Catheter care and infection control

Question 1

Standard and basic precautions of urinary catheter care

Answer 1

Gloves and apron

Question 2

How can you ensure that the urethral meatus is kept clean during long term catheterisation

Answer 2

Cleansing with soap and water.

Vigourously washing can increase bacterial colonisations.

Routine daily bathing or showering is recommeded.

Question 3

Managing drainage systems

Answer 3

The three main systems are:
- Closed drainage system using a 2 litre drainable bag

• Link drainage system using a combination of a leg bag and 2 litre drainage bag
• Catheter valve

Question 4

Under what circumstances should a 2 litre drainage bag be attached directly to the catheter or a link system be used?

Answer 4

When the patient is bedbound or only able to transfer from bed to chair and is not mobilising then a 2 litre drainage bag may be attached directly to the catheter.

If a patient is mobile or undergoing rehabilitation, for example, a link system should be used and the two litre drainage attached to a leg bag for night time drainage.

Question 5

Reflux of urine

Answer 5

Associated with infection .

Question 6

Flutter valve

Answer 6

2L drainage bag contains flutter valve. Consists of two pieces of plastic that are hekd together by surface tension.

If the level of urine reaches the level of flutter valve, it can open and cause reflux

Question 7

How should a drainage bag be positioned to prevent reflux of urine and other complications?

Answer 7

The two litre drainage bag should always:

• Be positioned below the level of the bladder
• Be positioned off the floor on a stand
• Be secured with a securement device to reduce tension on the catheter and trauma

These bags must never be put onto a bed or trolley

Question 8

How often should a 2 litre drainage bag be emptied?

Answer 8

Before urine reaches the level of flutter valve to prevent reflux

Question 9

Catheter Valves

Answer 9

Can be connected diretly to catheter and removes the need for drainage bag. Using a catheter is discreet and be tucked inside underwear to promote dignity

However the valve must be periodically released to prevent over distension of the bladder.

Question 10

Why may a Catheter valve be more preferred by some patients

Answer 10

• Dignity
• Reduce the incidence of bladder wall and urethral trauma

Question 11

What does the practitioner need to consider when assessing whether a patient may be a suitable candidate for using a catheter valve?

Answer 11

• have sufficient manual dexterity to be able to operate the valve independently
• have the cognitive ability to understand how to operate the valve and remember to open it
• have sufficient bladder capacity to retain urine
• have awareness of bladder sensation and the ability to identify when the bladder is full and the valve needs to be opened.

Question 12

Taking catheter specimens of urine

Answer 12

Samples should be taken only from sample port and never the drainage bag.
Clean the surface of the port with alcohol wipe and allow to dry.
Specimen taken from sterile syringe and needle or syringe alone if needle-free sample port.

Question 13

Balloon Non-deflation

Answer 13

water will not empty from the balloon when catheter removal is attempted.

Question 14

What should you never do if the balloon will not deflate

Answer 14

1. Cut the catheter to allow the water to drain out.
2. Draw back hard on the syringe
3. Insert sufficient extra water into the balloon to cause it to burst inside the bladder.

Question 15

Why should you never cut the catheter if balloon doesn’t inflate

Answer 15

Cutting the catheter does not always result in water emptying and if the catheter is under tension it can disappear up the urethra so the patient will require removal in the operating department

Question 16

Why should you not draw back hard on the syringe if balloon is not deflating

Answer 16

• Drawing back too hard on the syringe can cause a negative pressure which will collapse the inflation channel

Question 17

Why shouldn’t you Insert sufficient extra water into the balloon

Answer 17

A few mls of sterile water may be inserted in case a small particle has blocked the inflation channel, but large quantities that cause the balloon to burst should never be used. This would result in free fragment formation within the bladder and the patient would need to have these removed under anaesthetic.

Question 18

Bypassing

Answer 18

Caused by inflammation around the catheter or if it is blocked and prevented from draining

Question 19

potential causes of catheter blockage?

Answer 19

• urine bag above the level of the bladder preventing drainage
• urine bag too low (>30cm below bladder) which can create a negative pressure and “suck” bladder tissue into the eyelets of the catheter
• constipation and faecal impaction
• kinked catheter or drainage tubing
• encrustation

Question 20

If inflammation is suspected to be the cause of bypassing what action should the nurse take?

Answer 20

Change the catheter for a smaller size to reduce the pressure on the urethra

Question 21

What the cause of encrustation

Answer 21

result of a bacterial biofilm building up on the catheter causing crystalline deposits to build up inside the catheter lumen.

Question 22

How does Encrustation occur

Answer 22

• Urease producing bacteria, especially Proteus mirabilis, build up on the catheter
• The enzyme urease is secreted by the bacteria, which splits urea into carbon dioxide and ammonia
• Ammonia is a strong alkali and causes urinary pH to rise
• Struvite, calcium phosphate and magnesium phosphate crystals deposit out of this alkaline solution onto the catheter - urine normally has a slightly acidic pH which would ensure these crystals remain dissolved

Question 23

Catheter maintenance solutions

Answer 23

Opening Catheter valves help to reduce the risk of encrustation

You could aso:
- Document the patient’s catheter history including any incidents of encrustation and blockage

• Consider planned catheter changes based around the patient’s history of blockage
• Increase fluid intake