Affix ID Label

Patient Name: …………………..

Date of Birth………………………

NHS Number: ……………………

(Affix ID Label)…………

Nurse to negotiate and agree plan of care with Patient / Carer and obtain consent prior to initiation of treatment ð / Registered Practitioner
Ward / Dept
Hospital
PROBLEM & NEED IDENTIFIED / Signature
DATE & TIME
Patient requires catheterisation.
Individual Problem and Need:
Reason for catheterisation:
Drainage ð Instillation ð Investigation ð Bladder dysfunction/incontinence ð (refer to policy)
If retention, state residual volume: ______
Is antimicrobial prophylaxis required: Insertion ð Change ð Removal ð (refer to care bundle)
Details: Date of Catheterisation: ____/____/_____ Urethral ð Suprapubic ð
Insert Catheter Label: 2nd Label:

Medium term ð Long term ð Catheter requires changing at intervals ______wks
(up to 4 weeks) (up to 12 weeks)
Catheter Change Date: ____/____/_____ Or Catheter Removal Date: ____/____/_____
First catheter change to be completed by: Community Nurse ð Care Home Nurse ð Outpatient Appt ð Other: ______Further catheter changes to be done by: ______
GOAL STATEMENTS / Signature
DATE & TIME
a) To ensure the catheter insertion is appropriate, insertion procedure is optimal, evidence-based and minimises risk of infection to the patient b) to prevent or minimise the risks and complications associated with catheterisation and catheter management c) To ensure catheter remains patent and draining. Individual Problem and Need:
This Nursing Care Pathway is intended as a guide in providing care for the patient and their family. The pathway has been developed by a multidisciplinary team and takes in account evidence based best practice. Professionals are encouraged to exercise their own professional judgement, however any alteration to the practice identified within this ICP must be recorded. If appropriate, patients can come off the pathway.
Instructions for completion of this Nursing Care Pathway:
Page / Section Title / Guidance on completion
Pg 1 / Problems & Goals / To be completed by Registered Practitioner commencing nursing care pathway.
Pg 2 / Interventions / To be completed by Registered Practitioner. This section should be completed in full on Day 1 and all individualised needs written in detail, i.e. patient needs help with What? When? and How?
*Note: “minimal assistance” should not be written.
Pg 3 / Progress Chart &
Outcome Measure (level of independence) / All staff (each shift) should refer to the details contained in the care pathway (Pg 1 & 2) and complete the progress chart by inserting Ö for Met, X for Unmet or N/A for Not Applicable. Any action recorded as Unmet must be reported in the variance reporting section (Pg 4). To report Patient’s progress the ‘Level of Independence Score’ must be documented at the end of each week.
Pg 4 / Variance Reporting / This section is for all staff to record variances from planned interventions.
Pg 5 / Progress Notes / This section is for staff to record progress and details of any individual needs.
Pg 6 / Troubleshooting & TWOC / All staff to use as guidance when urine is not draining, and or removing catheter
Pg 7 & 8 / Catheter Change Form / To be completed by all staff at each Catheter Change
Pg 9-12 / Patient Information Leaflet / To be completed by staff and provided to Patient/Carer.
Variance
Code / INTERVENTION / ACTION TAKEN / COMMENTS
Add appropriate details to ensure individualised care. / Signature
DATE & TIME
C1
C1.1
C1.2 / Catheterisation Procedure:
Catheter inserted without difficulty using appropriate equipment and as per Royal Marsden Procedure Guidelines.
Catheter draining urine following procedure. / If problems encountered – report as variance (Pg. 4)
If catheter is not draining within 30 mins record as variance and Dr. informed ð
C2
C2.1
C2.2
C2.3
C2.4
C2.5
C2.6 / Catheter Care:
Daily assessment of need for catheter completed.
Closed system maintained.
Equipment:
Ensure appropriate drainage system in use: sterile valve/leg bag/drainable night bag (use in bed bound pts only).
For overnight drainage attach disposable single use non sterile night bag – link system
Catheter retaining device is used.
Positioning:
Ensure leg bag is securely fitted to prevent trauma to lower urinary tract whilst maintaining freedom of movement.
Ensure drainage bag is positioned below level of bladder, not in contact with floor i.e. use appropriate stand.
Monitoring:
Ensure adequate fluid intake (1 ½ - 2 litres unless contra indicated)
Monitor for signs of symptomatic urinary tract infection i.e. new loin/supra-pubic tenderness, rigors/high temp, sudden onset or increased confusion. / Details: ______
______
Device: ______
Positioned out of site to maintain
dignity ð
If UTI suspected discuss with Dr, obtain CSU using aseptic technique from sample port, and record as variance (Pg. 4)
C3
C3.1
C3.2
C3.3 / Catheter Drainage & Change:
Ensure use of gloves, apron and effective hand washing before and after handling catheter/drainage bags.
Ensure daily meatal hygiene is performed using soap and water.
Drainage:
To maintain urine flow and prevent reflux empty bag before becoming overfull (approx 2/3rds).
Ensure drainage bags are emptied prior to disposal in orange/yellow clinical waste bag (care setting only).
Catheter Change - Aseptic technique:
Catheter change form completed following each change (Pg.7), antimicrobial prophylaxis given as indicated.
Catheter valve/leg bag/night bag changed every 7 days. / Ensure single use / patients own container is used for this purpose.
Record on chart: Catheter Change = CC
Date / sign bag in indelible ink at time of change. Record on chart – Bag Change = BC
C4
C4.1 / Education:
Patient/Carer instructed in catheter care, given catheter care information leaflet (Pg. 9) and is aware of their role in preventing UTI. / Information leaflet provided (Pg. 7) ð
C5 / Discharge Planning: Appropriate arrangements made in preparation for discharge:
Patient / Carer aware of how to obtain supplies ð Community Nurse / Care Home staff informed and sent copy of pathway ð Catheter details completed on patient information leaflet (Pg. 7) ð Supplies ordered ð
Patient / Carer concerns and anxieties addressed ð Recommended review date: __/__/______
Registered Practitioner
Review of care pathway. / Wk 1 - Date: …../…../…….. Sign: ______
Wk 2 - Date: …../…../…….. Sign: ______
Wk 3 - Date: …../…../…….. Sign: ______
Wk 4 - Date: …../…../…….. Sign: ______
DAY / Day 1. / Day 2. / Day 3. / Day 4. / Day 5. / Day 6. / Day 7.
SHIFT / A
M / P
M / N
T / A
M / P
M / N
T / A
M / P
M / N
T / A
M / P
M / N
T / A
M / P
M / N
T / A
M / P
M / N
T / A
M / P
M / N
T
WEEK 1 / __/___/___ / __/___/___ / __/___/___ / __/___/___ / __/___/___ / __/___/___ / __/___/___
Indicate:
Met Ö
Unmet X
Not Applicable N/A / C2
C3
C4
INITIALS
END OF WEEK 1 – LEVEL OF INDEPENDENCE SCORE: 1 □ 2 □ 3 □ 4 □ 5 □
WEEK 2 / __/___/___ / __/___/___ / __/___/___ / __/___/___ / __/___/___ / __/___/___ / __/___/___
Indicate:
Met Ö
Unmet X
Not Applicable
N/A / C2
C3
C4
INITIALS
END OF WEEK 2 – LEVEL OF INDEPENDENCE SCORE: 1 □ 2 □ 3 □ 4 □ 5 □
WEEK 3 / __/___/___ / __/___/___ / __/___/___ / __/___/___ / __/___/___ / __/___/___ / __/___/___
Indicate:
Met Ö
Unmet X
Not Applicable
N/A / C2
C3
C4
INITIALS
END OF WEEK 3 – LEVEL OF INDEPENDENCE SCORE: 1 □ 2 □ 3 □ 4 □ 5 □
WEEK 4 / __/___/___ / __/___/___ / __/___/___ / __/___/___ / __/___/___ / __/___/___ / __/___/___
Indicate:
Met Ö
Unmet X
Not Applicable
N/A / C2
C3
C4
INITIALS
END OF WEEK 4 – LEVEL OF INDEPENDENCE SCORE: 1 □ 2 □ 3 □ 4 □ 5 □

