Unit 110: Care for Individuals with Urethral Catheters

1.1 Summarise the current legislation, national guidelines, policies, protocols and good practices related to caring for individuals with urethral catheters

Urethral catheters are commonly used in healthcare settings to manage urinary incontinence, collect urine for analysis, or to help drain the bladder during surgery or other medical procedures. Caring for individuals with urethral catheters involves following certain guidelines and protocols to prevent complications and ensure the best possible outcomes.

In the UK, the management of urethral catheters is guided by national guidelines, protocols, and good practices. These guidelines typically cover topics such as the indications for using a urethral catheter, the types of catheters that can be used, the proper insertion technique, and the care and maintenance of the catheter.

In general, the main principles of caring for individuals with urethral catheters include:

• Ensuring that the indication for catheterisation is clearly established and that the benefits of catheterisation outweigh the risks.
• Using an aseptic technique when inserting and maintaining the catheter. This includes washing hands thoroughly and using sterile equipment.
• Monitoring the catheterised individual for complications such as bladder spasms, urinary tract infections, and blockages.
• Keeping the catheter and urine drainage system clean and well-maintained. This may involve changing the drainage bag regularly and flushing the catheter to prevent blockages.
• Removing the catheter as soon as it is no longer needed to minimise the risk of complications.

The Health and Social Care Act 2008 requires health and social care professionals, such as doctors, social workers, and nurses, to ensure that they protect individuals who use social care services from the risk of abuse and wrong urethral catheter usage and provide them with the best care or support necessary. This law applies even if it has no direct relationship to medication administration and usage. Additionally, the Act ensures that individuals receiving care and support are given it in a safe manner by requiring healthcare service providers to be qualified, competent, and possess the necessary skills and experience.

The Human Medicine Regulations 2012 establish guidelines for pharmaceuticals intended for human use, including urethral catheters and related equipment used for urethral catheter care. These regulations cover the handling, production, distribution, importation, sales, and supply of medicines, as well as their packaging, marketing, and labelling instructions.

The National Institute for Health and Care Excellence (NICE) clinical guideline on catheterisation, which provides guidance on the appropriate use of urethral catheters and the management of catheter-associated urinary tract infections.

The British Association of Urological Surgeons (BAUS) guidance on the management of long-term urethral catheterisation, which covers the indications for using a urethral catheter, the types of catheters that can be used, and the care and maintenance of the catheter.

The National Institute for Health Research (NIHR) clinical research network portfolio on catheter-associated urinary tract infections, provides information on ongoing clinical research in this area.

1.2 Explain own responsibilities and accountability in relation to current legislation, national guidelines, organisational policies and protocols which affect work practice when carrying out care activities for individuals with urethral catheters

As a care supervisor, I have several responsibilities and areas of accountability in relation to current legislation, national guidelines, organisational policies and protocols when caring for individuals with urethral catheters. Some of my key responsibilities and areas of accountability may include:

• Ensuring that my team and I are familiar with and follow all relevant legislation, national guidelines, organisational policies and protocols when caring for individuals with urethral catheters. This includes ensuring that I am aware of any updates or changes to these guidelines and that the team is trained in the appropriate procedures and techniques for caring for individuals with urethral catheters.
• Monitoring the care provided to individuals with urethral catheters to ensure that it is consistent with current best practices and guidelines. This may involve reviewing care plans, observing care in practice, and discussing care with the individuals themselves.
• Providing leadership and direction to my team, including setting expectations for the care of individuals with urethral catheters and providing support and guidance as needed.
• Ensuring that appropriate resources and equipment are available to support the care of individuals with urethral catheters. This may include ensuring that there is an adequate supply of catheters and other necessary equipment and that the equipment is well-maintained and used appropriately.
• Being accountable for the care provided to individuals with urethral catheters, including being prepared to explain and justify the care provided and any deviations from guidelines or policies.
• Ensuring that informed consent is obtained before inserting or maintaining a urethral catheter and that the individual understands the risks and benefits of the procedure.
• Providing education and support to the individual and their family or caregivers about the care of the urethral catheter and the importance of proper hygiene and maintenance.
• Working with other members of the healthcare team, such as doctors, nurses, and physiotherapists, to coordinate the care of individuals with urethral catheters and ensure that their needs are met.
• Monitoring the catheterized individual for complications such as bladder spasms, urinary tract infections, and blockages and taking appropriate action if any issues arise.
• Ensuring that the catheter and urine drainage system are clean and well-maintained, including changing the drainage bag regularly and flushing the catheter to prevent blockages.
• Removing the catheter as soon as it is no longer needed, in accordance with guidelines and the individual’s specific needs.
• Participating in ongoing training and professional development to stay up-to-date on the latest guidelines, best practices, and new developments in the care of individuals with urethral catheters.

