Looking after an indwelling catheter. Information for patients Spinal Injuries

Transcription

1 Looking after an indwelling catheter Information for patients Spinal Injuries

2 The Princess Royal Spinal Injuries and Neurorehabilitation Centre Osborn Building Northern General Hospital Herries Road Sheffield S5 7AU Telephone: Fax: Minicom: page 2 of 8

3 What is an indwelling catheter? An indwelling catheter is a tube, usually with a balloon on the end, that stays in your bladder all of the time to drain urine. Indwelling catheters are usually additionally described as being: urethral (IUCD - indwelling urethral catheter drainage), using the urethra to enter the bladder; or suprapubic (SPC - suprapubic catheter), where a small opening is made between your pubic area and your umbilicus (belly button). The catheter enters your bladder through this. In either case the catheter is usually the same; it is just the route into your bladder that is different. What are the risks of long-term indwelling catheters? Damage to the urethra and bladder caused by the long-term presence of the catheter, or by it being pulled accidentally. The inside of the catheter can become encrusted (silted up) with stone-like debris, or stones can form in the bladder due to the constant presence of a foreign body. An indwelling catheter provides a route for bacteria to get into the bladder, and can provide them with shelter from the body s defence systems. Stones in the kidneys and ureters are more common if you have an indwelling catheter. If you have an indwelling catheter and keep it on free drainage, your bladder will always be empty. This will cause your bladder to shrink (lose capacity), which will eventually cause problems with bypassing (getting wet around the catheter) or, if you have an injury above T6, Autonomic Dysreflexia*. * Make sure you know if you are at risk of Autonomic Dysreflexia (generally this serious complication occurs in tetraplegics), and that you have had it explained to you if you are at risk. page 3 of 8

4 Are there any ways to reduce those risks? If you follow the advice below on how to maintain an indwelling catheter, you can greatly reduce the chance of these adverse effects. Good practice guidance: Change the catheter regularly We recommend that this is done every six weeks. This is the best thing that you can do to prevent blockage through encrustation. There is a lot of variation in the rate at which individuals produce encrustation, so you have to find out what is the best interval between changes for you. Some people change the catheter every two weeks or even less. Use the right size of catheter made of the right material The catheter needs to be as wide a bore as possible to slow down encrustation, without damaging the urethra. Most adults can use a size 16 or 18 gauge catheter via the suprapubic site. Any smaller and the risk of blockage increases. We recommend a catheter made of silicone. Use a valve ( flip-flo ) to shut off the flow of the catheter for periods during the day - see separate information leaflet By gradually increasing the time the valve is closed, you can increase or preserve the amount your bladder can hold without problems. Four hours is the maximum you should shut it off for, but any length of time is better than none. You can fit the valve to a leg bag, or many people just drain off into a night bag three or four times during the day. Leave the valve open, draining into a bag, at night. page 4 of 8

5 Drink regularly throughout the day We recommend 2.5 to 4 litres a day. Dilute urine reduces the rate of encrustation of the catheter and the risk of urinary tract infection (UTI). Many catheter users drink cranberry juice and/or fruit juices as these may further discourage encrustation. Be careful though: habitual drinking of more than 4 litres a day may upset your body chemistry. Learn, or make sure a carer learns, how to change the catheter Catheters can suddenly become blocked or pulled out. The sooner they are replaced, the lower the risk of Autonomic Dysreflexia or getting wet. If you are reliant on local medical services, it may be difficult to have the catheter changed or replaced as an emergency. Secure the catheter to your skin so that it isn t pulled accidentally It is easy to accidentally tug on the catheter while dressing or undressing, or transferring. This can cause damage to the urethra or the lining of the bladder. Sometimes it causes haematuria (blood in the urine). If you are male or a suprapubic user, tape the catheter to your abdomen. Women often tape the catheter to the top of the thigh. There are devices such as Cath-secure, available on prescription, that do this. We generally advise against strapping the catheter to your upper thigh, as this can pull on the catheter when you move. Alternatively, if you are using a flip-flo valve, it is often best to do without a leg-bag and just tuck the end of the catheter into the waistband of your trousers or underwear. page 5 of 8

6 Make sure you get regular check-ups You need regular investigations (X-ray and Ultrasound) to make sure you are not developing stones and that your kidneys are still working properly. You may also need regular cystoscopy. This is a small operation where the urologist crushes and washes out stones that are in your bladder, using a cystoscope. A cystoscope is a flexible catheter-like device that is passed along your urethra and into your bladder. Contact details Do contact the Centre for advice if you have any problems with the above procedure. Please contact us on the telephone numbers below: Paula Muter, Marie Watson, Carol Eggington Urology Nurse Specialists: Bleep 2494 or Ward Osborn 2: / 9 Outpatient Department: page 6 of 8

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8 Produced with support from Sheffield Hospitals Charity Working together we can help local patients feel even better To donate visit Registered Charity No Alternative formats can be available on request. Please Sheffield Teaching Hospitals NHS Foundation Trust 2018 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. PD6688-PIL2603 v3 Issue Date: January Review Date: January 2020