If a problem occurs refer to troubleshooting

guidance on Pg. 6 and detail as a variance below.

VARIANCE CODE / REASON/ACTION TAKEN/COMMENTS / Signature
DATE & TIME
REASON/ACTION/COMMENTS / Signature
DATE & TIME
PROBLEM / CAUSE / SUGGESTED ACTION
URINE DOES NOT DRAIN / MECHANICAL / ·  Rule out constipation
·  Check position of catheter and drainage system
·  Ensure no kinking in tubing
·  Check fluid intake
·  Does the drainage bag need emptying
·  Change position of patient
·  Check for restrictive clothing
DEBRIS/SMALL CLOTS / ·  Promote increased oral intake
·  Manipulate tubing to encourage drainage
·  Consider catheter maintenance solution – sodium chloride 0.9%
·  If unable to clear blockage change catheter
BLADDER SPASM/BYPASSING / ·  Rule out constipation
·  Reduce caffeine intake
·  Try alternative catheter i.e. silicone/open tip
·  Try a smaller charriere size
·  Consider anti-muscarinic medication
·  Ensure catheter is anchored securely
ENCRUSTATION / ·  Document catheter blockages
·  Check fluid intake
·  Patient-specific care regime
·  Review frequency of planned catheter changes
·  Observe catheter lumen on removal (cut along lumen)
·  Catheter maintenance solutions should not be used (Draft NICE guideline 2011)
Trial without catheter (TWOC) guidance
o  For removal of catheter procedure refer to Royal Marsden’s Manual of Clinical Nursing Procedures
o  Assess bladder function. Monitor patient for signs of voiding dysfunction with or without urinary retention, or pain
o  Complete bladder diary / fluid balance chart. Advise patient to drink normally 1½ to 2 litres (unless contra-indicated). Encourage patient to void urine on desire. If not voided within 6 hours of catheter removal encourage the patient to try
o  If concerns re: bladder function measure post void residual (PVR) using a bladder scanner. If residual >200ml re-check and consider bladder drainage using intermittent catheterisation
o  If the TWOC fails consider intermittent self-catheterisation if appropriate, if not, an indwelling catheter will need to be re-inserted
o  If incontinence occurs following TWOC provide appropriate containment i.e. sheath pads etc

Issue Date: 26.05.2011 / Review date: 26.05.2013 Version: BCUHB V1

Core References: BCUHB Urinary Catheterisation Policy (2010), Infection Control Policy (2009), Royal Marsden Hospital Manual of Clinical Nursing Procedures (2008), Fundamentals of Care (2003) & Effective rehabilitation for older people, Eshum (1999).