2.1 Describe the anatomy and physiology of the lower urinary tract of:

a. Male

Urinary Bladder: The urinary bladder is a muscular, balloon-like organ located in the pelvis. It stores urine until it is ready to be eliminated from the body. The wall of the bladder is made up of three layers: the inner mucosa, the middle muscularis, and the outer serosa. The mucosa is made up of transitional epithelium, which allows the bladder to expand as it fills with urine. The muscularis is composed of smooth muscle, which helps to expel urine from the bladder during urination. The serosa is a protective layer of connective tissue that covers the outside of the bladder.

Urethra: The urethra is a tube that carries urine from the bladder to the outside of the body. In males, the urethra is approximately 8 inches long and runs through the prostate gland, the pelvic floor muscles, and the penis. The urethra is lined with mucous membranes and has several sphincters that help to control the flow of urine.

Prostate Gland: The prostate gland is a small, almond-shaped gland located just below the bladder. It surrounds the urethra and produces a fluid that makes up a portion of semen. The prostate gland helps to maintain the pH and electrolyte balance of semen, which is important for the survival and motility of sperm. The prostate gland is made up of three zones: the outer zone, the middle zone, and the inner zone. The outer zone produces a thin, watery fluid that helps to lubricate the urethra. The middle zone produces a thicker, milky fluid that helps to nourish the sperm. The inner zone produces a thicker, sticky fluid that helps to seal the cervix during ejaculation.

b. Female

The female lower urinary tract includes the urinary bladder, urethra, and urethral sphincter.

Urinary Bladder: The female urinary bladder is similar to the male urinary bladder in structure and function. It is a muscular, balloon-like organ located in the pelvis that stores urine until it is ready to be eliminated from the body. The wall of the bladder is made up of three layers: the inner mucosa, the middle muscularis, and the outer serosa. The mucosa is made up of transitional epithelium, which allows the bladder to expand as it fills with urine. The muscularis is composed of smooth muscle, which helps to expel urine from the bladder during urination. The serosa is a protective layer of connective tissue that covers the outside of the bladder.

Urethra: The female urethra is much shorter than the male urethra, measuring only about 1.5 inches in length. It extends from the bladder to the outside of the body and is lined with mucous membranes. The female urethra is surrounded by the urethral sphincter, which is a muscular ring that helps to control the flow of urine.

Urethral Sphincter: The urethral sphincter is a circular muscle that surrounds the urethra and helps to control the flow of urine. It is made up of both voluntary and involuntary muscles, which allow the individual to consciously hold in or release urine. The urethral sphincter is under the control of the nervous system and can be affected by various factors, such as stress and hormonal changes.

2.2 Describe lower urinary tract functions and continence status

The lower urinary tract is responsible for the storage and elimination of urine from the body. The main functions of the lower urinary tract include:

Storage of urine: The urinary bladder stores urine until it is ready to be eliminated from the body. As the bladder fills with urine, it expands and the walls of the bladder become distended. This expansion stimulates the stretch receptors in the bladder wall, which send a signal to the brain that it is time to urinate.

Elimination of urine: When the brain receives the signal to urinate, it sends a message to the muscles of the urinary bladder to contract and expel the urine through the urethra. The urethra is a tube that carries urine from the bladder to the outside of the body.

Maintaining continence: Continence is the ability to control the flow of urine and prevent involuntary loss of urine. The lower urinary tract has several mechanisms that help to maintain continence, including the urethral sphincter and the pelvic floor muscles. The urethral sphincter is a circular muscle that surrounds the urethra and helps to control the flow of urine. The pelvic floor muscles are a group of muscles that support the bladder and urethra and help to keep them in place. When these muscles contract, they help to prevent the flow of urine.

