Top tips for prescribing continence products

See also guidance on Anal Irrigation Systems

Sheaths

  • Correct sizing and fitting is essential for effective use
  • Sheaths should be changed daily; during a bath or shower is the ideal time for changing the sheath
  • Prescription - 30 per box, ONE month supply

Intermittent self-catheterisation

  • Prescriptions for intermittent self-catheterisation (ISC) should be for nelaton catheters and ideally be single use. Re-usable catheters are available but may cause urethral irritation and UTI if not used correctly. It will not be unusual for a patient to require ISC several times a day depending on their post void urinal volumes. Some patients only pass urine via ISC. Always consider intermittent catheterisation as an alternative to indwelling catheter (NICE CG171: Urinary incontinence in women: management September 2013)
  • Intermittent Catheters - there are two categories, single use catheters licensed to be used once or single patient reusable catheters licensed to be used by the same patient for up to 7 days.
  • The single use catheters usually come in packs of 30 and it will depend on the frequency the patient catheterises as to how many catheters they require; normally 150 - 180 per month.

Indwelling Foley catheters and catheterisation packs

  • Prescriptions for catheters should always state the brand required
  • Indwelling urinary catheters (urethral or supra-pubic) are either short term (less than one month duration) or long term (can remain in situ up to 12 weeks)
  • The contents of a catheter pack include: one empty 10mL syringe to deflate the balloon during re-catheterisation, one pre-filled 10mL syringe of sterile water to inflate the newly inserted catheter balloon, BIOCATH® Hydrogel Coated Foley Catheter pre-connected to your choice of collection system, protective waterproof sheet and fenestrated drape, two pairs of latex gloves, cleansing solution and gauze, apron for the healthcare professional, STATLOCK® Foley Stabilisation Device, and a syringe of lubricating gel
  • If catheter life is less than four weeks, i.e. requiring recurrent re-catheterisation, consider a short term catheter and ensure an appropriate care plan is documented
  • Foley catheters are available in a variety of lengths; standard length, female, paediatric, longer than female length but significantly smaller lumen size. It is critically important that a female catheter is not inserted into a male urethra due to the risk of adverse events (see NPSA Rapid Response Report April 2009). Female length catheters-for use in females only
  • Wherever possible always use the smallest catheter size i.e. size 12-14 Ch for urethral catheters in adults. Supra-pubic catheters are larger i.e. 16-20 Ch
  • Please note that not all catheters are licensed for supra-pubic use. Check the manufacturer's instruction
  • Silver impregnated catheters are not included in the formulary, and if used off formulary should only be used for 3 months before their effectiveness is reviewed
  • Prescription - Patient should have max 2 catheterisation packs in reserve

Catheter valves

  • Correct selection of the patient is essential. A sterile valve can be attached to the catheter for 7 days. It should then be replaced
  • Ideally these should be considered as first choice as opposed to `free drainage' via a urine drainage bag, unless contraindicated for a medical reason or patient choice
  • A night bag can be attached directly to the valve outlet for `free drainage' at night
  • Using a valve 2-3 weeks prior to trial without catheter may help to regain bladder function and tone
  • Although there is no strong evidence for this many TWOCS are carried out before a catheter has been in place for that long
  • Need to be changed every 5-7 days
  • Prescription - 5 per box enough for 5 weeks supply, no more than one packet should be prescribed every month

Leg bags

  • For use with indwelling urinary catheters - sterile equipment (until package opened) and should remain attached to the catheter for one week to avoid unnecessary breaks in the catheter drainage system. Should a catheter maintenance solution be clinically required, a new sterile bag must be used after each solution used.
  • All leg bags may stay in place 5-7 days, however always check manufacturers recommendations
  • Collection of urine samples for CSU is taken using an aseptic procedure via a needle free port
  • For use with sheaths - non-sterile leg bags can be used as non-invasive, minimum use one week
  • All boxes of 10 bags contain at least one pair of leg bag straps
  • Prescription - 10 per box enough for 10 weeks supply. No more than one box of ten should be issued alternate months (i.e. 6 x 10 boxes per year)

Catheter bag support sleeves and straps

  • These in many cases can be more comfortable than the leg bag straps
  • It is important that the leg is measured before ordering
  • The `all in one' is designed to be placed directly onto the leg, it does not require folding over onto itself to enclose the leg bag
  • Sleeves prescription - 5 packet, usage will depend on wear time and washing regime
  • Catheter leg bag support straps prescription - 10 per box, each pair may last one week, so minimum 10 weeks supply

Night bags (single use)

  • These bags must be used by all patients unless `bed bound' where a 2 litre drainable night bag may used
  • Single use night bags can help reduce urinary tract infections
  • The chosen bags have single use taps, once opened cannot be re-used, this ensures safer opening for patients/carers, rather than tearing or cutting of bags
  • Night bag stands can be obtained from the bag manufacturers or dispensing contractors free of charge
  • Prescription - maximum of three boxes for ONE month supply

Anal inserts

  • Can be used for patients with ano-rectal incontinent problems
  • Can be worn up to 12 hours
  • Prescription - 60 inserts for ONE month supply

Lubricating gel

  • Catheterisation can be painful for both males and females. It is important that the urethra is prepared with a lubricating before insertion of the catheter
  • Lubricant gel is inlcuded in the catheterisation tray packs
  • Some patients may require anaesthetic gel, but this the exception rather than the rule

Catheter maintenance solutions

  • Catheter maintenance solutions should be used as a treatment plan and not as routine for every patient. Their use must be based on clinical need and after an appropriate assessment
  • Should only be used where proactive catheter changes are not suitable for the patient. They are treatment preparations for dissolving encrustation only and should only be prescribed for 4 weeks, then reviewed. They are not to be used prophylactically or to attempt to unblock a non-draining catheter
  • These should only be used after an assessment of need has taken place. Citric Acid 3.23% (Suby G) and Citric Acid 6% (solution R) should only be used once it has been established that encrustation is the cause
  • Sodium chloride should only be used for the washing of debris (blood, mucus and pus) from the catheter
  • Two sequential instillations of a small volume are more effective than a single administration (Getliffe 2000)
  • Prescription - amount will depend on frequency of catheter irrigation

 

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