The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [187]
Fistula formation Pressure on the penoscrotal angle Ensure that correct strapping is used
Penile pain on erection Not allowing enough length of catheter to accommodate penile erection Ensure that an adequate length is available to accommodate penile erection
Formation of crusts around the urethral meatus Increased urethral secretions collect at the meatus and form crusts, due to irritation of urothelium by the catheter (Fillingham and Douglas 2004) Correct catheter toilet
Leakage of urine around catheter Incorrect size of catheter Replace with the correct size, usually 2 ch smaller
Incorrect balloon size Select catheter with 10 mL balloon
Bladder hyperirritability Use Roberts tipped catheter
As a last resort, bladder hyperirritability can be reduced by giving diazepam or anticholinergic drugs (Nazarko 2009)
Unable to deflate balloon Valve expansion or displacement Check the non-return valve on the inflation/deflation channel. If jammed, use a syringe and needle to aspirate by means of the inflation arm above the valve
Channel obstruction Obstruction by a foreign body can sometimes be relieved by the introduction of a guidewire through the inflation channel
Inject 3.5 mL of dilute ether solution (diluted 50/50 with sterile water or 0.9% sodium chloride) into the inflation arm
Alternatively, the balloon can be punctured suprapubically using a needle under ultrasound visualization
Following catheter removal, the balloon should be inspected to ensure it has not disintegrated, leaving fragments in the bladder
Note: steps above should be attempted by or under the directions of a urologist. The patient may require cystoscopy following balloon deflation to remove any balloon fragments and to wash the bladder out
Dysuria Inflammation of the urethral mucosa Ensure a fluid intake of 2–3 litres per day. Advise the patient that dysuria is common but will usually be resolved once micturition has occurred at least three times. Inform medical staff if the problem persists
Retention of urine May be psychological Encourage the patient to increase fluid intake. Offer the patient a warm bath. Inform medical staff if the problem persists
Bladder irrigation
Definition
Bladder irrigation is the continuous washing out of the bladder with sterile fluid, usually 0.9% NaCl (Ng 2001).
Evidence-based approaches
Rationale
Indications
Bladder irrigation is performed to prevent the formation and retention of blood clots, for example following prostatic surgery. However, there is evidence emerging that postoperative bladder irrigation can be safely eliminated by modifying the surgical technique used for suprapubic prostatectomy (Okorie et al. 2010). On rare occasions bladder irrigation is performed to remove heavily contaminated material from a diseased urinary bladder (Cutts 2005, Fillingham and Douglas 2004, Scholtes 2002).
Principles of care
There are a number of risks associated with bladder irrigation (including introducing infection) and the procedure should not be undertaken lightly (McCarthy and Hunter 2001, NICE 2003). Prior to taking a decision to use bladder maintenance solutions, patients should be assessed (Rew 1999). The guiding principle for effective catheter management always involves addressing the individual needs of the patient (Godfrey and Evans 2000). Assessment of all aspects of catheter care and irrigation should be undertaken, including:
patient activity and mobility (catheter positioning, catheter kinking)
diet and fluid intake
standards of patient hygiene
patient’s and/or carer’s ability to care for the catheter (Getliffe 1996a, Ng 2001, Rew 1999, Rew 2005).
An important aspect of management for patients in whom a clear pattern of catheter history can be established is the scheduling of catheter changes prior to likely blockages