Catheter Care (Urethral Catheters)
It is really very important to try less invasive options before considering catheterisation and, if used, urethral catheters should be removed as soon as they are no longer necessary, given the virulence an intractability of CAUTI’s (Catheter associated UTIs) and the resultant cost in money and health.
However, should catheterisation be unavoidable, it is essential to take care of your catheter to prevent the associated risks of urinary tract infection and the more serious risks of kidney infection and septicaemia. The risk of developing a catheter-related UTI rises by five per cent for each day the catheter remains in place (Tambyah et al, 2002).
Research has shown silver alloy/hydrogel coated catheters lessen the chance of infection as they inhibit the formation of biofilms and reduce the adherence of Staphylococci, Enterococci and yeasts. Results indicated a reduction of 60 per cent (Roadhouse and Wellsted 2004). The use of a urinary catheter such as a Foley Catheter should be monitored regularly; for example, daily or weekly with an aim to removing the catheter as soon as possible.
Foley catheters are held in place by a balloon that is inflated to a capacity of 10ml. Frederic Eugene Basil Foley (1891-1966) was an American urologist who invented the self-retaining balloon catheter in the 1930s.
Catheter Hygine Preparation
- Wash hands thoroughly using an antimicrobial wash before and after touching any part of the catheter or emptying the bag.
- Sterile, single-use gloves and aseptic non-touch technique to be used in catheter insertion
- It is important to ensure good personal hygiene particularly around the genitals and meatus (urethral opening) with daily washing with soap and water
- Before and after opening and closing the outlet valve, it is important to clean the around the drainage tube using an alcohol swab.
- After emptying the drainage bag, clean this with a squirt bottle containing a mixture of water and vinegar or water and bleach
- Drink plenty of water to ensure adequate hydration
Urinary Catheter Insertion Technique (usually done by nurse)
- Wash hands thoroughly, wear sterile gloves and apron and create a sterile field either with the catheter pack or sterile hand towels
- For males, retract the foreskin gently and clean the glans using a sterile swab and sterile water.
- For females, separate the labia minora and wash the urethral opening in a downwards motion using sterile water and a sterile swab.
- Lubricate the urethra using a single use syringe containing anaesthetic gel (use the full contents of the syringe and wait 5 minutes for the anaesthetic to work).
- Next, slowly insert the catheter into the urethral opening, avoiding contact with surrounding genital area. Continue inserting slowly through the urethra until urine is noted and continue another 1-2 inches.
- Inflate the catheter balloon using 10ml of sterile water.
- Draw back a little until you feel a slight resistance.
- For males, push the retracted foreskin back in place (this prevents swelling and paraphimosis)
- Attach external end of catheter to drainage bag and attach to leg, ensuring there are no kinks in the tubing and the drainage bag is adequately supported
- Dispose of packaging, gloves, apron, etc.
- Thoroughly wash hands
Care of the Drainage Bag
The drainage bag should be stored lower than bladder level. Many people strap this to their leg during the day using a leg strap, bag or leg sleeve. A larger capacity bag is used overnight which is placed on a stand by the bed (but not touching the floor). It is important to make sure the bag is supported and will not pull on the catheter in any way. The drainage bag should be emptied every 4-8 hours or when the bag is half full, whichever comes first. On draining, ensure that the end of the catheter never touches the container that it is being drained into. It is necessary to maintain a closed drainage system to prevent infection.
Changing the Catheter
How often the catheter needs to be changed is based on manufacturer’s instructions. A standard catheter is generally changed between 2 and 12 (maximum) weeks. A silver alloy coated catheter may need to be changed more regularly (monthly).
Preventing Catheter Related Urine Infections
- The dose level of D-Mannose for catheterised/catheterising people, men or women, generally needs to be higher than the dose level for people who do not catheterise.
- The amount you need requires a level of trial and error. It is better to start on a higher dose level and gradually reduce the dose to the point where ecoli infections are kept at bay.
- If you feel an infection starting, it is an indication that you are not taking enough to cope with the level of bacteria present in the urine. Please also get a urine test to identify the bacteria.
If you stay symptom free for a period of time when you would have expected an infection, it is usually safe to reduce the dose frequency or level, and perhaps just take more around the time of changing the catheter.