There are several factors that can affect continence, such as age, pregnancy, childbirth, obesity, and certain medical conditions. Some people may experience incontinence, which is the inability to control the flow of urine. Incontinence can be caused by a variety of factors, including muscle weakness, nerve damage, and certain medications. Incontinence can be treated with a variety of methods, such as pelvic floor muscle exercises, medications, and surgery.

2.3 Describe the causative factors which determine the need for urethral urinary catheters

Bladder outlet obstruction: Bladder outlet obstruction is a condition in which there is a blockage in the urethra or the prostate gland that prevents the normal flow of urine. This can be caused by an enlarged prostate, a tumor, or a stricture (narrowing) in the urethra. A urethral catheter can be used to relieve the obstruction and allow urine to drain from the bladder.

Urinary incontinence: Urinary incontinence is the inability to control the flow of urine. This can be caused by a variety of factors, such as muscle weakness, nerve damage, and certain medications. A urethral catheter can be used to collect urine in individuals who are incontinent and unable to use a toilet or bedpan.

Post-surgery: After certain surgeries, such as prostatectomy or a cystectomy, a urethral catheter may be inserted to allow the bladder to rest and heal.

Urinary retention: Urinary retention is the inability to completely empty the bladder. This can be caused by an obstruction in the urinary tract, nerve damage, or an enlarged prostate. A urethral catheter can be used to drain the bladder in individuals with urinary retention.

Bladder dysfunction: Certain medical conditions, such as spinal cord injuries and multiple sclerosis, can cause bladder dysfunction, which can lead to a loss of control over urination. A urethral catheter can be used to manage bladder function in individuals with these conditions.

Measurement of urine output: A urethral catheter can be used to measure urine output in certain medical situations, such as in critically ill patients or during surgery. This can help to assess the individual’s fluid balance and kidney function.

Preoperative preparation: A urethral catheter may be inserted before certain surgeries, such as a gynaecological or prostate surgery, to empty the bladder and prevent the need for a bedpan during the procedure.

Post-partum care: After childbirth, a urethral catheter may be inserted to allow the mother to rest and recover while the catheter drains urine from the bladder.

2.4 Explain the effects of urethral catheterisation on an individual’s comfort and dignity

Urethral catheterisation is the insertion of a thin, flexible tube (catheter) through the urethra and into the bladder to drain urine. While urethral catheterisation can be a necessary medical procedure in certain situations, it can also have an impact on an individual’s comfort and dignity.

Effects on Comfort: Urethral catheterisation can be uncomfortable for some individuals, as the catheter must be inserted through the urethra, which is a sensitive area. The procedure may be performed under local anaesthesia to minimise discomfort, but some individuals may still experience pain or discomfort. In addition, the presence of a catheter can be physically uncomfortable, as it may cause a feeling of fullness or pressure in the bladder. The catheter may also cause discomfort or irritation to the urethral area.

Effects on Dignity: Urethral catheterisation can also have an impact on an individual’s dignity, as it involves the insertion of a foreign object into a private area of the body. The procedure may be performed in a hospital setting, which may be unfamiliar or intimidating to some individuals. The presence of a catheter may also be a source of embarrassment for some individuals, as it is visible and may require the use of a bag to collect urine.

It is important for healthcare professionals to consider the effects of urethral catheterisation on an individual’s comfort and dignity and to take steps to minimise these impacts. This may include using local anaesthesia, respecting the individual’s privacy, and providing emotional support. In addition, it is important to remove the catheter as soon as it is no longer medically necessary to minimise the impact on the individual’s comfort and dignity.

3.1 Describe catheter care equipment that can be used to meet individuals’ specific needs

Catheter bags: Catheter bags are used to collect urine drained from the bladder through the catheter. There are several types of catheter bags available, including leg bags, bedside bags, and portable bags. Leg bags are small, lightweight bags that are worn around the leg and are suitable for individuals who are mobile. Bedside bags are larger bags that are hung from the bed frame and are suitable for individuals who are bedridden. Portable bags are small, discreet bags that can be worn under clothing and are suitable for individuals who are on the go.