Patient Name: …………………..

Date of Birth………………………

NHS Number: ……………………

(Affix ID Label)…………

Issue Date: 26.05.2011 / Review date: 26.05.2013 Version: BCUHB V1

Core References: BCUHB Urinary Catheterisation Policy (2010), Infection Control Policy (2009), Royal Marsden Hospital Manual of Clinical Nursing Procedures (2008), Fundamentals of Care (2003) & Effective rehabilitation for older people, Eshum (1999).

Patient Name: …………………..

Date of Birth………………………

NHS Number: ……………………

(Affix ID Label)…………

Catheter Change Form / Stop! Think! Avoid If Possible / Is the catheter still needed?
Date
Time
Name of catheter / PLEASE STICK / PLEASE STICK / PLEASE STICK
Catheter size / CH / ADHESIVE / ADHESIVE / ADHESIVE
Balloon size / ML / CATHETER / CATHETER / CATHETER
Lot Number / LABEL HERE / LABEL HERE / LABEL HERE
Expiry Date
Weeks in Situ
Date of planned catheter change
Reason for change
Cleansing solution / Type / Saline / Saline / Saline
Lot No
Lubricant
(check at each change for lignocaine allergy) / Type / Instilagel / Instilagel / Instilagel
Lot No
Signature

Issue Date: 26.05.2011 / Review date: 26.05.2013 Version: BCUHB V1

Core References: BCUHB Urinary Catheterisation Policy (2010), Infection Control Policy (2009), Royal Marsden Hospital Manual of Clinical Nursing Procedures (2008), Fundamentals of Care (2003) & Effective rehabilitation for older people, Eshum (1999).

Patient Name: …………………..

Date of Birth………………………

NHS Number: ……………………

(Affix ID Label)…………

Catheter Change Form / Stop! Think! Avoid If Possible / Is the catheter still needed?
Date
Time
Name of catheter / PLEASE STICK / PLEASE STICK / PLEASE STICK
Catheter size / CH / ADHESIVE / ADHESIVE / ADHESIVE
Balloon size / ML / CATHETER / CATHETER / CATHETER
Lot Number / LABEL HERE / LABEL HERE / LABEL HERE
Expiry Date
Weeks in Situ
Date of planned catheter change
Reason for change
Cleansing solution / Type / Saline / Saline / Saline
Lot No
Lubricant / Type / Instilagel / Instilagel / Instilagel
Lot No
Signature

Issue Date: 26.05.2011 / Review date: 26.05.2013 Version: BCUHB V1

Core References: BCUHB Urinary Catheterisation Policy (2010), Infection Control Policy (2009), Royal Marsden Hospital Manual of Clinical Nursing Procedures (2008), Fundamentals of Care (2003) & Effective rehabilitation for older people, Eshum (1999).

Patient Name: …………………..

Date of Birth………………………

NHS Number: ……………………

(Affix ID Label)…………

Urinary Catheter Patient Advice & Information Leaflet
Reason for Catheterisation:
Catheter make and code:
Catheter size: / Balloon size:
Leg bag make and code: / Night bag make and order code:
Catheter valve make and order code: / Catheter retaining strap, make and code:
Catheter change due: ____/____/______
How to get supplies:
How Your Bladder And Kidneys Work
Your kidneys filter waste products from your blood to produce urine. This is passed to your bladder via two tubes called ureters. When your bladder is full, urine is passed through the urethra and out of your body.
If your bladder does not work properly, urine can be left behind. If this urine is not removed it can become stale and may cause infection and discomfort. It may also cause some back pressure on your kidneys. Having an indwelling urinary catheter inserted will allow your bladder to empty.
What Is A Catheter?
A urinary catheter is a hollow flexible tube that drains urine from your bladder. To prevent the catheter falling out, a small balloon is filled with sterile water at the time the catheter is inserted.
The most common reasons for requiring a catheter are: before and after surgery on the bladder, prostate, or any other part of the urinary tract; as a result of an injury or medical conditions; or because the bladder does not empty very well. Requiring a catheter may be a long or short-term measure depending upon the reason for its use.
Your catheter may be urethral (inserted into the bladder from down below), or supra-pubic (the catheter is inserted through the abdominal wall just above the pubic bone).
As urine fills your bladder, it drains down the catheter and is collected in a drainage bag. You will not need to pass urine in the usual way when you have a catheter in place. However, when you first have the catheter inserted you may probably have the feeling that you need to pass urine or may experience bladder spasm or cramp from time to time. This usually stops within 24-48 hours and is nothing to worry about but if it continues you will need to seek advice.