the hand washing technique is very important to ensure effective results in preventing the spread of infection. 6 - STEP HANDWASHING GUIDE 1: Wash palms of hands. 2: Wash between fingers at 3: Wash between fingers back of hands. palm to palm. 4: Wash palm area. 5: Pay particular attention to 6: Wash finger tips paying thumb area and thumb joint. particular attention to nails. Dry hands well. 15

17 MOST COMMONLY MISSED AREAS Hand washing is the simplest and easiest way of preventing the spread of infection to yourself and other people. If a healthcare worker is dealing with your catheter, you should expect them to wash their hands before and after and wear gloves. IMPORTANT POINTS LEAST FREQUENTLY MISSED LESS FREQUENTLY MISSED MOST FREQUENTLY MISSED 16 Reference (Images): Taylor L (1978) Hand washing is the simplest and easiest way of preventing the spread of infection to yourself and other people. Thorough rinsing under running water is an important part of the procedure. Finally, dry the hands thoroughly - this helps to prevent soreness. EFFECTIVE HAND WASHING

18 LIVING WITH A CATHETER Having a catheter should not limit your social and leisure activities or prevent you going on holiday. In fact some people find that it helps to improve their quality of life. Below are some tips on living with your catheter day to day... PERSONAL HYGIENE GETTING BACK ON YOUR FEET You can bathe or shower daily leaving your drainage system in place (hang leg bag over the side of the bath or attach a valve or tap). If bathing is difficult please keep the genital area and skin surrounding the catheter clean warm mild soapy water is best. Dry carefully. Wash every morning and night and, if possible, after a bowel motion. Wash around the catheter using downward strokes away from the body to reduce your risk of infection. Personal hygiene is extremely important. Avoid strongly perfumed soaps, talc and creams to minimise skin irritants and infection. Catheters do rub, chafe and catch. To try to help with this, you could try the following: Make sure that you have your retaining strap on and it is in the right position (see page 22) Make sure that no tubes are pulling. Try the leg bag/valve in different positions on your leg. If the discomfort continues, numbing gel is available from your local nurse 17

19 HEALTHY LIVING Maintain a healthy bladder by drinking at least litres of fluid daily. Be guided by the colour of your urine, aim for light yellow or straw coloured urine. If it s dark yellow then you need to drink more. Eat a well-balanced diet to prevent constipation. Constipation can stop the flow of urine. Sometimes, constipation can cause problems with the catheter such as leaking. Eating high fibre foods e.g. porridge, bran, wholemeal bread, fruit and vegetables is essential to avoid constipation. Maintaining your daily exercise routine is not only important for keeping fit; it is also essential for healthy kidneys, bowel and bladder and helping the catheter to drain well. You may find that certain exercises are easier with a catheter valve rather than a leg bag, ask your nurse for guidance. WHAT SHOULD I WEAR? This is a frequent and understandable question, especially for long term catheter users. From a practical point of view, your clothes should not pinch the tubing as this might block the flow of urine from your bladder. We also know people are often worried about the changes to their body shape by the addition of the catheter bag. Take the opportunity to go through your wardrobe with a trusted friend or family member and decide which clothes best suit the new you you may find that most of your clothing still fits perfectly well. Some people have taken advantage of services offered by most of the large department stores for example Personal Shoppers. Many people choose to use a valve rather than a leg bag as it is more discreet. See Page 20, 23 & 24 to learn more about valves and talk to your nurse about whether this would be suitable for you. 18 LIVING WITH MY CATHETER

20 LOOKING AFTER MY RELATIONSHIPS INTIMATE RELATIONSHIPS People do have loving and sexually-active relationships with a catheter but it takes a little more planning. Other catheterisation options, such as supra-pubic catheterisation or intermittent self-catheterisation, are sometimes possible for those couples who would prefer greater sexual freedom. Please do not feel embarrassed to talk to your health professionals about any sexual options as they are very used to answering this type of question. You can leave the catheter in place or pull it forward and tape it onto your stomach or to the side although the best position for the catheter will be established through experience. In some special situations the District Nursing Teams will consider teaching you or your partner how to remove and reinsert your normal catheter before and after sex. The drainage bag should always be emptied before sexual activity or use a catheter valve and both partners should take care with hygiene before and after sexual activity. It helps to use plenty of water-based lubrication such as K-Y jelly but not Vaseline as this may damage the catheter. Remember that the catheter is entering the urethra (water passage) and not the vagina. There are other options available that may be more suitable for you and give you greater sexual freedom: Supra-pubic catheterisation this is where the catheter is surgically inserted through the abdominal wall into the bladder rather than via the urethra. This is a one-off surgical procedure performed in the hospital. Routine changes of the catheter can then be carried out by your District Nurse. Make an appointment with your GP to discuss this. Intermittent Self-catheterisation this is where you are taught how to pass a catheter into your bladder via your urethra a number of times a day to empty the bladder regularly. You would therefore spend most of your day and night catheter-free. You may find it worthwhile looking at healthtalk online to listen to people discuss their experiences and solutions of having sex with a catheter. Please see the link on the back cover. 19

