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 included 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