The guidance within the continence care section of this formulary is directed towards adult care. Advice on continence issues should be directed to the continence specialist nurse.

Bladder and bowel dysfunction are embarrassing and debilitating problems which can affect up to one third of the population. At best, it might cause minor irritation but often causes social isolation, shame and depression.

70% of bladder problems have been found to be curable or significantly improved, with relevant guidance, and it should be remembered that incontinence, frequency, urgency, constipation, etc. are symptoms of underlying conditions which need to be diagnosed and treated appropriately, following adequate assessment using care pathways and relevant assessment tools.

Reminder of the basic principles of good catheter care

Catheterisation should only be used as a last resort in the management of incontinence. An indwelling catheter may be inserted into the bladder via the urethra or a supra pubic cystostomy. Catheterisation is associated with a number of potential complications, which in the case of supra pubic catheterisation includes bowel perforation. It should also be remembered that of the 1-4% of patients develop bacteraemia from a catheter acquired urinary tract infection (CAUTI) which can be life threatening. There are, however, some patients for whom long-term catheterisation is the most appropriate form of care.

The aims of catheter management are:

1. To relieve and manage urinary dysfunction
2. To recognise and minimise risk of secondary complications
3. To promote patient dignity and comfort and to assist patients reach their own potential in terms of self-care and independence
4. To provide a cost-effective service

Before carrying out long-term catheterisation the nurse should:

• carry out a holistic assessment of the patient
• discuss with GP
• gain informed consent. This should be a joint decision with the patient, health professional and if appropriate with the carer/relative (see local policy on consent)
• select the appropriate type and size of catheter
• have the appropriate knowledge and skills to carry out the procedure
• discuss sexuality as appropriate to the individual patient
• give verbal and written information about the catheter and its care
• provide appropriate leg bags and night bags for the 24 hours link system
• provide the appropriate suspension system
• plan individualised care

Catheterisation is an aseptic procedure. The genitalia or meatus should be cleansed prior to insertion with sterile or normal saline. Further information can be obtained from the relevant local policy.

The nurse responsible for the catheterisation will carry out the relevant documentation. This will include:

• patient consent to be gained and documented
• the date and time of the procedure
• site of catheter: urethral or supra pubic
• the type, size and batch number of the catheter
• the residual volume of urine drained if first time catheterisation
• the date the catheter is due to be changed
• complete care plan

Contact Details

Clinical staff can call on the Bladder and Bowel Care Services to give support, help or advice in the care of any particular patient or to assist in decision making regarding urinalysis.

Exeter: 01392 208478

South Molton: 01392 675336

Newton Abbot: 01626 324685