21 DRAINAGE OPTIONS What s Best for Me? The catheter itself is only one part of the system - the catheter also needs to be connected either to a valve (like a tap) or to a collection bag. CATHETER CATHETER CATHETER CATHETER CATHETER CATHETER VALVES VALVE VALVE VALVE LEG BAG LEG BAG LEG BAG LEG BAG NIGHT BAG NIGHT BAG For some patients a catheter valve may be the best way to empty the bladder. A catheter valve (like a tap) connects directly to your catheter. The tap, when shut, allows your bladder to fill and when opened allows Catheter valve with retaining strap your bladder to empty. A catheter valve can be more discreet as there is no bag involved but may not be suitable for everyone. Ask your health care professional if a catheter valve is suitable for you. Catheter valves should be changed every 7 days (or before if necessary see Point of Interest box on the next page) and weekly thereafter. Key: CATHETER + DAY NIGHT 20 DRAINAGE OPTIONS FOR MY CATHETER

22 LEG BAGS Catheter Retaining Strap Leg Bag Drainage Tap NIGHT BAGS Catheter plus leg bag supported by a sleeve Leg bags can be worn on the thigh or lower leg and can hold different volumes of urine e.g. 350ml, 500ml, 750ml or 1000ml. The leg bag has a tap at the bottom which allows the urine to be drained from the bag, this tap also has a rubber extension at the end which allows the night bag to be attached securely. If using a valve, the leg bag can be attached to a valve to add reassurance for special social occasions. They can be secured by Velcro straps or a leg bag holder known as a sleeve. Leg bags should be changed every 5-7 days (or before if necessary see Point of Interest box below). Night bags are connected directly to either the leg bags or the catheter valve to keep a closed system and usually are 2000ml/2L bags. The larger night bags mean you don t have to get up in the night to empty the bag. They should be supported on a catheter drainage stand. POINT OF INTEREST Maintaining a closed system is central to the prevention of infections. A closed system is achieved by not unnecessarily undoing the connections between the catheter and its accessories (e.g. leg bag). Undoing the connections can allow bacteria to travel up the catheter and into the bladder which may lead to an infection. If any of the drainage connections become detached or soiled then it must be replaced. (Loveday, H.P et al 2014) 21

23 CATHETER RETAINING STRAP A retaining strap secures the leg bag or catheter valve firmly and comfortably against your leg. This acts as a shock absorber against any sudden movement, minimising risk of pain or discomfort, trauma or leaking, as it stops the catheter from being accidentally pulled. bag. Catheter retaining strap with a valve. POINT OF INTEREST There are different sizes of catheter retaining straps. Catheter retaining strap with a leg bag. valve and a leg 22 SECURING MY CATHETER

24 ATTACHING/CHANGING MY VALVE 1. Always wash your hands. 2. Have tissue/toilet paper ready to catch any drips. 4. Remove the new catheter valve from packaging. 5. Pinch catheter tube to stop the flow of urine and pull out old valve. You may need to twist and turn valve to remove. Remember to hold on firmly to your catheter with your other hand to stop it pulling. 3. Always empty your bladder first by opening the valve and allowing the urine to drain. 23

25 Tap in closed position 6. Push new catheter valve firmly into catheter right up to the hilt making sure it is secure. 7. Fix to catheter retaining strap or tuck into pants. Do not leave dangling. 8. Wrap old valve in newspaper or old carrier bag and dispose of in household rubbish. Do not burn on an open fire or an electric incinerator. 9. Please ensure your catheter is comfortable, not pulling and feels secure. Long-term (all silicone) catheter + valve, secured to the leg with a retaining strap. DRAINAGE OPTIONS: ATTACHING / DETACHING MY VALVE 24

