John Heesakkers, Christopher Chapple, Dirk De Ridder and Fawzy Farag (eds.)Practical Functional Urology10.1007/978-3-319-25430-2_14

14. Practical Catheter Management

Shirley Budd¹

(1)

SEQOL Wiltshire, Continence Advisory Service, Swindon, UK

Shirley Budd

Email: SABudd56@hotmail.co.uk

Catheters are a common method of bladder drainage for obstructive voiding or incomplete bladder emptying. Presuming that a clinical rationale has been proven identifying that a Foley catheter has been assessed as the best method for bladder drainage, this chapter will identify evidence-based practical ideas to support management of the problematic indwelling catheter. This includes explanations and solutions to catheter-associated UTI (CAUTI), bypassing and expelled catheters, the non-draining catheter including catheter encrustation, pain associated with catheters and general problems associated with catheter insertion and removal. Practice that is advised and not advised is detailed.

Assess the patient for potential problems to provide proactive care.

A risk assessment should include an assessment to identify bladder and bowel dysfunction. Assess the patient’s medical conditions, the medication they are taking and the effect these may have on catheter function. A health and social assessment to include fluid intake, types of fluid, diet, and bowel function, abilities of self-care, cognition, mobility, dexterity, eyesight and environment enables proactive care and treatment. Poor fluid intake, constipation and neuropathy will cause problems for catheter management before you have even decided they need a catheter.

Catheter management should involve a multidisciplinary team. It is usually the jurisdiction of a nurse to provide catheter insertion, daily care, assessment and patient education.

Remove the catheter as early as possible. Assessing for catheter removal is identified as an effective nurse-led protocol to reduce CAUTI.

Reasons for catheterisation: use the acronym HOUDINI (make the catheter disappear) to empower nurses to remove catheters:

Haematuria visible
Obstruction/inability to empty bladder
Urological surgery or gynae procedures
Decubitus ulcer/open sacral wound
Input/output fluid monitoring haemodynamic instability
Nursing care only/end of life care to promote comfort
Immobility

CAUTI

Catheter-associated UTI is the most prevalent nosocomial infection. The design of a Foley catheter results in a number of challenges. The balloon causes a sump of urine collecting below the eyelets. The catheter is a foreign body onto which bacteria adhere and create a self-protecting biofilm as a cause of bacteriuria and symptomatic CAUTI.

Wherever possible assess for using a catheter valve negating the need for a drainage bag to promote bladder filling and emptying and increase flushing of bacteria out with urine.

Assess for suprapubic catheterisation if CAUTI is recurrent and/or a cause of bacteraemia.

Apply aseptic non-touch technique (ANTT) at catheter insertion and change by maintaining sterility and not touching key areas of the catheter.

Effective hand washing and application of clean gloves have been proven to reduce CAUTI. Ensure hands are washed before and after any contact with the patient or provision of catheter care. Alternatively apply alcohol hand rub using the same hand washing technique to cover all areas of the hands when appropriate, e.g. lack of facilities in a patient’s home and hands visibly clean.

Teach patients and carers hand hygiene requirements and skills.

Give fluid and dietary advice including required fluid volume; patient should aim to drink 2.5–3 l or until urine looks clearer and paler. Avoid caffeinated drinks if sensitive to caffeine.

Maintain the closed drainage system by adhering to manufacturers guidelines of 5–7 days to reduce CAUTI.

Only if the patient is unwell as a result of CAUTI should urine samples be taken to ascertain the appropriate antibiotic. Take samples aseptically from the sample port on the drainage bag. Do not use antibiotics to treat bacteriuria. The biofilm on the catheter protecting the bacteria prevents antibiotic effectiveness. Do not use antiseptic bladder washouts. This promotes resistant bacteria.

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