Catheter valves: Catheter valves are devices that can be attached to the catheter to control the flow of urine. Some catheter valves allow the individual to stop and start the flow of urine, while others allow the individual to regulate the flow. Catheter valves can be useful for individuals who have difficulty emptying their bladder completely or for those who need to measure their urine output.

Catheter insertion kits: Catheter insertion kits are sets of supplies that are used to insert a urethral catheter. These kits may include gloves, lubricant, a sterile drape, and a catheter.

Catheter irrigation kits: Catheter irrigation kits are sets of supplies that are used for flushing the catheter and bladder with sterile water or saline solution. These include a sterile solution, a syringe, and tubing.

Catheter securement devices: Catheter securement devices are used to keep the catheter in place and prevent it from dislodging or falling out. These devices may include straps, adhesive patches, or retention sutures.

Catheter care trays: Catheter care trays are sets of supplies that are used to care for the catheter and surrounding area. These include gloves, wipes, lubricant, and a sterile drape.

Catheter cleaning supplies: Catheter cleaning supplies, such as sterile wipes or a cleaning solution, can be used to maintain the cleanliness of the catheter and reduce the risk of infection.

3.2 Describe the types of catheter care advice to give to individuals

In most cases, carers have a responsibility to teach and acquaint patients with safe and hygienic handling techniques as well as ways to maintain and care for themselves and the urinary catheter that has been attached.

One of the tips for caring for a catheter is to always try to wash your hands with mild soap and water both before and after handling/cleaning the catheter. After washing, disposable paper towels should be used to dry the hands and then thrown away in the trash.

• People should avoid overfilling their catheters because doing so can result in a backflow of urine into the bladder, which increases the risk of infection in the urethra and bladder.

• To prevent the urinary catheter from being pulled down by gravity, individuals should be instructed and trained on how to properly use the straps that are typically provided with the leg bags.

• Individuals should be encouraged to drink a lot of water to avoid urinary infections.

• Individuals need to be taught how to change their leg bags to avoid getting infections.

• It’s best to keep the leg bag below the bladder so that gravity can easily transfer the contents.

• The caregiver should help the person choose the necessary supplies they’ll need and can afford, and they should give them advice on where and how to buy them.

• Individuals should be taught and given advice on self-monitoring of fluid intake to prevent leakages and dehydration.

• Individuals should also be taught and given advice on the newest products, their use, and how to get them.

• The individual should receive instruction and advice on how frequently to change the catheter and drainage bag as well as how to manage their bowels to avoid constipation.

• They should be given advice on clothing choices that are appropriate for their conditions and support their right to privacy and dignity.

Additionally, individuals should be provided with information on catheter complications like infections and blockages, as well as the appropriate course of action and solutions. They should also be given a contact number for additional support and guidance.

Individuals need to be instructed on safe sexual practices for having sex while wearing a urinary catheter. Individuals should be instructed on how to insert the catheter, remove it after sexual activity, and replace it, as well as the safest lubricants to use and the ideal positions to adopt.

3.3 Describe when to undertake urinalysis, obtain a catheter specimen of urine (csu) or screen for multi-Resistant bacteria

There are several situations in which it may be necessary to undertake a urinalysis, obtain a catheter specimen of urine (CSU), or screen for multi-resistant bacteria.

Urinalysis: A urinalysis is a laboratory test that analyses a sample of urine to assess the health of the urinary system and identify any abnormalities. Urinalysis can be used to diagnose a variety of conditions, such as kidney disease, urinary tract infection, and diabetes. A healthcare provider may order a urinalysis if an individual is experiencing symptoms such as pain or burning during urination, frequent urination, or blood in the urine. A urinalysis may also be ordered as part of a routine health check or to monitor the effectiveness of treatment for a urinary condition.

Catheter Specimen of Urine (CSU): A CSU is a urine sample that is collected using a catheter. A CSU is often obtained when it is not possible to obtain a clean-catch urine sample, which is a sample of urine collected by the individual after cleaning the genital area. A CSU may be obtained if an individual is unable to urinate on their own or if a clean-catch sample is not possible due to a physical or mental disability. A CSU is often used to diagnose a urinary tract infection or to monitor the effectiveness of treatment for a urinary condition.