26 ATTACHING/DETACHING MY ATTACHING/DETACHING MY LEG BAG 1. Always wash your hands. 2. Have tissue/toilet paper ready to catch any drips. 5. Pinch catheter tube to stop the flow of urine and pull out old leg bag from the catheter. Tap in open position 3. Always empty your leg bag first. 4. Remove the new leg bag from packaging. 6. Push new leg bag firmly into catheter right up to the hilt making sure it is secure

27 7. Fix leg bag to leg with Velcro straps (which should go behind the leg bag tubing/bag) or sleeve. Long Short tubing tube leg leg bag secured with a Velcro sleeve. straps. Velcro strap seen here in a criss cross... Short tubing leg bag secured with a sleeve. 8. Wrap old leg bag in newspaper or old carrier bag and place in dustbin. Do not burn on an open fire or an electric incinerator....and here using a different method. Valve plus longtubing leg leg bag bag short tube secured with velcro straps......as seen from the back. Different lengths of leg strap. Please ensure your catheter is comfortable, not pulling and feels secure. DRAINAGE OPTIONS: ATTACHING / DETACHING MY LEG BAG 26

28 ATTACHING MY NIGHT BAG TO MY VALVE 1. Always wash your hands. 2. Remove night bag from package and take off cap. 4. Push night bag into rubber end of the catheter valve firmly. Tap in closed position 3. Ensure catheter valve is closed. Tap in open position 5. Open catheter valve to allow the urine to flow. 6. Hang the night bag on a stand so the bag is lower than the bladder to allow drainage. 27

29 DETACHING MY 1. When you get up in the morning close the catheter valve. Tap in open position 3. Empty urine from the night bag see table on page 31. NIGHT BAG FROM MY VALVE 2. Disconnect the night bag from the catheter valve. 4. Wrap old night bag in newspaper or old carrier bag and place in dustbin. Do not burn on an open fire or an electric incinerator. NIGHT TIME DRAINAGE OPTIONS: ATTACHING/DETACHING NIGHT BAGS & VALVES 28

30 ATTACHING MY NIGHT BAG TO MY LEG BAG 1. Always wash your hands. 2. Remove night bag from package and take off cap. 3. You can remove / loosen the velcro straps or remove sleeves to improve your comfort overnight. 4. Push night bag into rubber end of the leg bag firmly. 5. Make sure leg bag tap is on open to allow the urine to flow through the bag into the night bag. 6. Hang the night bag on a stand so the bag is lower than the bladder to allow drainage. POINT OF INTEREST Always attach the night bag to your catheter valve or leg bag to keep a closed system, rather than attaching it directly to the catheter itself. You do not have to use the night bag. You can just empty your leg bag or catheter valve overnight if this suits you better. 29

31 DETACHING MY 1. Always wash your hands. 2. When you get up in the morning close the valve at the bottom of the leg bag. 3. Disconnect the night bag from the leg bag. NIGHT BAG FROM MY LEG BAG 4. Re-tighten the velcro straps or put the sleeves back on. 5. Empty urine from the night bag - see table overleaf. 6. Wrap old night bag in newspaper or old carrier bag and place in dustbin. Do not burn on an open fire or an electric incinerator. NIGHT TIME DRAINAGE OPTIONS: ATTACHING/DETACHING NIGHT BAGS & LEG BAGS 30

32 DRAINAGE OF NIGHT BAGS Non-drainable night bags Drainable night bags These are night bags without a reusable tap so can only be used for one night and disposed of in the morning. The tap is twisted off in the morning to allow the bag to be emptied before putting in household rubbish. To empty non-drainable night bags:- 1. Turn the bag upside down so that the tap is pointing upwards 2. Pinch the tap and twist off the external part of the tap 3. Carefully tip the bag the right way up again and empty the urine down the toilet. These are night bags that have a re-usable tap and can be used for up to 7 days. To empty drainable bags:- 1. Empty the urine into the toilet using the re-usable tap at the bottom 2. Rinse through with warm water. You do this by putting the tube under running water allowing the water to run down the tube through the bag and out through the open tap at the bottom 3. Close the tap. It is then ready to use again the next night. 31

