Procedure for removal and reinsertion of an indwelling urethral catheter (female)

Transcription

1 Procedure for removal and reinsertion of an indwelling urethral catheter (female) Refer to National Infection Prevention and Control Manual for information on aseptic technique/cleaning equipment. Equipment required Perform this procedure as an aseptic technique to minimise the risk of introducing infection. Clean the trolley (or equivalent). Assemble the equipment on the bottom shelf while the top shelf acts as a clean working surface (if available). Clean disposable apron Alcohol based hand rub (ABHR) Catheterisation pack Catheter appropriate size, length and material, check expiry date One pair of procedure gloves Two pairs of sterile nitrile gloves One sachet of normal saline Sterile water and one 10ml syringe and needle if not already supplied with catheter Appropriate drainage bag or catheter valve (refer to Products section from the Adult Bladder and Bowel Dysfunction Protocol) Lubrication: Anaesthetic gel must be prescribed if being used and checked for contraindications. A single use sachet of 5g plain lubricating gel may be used if preferred or if an anaesthetic gel is contraindicated. Bed protection Disposal bag Bladder and Bowel Nursing Team Page 1 of 5 October 2014

2 Encourage personal hygiene (shower or bath). Ensure privacy. Explain and discuss the procedure with the patient. Obtain and document informed consent in nursing notes. Allow time for questions. Adjust the height of the bed (if appropriate) and assist the patient into the supine position. Place the procedure pad under buttocks and leave the patient covered. Ensure the bedside lighting is good. Perform hand hygiene as per local policy. Put on a disposable apron. Using an aseptic technique prepare the equipment: Open the catheterisation pack ensuring you only touch the corners and lay it flat to create a sterile field. Open the other equipment required for the procedure and drop on to the sterile field. Fold back the patient s bedclothes. Perform hand hygiene using ABHR (Alcohol Based Hand Rub). Put on procedure gloves. To promote privacy and maintain dignity. To obtain informed consent and co-operation. As a legal requirement. To alleviate anxiety. To aid procedure. To maintain dignity. To enable the supra pubic site to be clearly seen. Create a sterile field. To promote clean work area and maintain dignity. Bladder and Bowel Nursing Team Page 2 of 5 October 2014

3 Perform routine catheter cleansing. Attach a syringe to the inflation channel of the catheter and allow spontaneous deflation of the balloon. Gently remove the catheter. Examine the condition of the catheter. Dispose of equipment according to local policy (refer to National Infection Prevention and Control Manual). Remove gloves. Put on the first pair of sterile gloves. Clean the labia with the sterile swabs and normal saline using a single downward stroke to cleanse the right and left labia majora, right and left labia minora. Use a new swab for each stroke and then discard. Separate the labia minora and identify the urethral meatus. If using anaesthetic gel insert slowly into the urethral meatus as per manufacturer s instructions. If using a single sachet of 5g plain lubricating gel, apply to the insertion end of the catheter, taking care to avoid clogging the eyelets with the gel if possible. Remove the contaminated gloves. Apply a second pair of sterile gloves. To deflate the balloon and help to prevent ridges forming on the catheter balloon that may cause discomfort/spasm on catheter withdrawal. To facilitate replacement. To assist in planning of future catheter management. To promote a safe environment and minimise the risk of cross infection. Use of an anaesthetic gel will anaesthetise, lubricate and provide antibacterial protection. If a plain single use lubricant is used, the procedure can take place immediately. Clogged eyelets may prevent urine drainage. Bladder and Bowel Nursing Team Page 3 of 5 October 2014

4 Place the sterile fenestrated drape over the patient leaving the pubic area exposed. A sterile valve or drainage bag should be attached to the catheter at this point. Gently advance the catheter along the urethral tract. Once the urine starts to drain from the catheter, insert a further 2-3cm. Carefully inflate the balloon according to the manufacturer s instructions. Withdraw the catheter slightly. Dry area with swabs. Ensure the catheter drainage bag is supported. Dispose of equipment according to local policy (refer to National Infection Prevention and Control Manual). To promote a clean work area and maintain dignity. To make the catheter easily accessible and allow the urine to drain into the leg bag. To ensure the catheter is in the bladder and not in the urethra. To promote patient comfort. To minimise the risk of secondary infection and skin irritation. To ensure the patient is comfortable after the procedure. To promote a safe environment and reduce the risk of cross infection. Document information in the patient urinary catheter passport. Details are all relevant to future management. Bladder and Bowel Nursing Team Page 4 of 5 October 2014

5 Post procedure care Ensure the method of supporting the catheter and chosen drainage system is appropriate (refer to Products section from the Adult Bladder and Bowel Dysfunction Protocol). Ensure catheter care is ongoing: Daily shower or wash insertion site daily with warm water and soap (avoid strongly perfumed soaps, talcum powder and creams) Clean the catheter itself starting from the insertion site and working towards the distal end Encourage a normal fluid intake of 1½-2 litres daily (unless contraindicated) Ensure the patient and/or carer has a copy of the catheter passport and has relevant contact details. To reduce trauma, irritation and patient discomfort. To prevent obstruction of urine from the bladder. To minimise the risk of urinary tract infection and constipation. To increase the patient and/or carer s knowledge and confidence in caring for the catheter. Bladder and Bowel Nursing Team Page 5 of 5 October 2014