Screening for Multi-Resistant Bacteria: Multi-resistant bacteria are bacteria that are resistant to multiple types of antibiotics. These bacteria can cause serious infections and are difficult to treat. It is important to screen for multi-resistant bacteria to identify individuals who may be at risk of these infections and to implement appropriate infection control measures. A healthcare provider may order screening for multi-resistant bacteria if an individual has a catheter or has been hospitalised for a prolonged period of time, as these individuals may be at higher risk of developing a bacterial infection.

3.4 Describe the indications, mode of action, risks, side-Effects, cautions, contra-Indications and potential interactions of urethral catheter care

Indications for Urethral Catheter Care

Urethral catheter care is the process of maintaining and caring for a urethral catheter, which is a thin, flexible tube that is inserted through the urethra and into the bladder to drain urine. Urethral catheter care is indicated in several situations, including:

• Bladder outlet obstruction: A urethral catheter may be inserted to relieve a blockage in the urethra or the prostate gland that prevents the normal flow of urine.
• Urinary incontinence: A urethral catheter may be inserted in individuals who are incontinent and unable to use a toilet or bedpan.
• Post-surgery: After certain surgeries, such as prostatectomy or a cystectomy, a urethral catheter may be inserted to allow the bladder to rest and heal.
• Urinary retention: A urethral catheter may be inserted in individuals with urinary retention, which is the inability to completely empty the bladder.
• Bladder dysfunction: A urethral catheter may be used to manage bladder function in individuals with certain medical conditions, such as spinal cord injuries and multiple sclerosis.
• Measurement of urine output: A urethral catheter may be used to measure urine output in certain medical situations, such as in critically ill patients or during surgery.

Mode of Action of Urethral Catheter Care

The main mode of action of urethral catheter care is to maintain the cleanliness and proper functioning of the catheter. This includes:

• Keeping the catheter and surrounding area clean: Urethral catheter care involves keeping the catheter and the surrounding area clean to prevent infection and irritation. This involve using sterile wipes or a cleaning solution to clean the catheter and the surrounding skin, as well as washing hands before and after handling the catheter.
• Maintaining the patency of the catheter: Urethral catheter care also involves maintaining the patency of the catheter, which means keeping the catheter open and free-flowing. This involves flushing the catheter with sterile water or saline solution on a regular basis to prevent it from becoming blocked.
• Monitoring for complications: Urethral catheter care also involves monitoring for complications, such as infection, bladder spasms, or catheter displacement.

Risks and Side-Effects of Urethral Catheter Care

There are several risks of urethral catheter care that individuals should be aware of:

• Infection: One of the main risks of urethral catheter care is the risk of infection. The presence of a foreign object in the body, such as a urethral catheter, can increase the risk of infection. Symptoms of a urinary tract infection include fever, chills, pain or burning during urination, and an urgent or frequent need to urinate.
• Bladder spasms: Urethral catheter care may also cause bladder spasms, which are involuntary contractions of the muscles in the bladder. Bladder spasms may cause discomfort or pain and may make it difficult to urinate.
• Catheter displacement: Urethral catheter care may also result in catheter displacement, which is when the catheter becomes dislodged or falls out. This can cause the urine to leak out, which may lead to skin irritation or infection.
• Urethral irritation: The urethra, which is the tube that carries urine from the bladder to the outside of the body, may become irritated or inflamed as a result of urethral catheter care. This may cause discomfort or pain during urination.

Cautions and Contra-Indications for Urethral Catheter Care

There are several cautions and contra-indications that individuals should be aware of when undergoing urethral catheter care:

• Allergies: Individuals with allergies to certain materials, such as latex or silicone, may be at risk for an allergic reaction to the urethral catheter.
• Previous surgery: Individuals who have had previous surgery in the urethral area may be at increased risk for complications during urethral catheter care.
• Certain medical conditions: Certain medical conditions, such as prostate cancer or an enlarged prostate, may increase the risk of complications during urethral catheter care.

Potential Interactions for Urethral Catheter Care

There are several potential interactions that individuals should be aware of when undergoing urethral catheter care:

• Medications: Certain medications, such as blood thinners or anticoagulants, may increase the risk of bleeding or other complications during urethral catheter care. It is important to inform the healthcare provider of all medications that are being taken.
• Other medical procedures: Urethral catheter care may interact with other medical procedures, such as radiation therapy or surgery. It is important to inform the healthcare provider of all medical procedures that are being undergone.