33 COMING TO TERMS WITH MY EMOTIONS We know that living with anything new requires an adjustment in the way we think and act. The catheter is no different and it may take a while to get used to it being part of you. Other catheter-users tell us that this adjustment was made easier by knowing exactly why they had to have the catheter. This is why we ask you to write this reason down at the start of this booklet. Becoming familiar with the catheter and accessories and understanding how they work will help encourages you to take part in activities such as bag changes and emptying The Catheter Diary (Pages 9-12 & 37) has been designed to help you think about this change to your way of life and you might like to talk about what you have written in your diary with someone. We hope that your inner concerns and triumphs can be shared and, when necessary, solutions discussed. Your nurse will be able to guide you and you may also consider contacting charities with expert knowledge in these areas. See the back cover for contact details. WHO SHOULD I TELL ABOUT MY CATHETER? Most people decide to let their closest family and friends know about their catheter. Even though it can be an embarrassing conversation it may well pay dividends. A few hand-picked friends or family who know about the about. A catheter valve can be more discreet than a leg bag see page 18 for more information about this option. 32 MY CATHETER PASSPORT

34 HAVING MY CATHETER CHANGED Your catheter will need to be changed regularly (see page 2). It may be uncomfortable so a gel will be used to lubricate and numb the urethra (your water passage). Most catheters are inserted easily but sometimes difficulty can occur with narrowing of the urethra or intricacies of locating the anatomical position of the urethra. The urology department run a weekly catheter clinic for any changes that require greater urological expertise, specific instrumentation or the use of Entonox (medical gas). However, community nurses undertake most catheter changes at home. Catheterisation should always be an aseptic (sterile) technique. This reduces the risk of introducing infection into the bladder. The smallest size catheter allowing effective drainage should be used. The catheter is a foreign body and can cause discomfort and bleeding due to irritation of the urethra and bladder but usually subsides within 24 hours of the catheter being inserted however for some people it can persist. BLADDER PAIN AND LEAKING URINE AROUND THE CATHETER Catheters can be problematic and unfortunately it is common to have some leakage of urine from around the catheter, making your clothes wet. You may feel more comfortable by wearing a pad in some close-fitting underwear which will absorb the urine. These can be purchased from any supermarket/chemist in the sanitary products aisle. Please take extra care with your personal hygiene. Once the catheter is in you may experience bladder spasms (a sudden contraction of your bladder muscle) which is caused by the catheter irritating the bladder and the bladder trying to get rid of the foreign body (catheter). They can vary from a dull ache to severe pain, make you feel like you need to pass urine and cause urine to leak out around the catheter. This leaking can also be known as bypassing. Bladder spasms due to catheters are very distressing but do not normally increase in intensity or frequency. Spasms occurring immediately after catheter changes may be temporary and settle down after hours. If they persist, consider: Do you still need a catheter? If spasms continue and cannot be controlled consider self-catheterisation or condom drainage. Use catheter retaining strap so the bag is not pulling. Avoid spicy, acidic and citrusy foods. Certain preservatives may irritate such as artificial sweeteners, chocolate, pickled foods and tomatoes. Avoid alcohol and caffeine. Keep hydrated your urine should be pale straw colour. If spasms persist then your GP may consider prescribing you medication called anti-cholinergic (anti-spasm). There are a variety of these medications available and one may suit you better than another. 33

35 WHAT SHOULD I DO IF... Issue Possible cause Suggested action My catheter is leaking My catheter is not draining well Kinks in the tubing Bladder spasm Catheter tends to block Constipation Check catheter and bags are secure and draining freely Straighten any tubing The leg bag tubing may be too long or too short for your height try a different tube length Ensure the bag is below the level of your bladder to allow free drainage it works on gravity Discuss this with your health-care professional & see page 33 Using a smaller size catheter Reducing the balloon size of the catheter Start medication (anticholinergic) Discuss this with your health-care professional Consider using catheter valve to promote regular flushing through the catheter Your nurse may use a catheter maintenance solution Using a catheter diary to determine optimal time to change catheter Maintain a healthy balanced diet (see page 18) Treat constipation discuss suitable medications with your chemist or health-care professional (If you have a catheter problem, please see Page 6 for contact telephone numbers) 34 WHAT SHOULD I DO IF...

