Indications for catheterisation and catheter selection Flashcards
Questions to ask during in depth assessment for catherisation
- How often do you go to the toilet to empty your bladder during the day?
- How often are you woken at night by the desire to pass urine?
- Do you ever feel an urgent need to rush to the toilet? If so do you make it in time?
- Do you ever feel like you are not emptying your bladder fully?
What does a continence assessment tool consist of
- history taking (cognitive and functional ability as well as lower urinary tract symptoms),
- physical examination and
- simple investigations.
key components to assess when taking a continence history
- Past medical, surgical and obstetric history
- Diet and fluid intake (volume and type of fluid, including bladder irritants e.g. caffeine, alcohol)
- Drug history (check for medication that may have effects/side-effects on the bladder)
- History of incontinence and urinary symptoms (refer back to table 1&2 the learning activity: Normal physiology and pathophysiology of the lower urinary tract)
- Bowel habit
- Functional ability (manual dexterity, mobility)
- Cognitive ability
- Quality of life for patient and family/carers
Identify key components of physical examination required.
Abdominal examination, pelvic floor, perineal and rectal examination.
Identify key simple investigations that would be required.
- Urinalysis,
- Post-void residual urine measurement
- frequency/volume charting
valid indications for catheterisation?
- Urinary retention
- Monitoring fluid balance in an acutely ill patient
- Pre/peri/post operatively for a variety of reasons
- For assessment or investigations, e.g. urodynamics
- To instil medication into the bladder
- To manage urinary incontinence only as a last resort, e.g. at the end of life or if wound healing is compromised because dressings are becoming wet
contra-indications to urinary catheterisation?
Or when should you not attempt catherisation
- Patient has not consented to the procedure
- Permission not obtained from medical staff or local policy prevents this
- Two failed attempts at catheterisation
Catheter selection:
Intermitent Vs Indwelling
Intermittent- inserted by patient or nurse and can be removed after some time while indwelling the catheter is left in situ in the bladder
When might you insert an intermittent catheter
- Long-term bladder drainage, especially for patients with neurological conditions
- Post-operative urinary retention
- Measurement of post-void residual volume if using portable ultrasound is not possible.
Why are intermittent catheters more widely used
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Leaving a catheter in situ promotes the development of a biofilm, a living layer of bacteria, on the catheter that can increase the risk of infection. Removing the catheter reduces this risk.
If an indwelling catheter is necessary then it may be better for the patient’s quality of life to have a supra-pubic catheter inserted. When may a supra pubic catheter be advantageous?
- To enable patients who are wheelchair bound to manage their own catheter - it is easier to access on the abdomen
- To promote sexual relationships in patients who are sexually active
- To reduce the risk of infection - by removing the catheter from the perineum in females the risk of infection from gut flora can be significantly reduced.
What three aspects of size needs to be considered when selecting a urinary catheter
- Balloon Size
- Length
- Charriere size (diameter)
What two sizes do cathether balloons come in
10mls and 30 mls
WHich balloon size should be used for routine drainage
10mls
Can use smaller for children (5mls)
When should 30mls balloon be used
A 30ml balloon should only be used in urology settings - it is used to aid homeostasis by applying pressure to the very vascular prostatic bed following surgery.
Should never be used:
To stop catheter falling out
Or deter patient from pulling it out