It is important to follow the instructions of the healthcare provider and to inform them of any concerns or adverse reactions during urethral catheter care.

3.5 Describe the medication, antibiotics, anaesthetic agents and associated solutions used for individuals with urethral catheters

There are several medications, antibiotics, anaesthetic agents, and associated solutions that may be used for individuals with urethral catheters:

Medications: Certain medications may be prescribed for individuals with urethral catheters to manage urinary symptoms or other medical conditions. For example, alpha-blockers may be used to relax the muscles in the prostate and allow for easier urination in individuals with an enlarged prostate. Antispasmodic medications may be used to relax the muscles in the bladder and prevent bladder spasms.

Antibiotics: Antibiotics may be prescribed for individuals with urethral catheters to treat or prevent urinary tract infections. These infections are common in individuals with catheters due to the presence of a foreign object in the urinary tract. It is important to take the entire course of antibiotics as prescribed to ensure that the infection is fully treated.

Anaesthetic agents: Local anaesthetic agents may be used to numb the urethral area before inserting a urethral catheter to minimise discomfort. These agents may be applied topically or injected into the urethra.

Associated solutions: There are several solutions that may be used in conjunction with urethral catheters, including:

• Sterile water or saline solution: These solutions may be used to flush the catheter and keep it open and free-flowing.
• Lubricant: Lubricant may be applied to the catheter to make it easier to insert and to minimise irritation to the urethra.
• Antiseptic solution: Antiseptic solution may be used to clean the skin around the urethra before inserting the catheter to reduce the risk of infection.

It is important to follow the instructions of the healthcare provider and to inform them of any adverse reactions or concerns related to medications, antibiotics, anaesthetic agents, or associated solutions.

REFERENCES

• Anderson, C., & Herring, R. (2019). Pediatric Nursing Interventions and Skills. In M. Hockenberry, D. Wilson, & C. Rodgers (Eds.), Wong’s Nursing Care of Infants and Children (pp. 701-704) St. Louis, Missouri: Elsevier.
• Australia and New Zealand Urological Nurses Society, (2014). Catheterisation Clinical Guidelines
• Australian Guidelines for the Prevention and Control of Infection in Healthcare (2019) pages 137-140 https://www.nhmrc.gov.au/guidelines-publications/cd33
• Fasugba, O., Koerner, J., Mitchell, B. G., & Gardner, A. (2017). Systematic review and meta-analysis of the effectiveness of antiseptic agents for meatal cleaning in the prevention of catheter-associated urinary tract infections. Journal of Hospital Infection, 95(3), 233-242.
• Galiczewski, J. M. (2017). An intervention to improve the catheter associated urinary tract infection rate in a medical intensive care unit: direct observation of catheter insertion procedure. Intensive Critical Care Nursing. 40:26–34. Intensive & Critical Care Nursing, 41, 2. https://doi.org/10.1016/j.iccn.2017.04.002
• Gould, C., Umscheid,C., Agarwal,R., Kuntz,G., Pegues, D., & the Healthcare Infection Control Practices Advisory Committee (HICPAC). (2009) Guideline for prevention of catheter associated urinary tract infections (2009) Updated: June 6, 2019. https://www.cdc.gov/infectioncontrol/pdf/guidelines/cauti-guidelines-H.pdf
• Government of Western Australia Department of Health (2015). Indwelling Catheter: Blockage. Clinical Guideline, Women’s and Newborn Health Service, King Edward Memorial Hospital.
• Government of Western Australia Department of Health. Urethral Catheterisation Neonatal Guideline. (2019).
• Holroyd, S. (2019). Indwelling catheterisation: evidence-based practice. Journal of Community Nursing, 33(5), 40-46.
• NHS Southern Health, Urinary Catheter Care Guidelines (2020)
• Pradhan, S. K., & Das, K. (2017). Urinary Bladder Catheterization. Practical Procedures in Pediatric Nephrology, 4.
• Royal College of Nursing Catheter Care RCN Guidance for Healthcare Professionals (2019)
• Rowe, J. (2020). Urinary catheter management. Starship Hospital New Zealand.