36 Issue Possible cause Suggested action My catheter is not draining well (continued) There is debris in my catheter bag / urine I have blood in my urine (haematuria) The catheter eyelet can get sucked into the bladder lining and block the catheter Low fluid intake Underlying condition Infection Leave 5-10 ml (about a tablespoon) of urine in your bag when emptying it to prevent this vacuum effect Aim for fluid intake of 1.5L to 2L over 24 hour period (unless medically advised otherwise) Urine should be pale straw colour A little exercise can help get rid of debris such as old cells Contact your Healthcare Professional You may be referred to the Urology Department, if clinically indicated They may flush your catheter if blockage occurs Contact your Healthcare Professional They may take a urine and treat you with antibiotics Drink more, unless drinking is restricted due to medical reasons. The recommendation, if you are not restricted, is 3 litres over 24 hours for 7 days Injury (trauma) Avoid allowing the catheter to pull on the bladder neck by using a catheter retaining strap (If you have a catheter problem, please see Page 6 for contact telephone numbers) 35

37 Issue Possible cause Suggested action I have an infection Contact your Healthcare Professional if you have: Fever/chills Nausea / feeling sick New pain or tenderness in your side (upper abdomen, back or side) or lower abdomen Change in the look and smell of urine Worsening mental status Feeling unwell If you do not have any of these symptoms it is unlikely that you will be prescribed antibiotics for an infection. This is because they are unlikely to be needed and may lead to antibiotic resistance Dehydration Bladder Stones Personal Hygiene Drink more, unless drinking is restricted due to medical reasons. The recommendation, if you are not restricted, is 3 litres over 24 hours for 7 days If persistent infections occur, you and your Healthcare Professional may consider referral to the Urology Department for investigation and treatment Adhere to hand hygiene guidelines as described (see pages 15 & 16) Cleanse around the catheter daily with soap Don t use oil based creams or talcum powder around catheter area (If you have a catheter problem, please see Page 6 for contact telephone numbers) 36 WHAT SHOULD I DO IF...

38 MY CATHETER DIARY Just before my first catheter change Date: What Next? From a practical point of view, how am I managing with my catheter? Set a goal for tomorrow From an emotional point of view, how do I feel about the catheter? At 6 months Date: What Next? From a practical point of view, how am I managing with my catheter? From an emotional point of view, how do I feel about the catheter? Set a goal for tomorrow (For help with completing this page, please have a look at page 11) 37

39 WOULD YOU LIKE MORE INFORMATION? Bladder & Bowel Foundation Helpline Living with a Urinary Catheter People with catheters share their Association for Continence Advice Tel: Tel: Department of Health Tel: PromoCon Helpline : REFERENCES Education And Resources For Improving Childhood Continence (ERIC) Helpline: International Continence Society (ICS) Tel: Multiple Sclerosis Society UK Helpline: Helpline@mssociety.org.uk Spinal Injuries Association Freephone Advice Line: Prostate Cancer UK Specialist Nurses helpline: Loveday, H.P et al (2014) epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. Journal of Hospital Infection 86S1 S1 S70. Available from: Preventing_HCAI_in_NHSE.pdf [accessed 07/11/14] Taylor, L. (1978) An Evaluation of Hand washing Techniques, Nursing Times, Jan , p Further references available from: 0r by post: Urology Department (D11), Royal United Hospital, Combe Park, Bath, BA1 3NG 38 USEFUL WEBSITES AND ADDRESSES

40 Created by: MELANIE DE JAEGER Lead Nurse - Catheter Passport Service Improvement Action Research Project and Staff Nurse, Royal United Hospitals Bath NHS Foundation Trust melaniedejaeger@nhs.net JACKIE ROBINSON Senior Sister - Urology Outpatients Department, Royal United Hospitals Bath NHS Foundation Trust jackie.robinson10@nhs.net Designed in collaboration with patients, ward nurses, district nurses, community hospital nurses, university researchers & the RUH urology specialist, communication and quality improvement teams. Photography: Anita Houlding The advice given in this guide should not replace recommendations from your health team. Any questions or worries you may have should be discussed with your District Nurse. An action research project to develop, implement and evaluate the Catheter Passport is being supported by the Foundation of Nursing Studies Practice Based Development and Research Programme in partnership with the General Nursing Council for England and Wales Trust Published August 2016 Version 3 Copyright: Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, BA1 3NG Tel: (01225) ruh-tr.patientadviceandliaisonservice@nhs.net Source: Royal United Hospitals Bath NHS Foundation Trust (RUH). This information is published with the permission of the RUH. This information was generated by proprietary tools developed by the RUH. No further copying or reproduction is allowed without the written permission of the RUH. This document can be shared. If you would like to reproduce any part of this document (outer folder, Catheter Passport male and female versions, Urinary Catheter Record Book), please contact our Library Team 2 at ruh-tr.library@nhs.net. 1WRU360