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17 Draw back the curtains once the patient has been covered. To maintain the patient’s dignity (NMC 2008b, C).
18 Record information in relevant documents; this should include:
reasons for applying penile sheath
date and time of application, sheath type
length and size
manufacturer
any problems negotiated during the procedure
a review date to assess the need for reapplication.
To provide a point of reference or comparison in the event of later queries (NMC 2009, C).
Problem-solving table 6.1 Prevention and resolution (Procedure guideline 6.3)
Urinary catheterization
Definition
Urinary catheterization is the insertion of a specially designed tube into the bladder using aseptic technique, for the purposes of draining urine, the removal of clots/debris and the instillation of medication.
Related theory
Urinary catheterization is an invasive procedure and should not be undertaken without full consideration of the benefits and risks. The presence of a catheter can be a traumatic experience for patients and have huge implications for body image, mobility, pain and discomfort (Clifford 2000, RCN 2008).
Evidence-based approaches
Rationale
Indications
Urinary catheterization may be carried out for the following reasons.
To empty the contents of the bladder, for example before or after abdominal, pelvic or rectal surgery, before certain investigations and before childbirth, if thought necessary.
To determine residual urine.
To allow irrigation of the bladder.
To bypass an obstruction.
To relieve retention of urine.
To introduce cytotoxic drugs in the treatment of papillary bladder carcinomas.
To enable bladder function tests to be performed.
To measure urinary output accurately, for example when a patient is in shock, undergoing bone marrow transplantation or receiving high-dose chemotherapy.
To relieve incontinence when no other means is practicable.
To avoid complications during the insertion of radioactive material (e.g. caesium into the cervix/womb, brachytherapy for the prostate).
Legal and professional issues
Competencies
The Nursing and Midwifery Council (NMC 2008b) states that nurses performing urinary catheterization should have:
a good knowledge of the urinary tract anatomy and physiology
a sound knowledge of the principles of aseptic technique
a knowledge of equipment and devices available
awareness of infection control practice and legislation
practice within the limits of competence and be able to recognize when they need to seek help from more experienced staff
understanding of the issues of informed consent and a knowledge of the Mental Capacity Act
the ability to deliver care based on the best available evidence or best practice.
Preprocedural considerations
Patients should be assessed individually as to the ideal time to change their catheters. The use of a catheter diary will help to ascertain a pattern of catheter blockages so changes can be planned accordingly.
Equipment
‘A catheter is a hollow tube that is used to remove fluid from, or instil fluid into, a body cavity or viscus’ (Pomfret 1996, p.245).
Catheter selection
A wide range of urinary catheters are available, made from a variety of materials and with different design features. Careful assessment of the most appropriate material, size and balloon capacity will ensure that the catheter selected is as effective as possible, that complications are minimized and that patient comfort and quality of life are promoted (Pomfret 1996, Robinson 2001). Types of catheter are listed in Table 6.1 and illustrated in Figure 6.4, together with their suggested use. Catheters should be used in line with the manufacturer’s recommendations, in order to avoid product liability (Fraise and Bradley 2009, NHS Supply Chain 2008, RCN 1994).
Table 6.1 Types of catheter
Catheter type Material Uses
Balloon (Foley) two-way catheter: two channels, one for urine drainage and second, smaller channel for balloon inflation Latex, PTFE-coated latex, silicone elastomer coated, 100% silicone, hydrogel coated Most commonly used