Overview

• HomeWise Health (HWH) is committed to ensuring the safe management of catheters within our service to ensure our clients can remain at home, reduce infections and complications and enjoy a good quality of life. 
• HWH will work with each of our clients who have a urinary catheter to make sure they receive the support required to meet their specific needs. The CMs will engage with each client and their support and health network when assessing and developing a plan for the management of their catheter.
• We will work in conjunction with Community nursing services. In some cases, the HWH RN may change the catheter, whereas in other situations this will be done by their community nurse. When appropriate the HWH team will provide education, management, SPC site care and in some cases regular flushes. 

• This policy provides the principles around providing supports and services to clients with urinary catheters. Individuals of any age may require catheterisation for a range of reasons, such as:
  • to relieve urinary incontinence when no other means is possible
  • to relieve retention of urine
  • for investigations
  • to accurately measure urine output
  • to drain the bladder prior to or after surgery.
• Urinary catheters may be used by persons with spinal cord injury, stroke, multiple sclerosis, spina bifida or other medical conditions, and before or after surgery of the bladder, prostate or other parts of the urinary tract.

• A urinary catheter is a flexible or rigid hollow tube introduced into the urinary tract and bladder to drain urine. 
  • It is held in place by a small balloon at the catheter tip inside the bladder. 
  • The balloon is filled with sterile water to hold the catheter in place. 
  • The catheter provides a flow of urine for those who are unable to control micturition or those with an obstruction or spinal cord injury, paralysis, chronic neurologic disorders. 
  • As urine fills the bladder, it drains down the catheter into the drainage bag, which can be attached to a person’s leg or discretely hidden beneath clothing. 
  • The bag is emptied by the use of a valve that opens and closes. 
  • Sometimes the catheter line can go straight to a valve without the use of a bag.
• There are different types of catheters for different individual needs: 
  • An Intermittent catheter (in-out catheter)—a straight single-use catheter introduced long enough to empty bladder (5-10 mins). Repeated as necessary. Most clients would self-catheterise using this type of catheter.
  • Indwelling urethral catheter—for short term or long-term use. Introduced to the bladder via the urethra. These are changed every 4 weeks. 
  • Suprapubic catheter—inserted through an incision in the abdominal wall (whilst patient under general anaesthetic) by use of a trocar above the symphysis pubis. Used in temporary situations post-surgery OR long term for selected patients i.e quadriplegia. These are changed every 6 weeks. 

• Each client’s needs should be considered when selecting their catheter type. These include:
  • indication for catheterisation
  • type of catheterisation i.e. urethral, suprapubic or in-out
  • consistency of urine
  • anticipated duration of catheterisation—intermittent/short-term/long-term
• The client's urologist or medical specialist will decide on what catheter is required and how frequently it is changed. 
• This is written on a catheter authority form and is kept in the client's file.

• Urinary elimination for many of our clients is physiologically difficult. A thorough assessment of a client’s continence needs is essential and planning is important.
• Correct catheter care is important to ensure its correct function and to prevent catheter-associated urinary tract infection. 
• Workers providing services to clients with catheters must be trained in the care of a catheter in order to assist clients with correct catheter management. 
• Education and experience are vital to preventing infection, maintaining skin integrity and comfort.

• when supporting clients with urinary catheters
• to all employees, supervisors and key managers supporting clients with catheters.

• Urinary Catheter Information - Accessible
• Urinary Catheter Management in the Community Setting - SESLHD -  
  • Provides community nurses with guidance for the assessment, insertion, removal and management of indwelling catheters in the community setting.  
  • https://www.seslhd.health.nsw.gov.au/sites/default/files/documents/SESLHDGL065.pdf
• Autonomic Dysreflexia
  • https://aci.health.nsw.gov.au/__data/assets/pdf_file/0007/155149/Autonomic-Dysreflexia-Treatment.pdf

Policy

• Any carer, RN or CCM associated with the client will have had adequate and appropriate training in caring for a urinary catheter. This will be kept up to date regularly and opportunities for development will be provided by HWH
• When to change or remove a catheter is decided by a qualified health professional.
• Catheterisation is a skill. Knowledge and education are key for the provision of appropriate support for catheterised clients. 
• Only Registered Nurses who are specifically trained can change a urinary catheter. 

• all workers supporting clients with catheters must adhere to "best practice" in monitoring the safety and comfort of individuals who are catheterised
• determine possible allergy to tape, latex or lubricant before any intervention
• obtain permission/consent of clients prior to any physical examination
• always assess the client's knowledge of the purpose of catheterisation and explain your actions.
• ensure carers know the signs of autonomic dysreflexia (refer below)

• During every shift, the tubing and bag will be observed and care carried out as required according to the Care Management plan. This may include dressing changes of an SPC site, bag emptying and change or cleaning of night bags. See care instructions for specific tasks.
• Signs of infection need to be monitored consistently and reported to the CCM (see below). 
• It can be a clinical emergency if the catheter is not draining for a long period of time. 
• It is vital that workers are able to determine any malfunction of catheters including:
  1. monitor and watch for potential safety issues i.e. if there is oliguria or no urine in the drainage bag, check that catheter has not become misplaced in the vagina (females)
  2. check if the catheter has not accidentally been expelled by bladder or urethral contraction (males)
  3. check SPC site for pressure area or infection
  4. check drainage tubing for patency
  5. note any inability to void (urinary retention)
  6. rapid drainage of urine might result in hypotension
  7. diuresis might require Intravenous electrolyte replacement
  8. note client complaints of pain or fever.

• Catheters provide easy access for bacteria and can be a common cause of infection. This can be especially dangerous for those with an SPC as the catheter goes straight into the bladder with a shorter tube which lessens the chance for urine to flush bacteria away.
• The first signs of a UTI can be foul-smelling urine, dark (concentrated) and cloudy urine and changes in the behaviour of the client (eg confusion or lack of appetite).
• The risk of infections can be reduced by  
  • Increasing fluid intake
  • Using clean techniques when handling the catheter, bag or touching the site
  • Keeping the SPC site clean and the skin surrounding it
  • Using medicines such as Urol if appropriate. 
  • only insert catheters using an aseptic non-touch technique (ANTT)
• If an infection is suspected a CSU can be taken to confirm the cause and antibiotics can then be prescribed. 

• Flushes are to be managed on an as-needed basis. In the case of a catheter causing sediment then, regular flushing can reduce blockages or leakage. 
• The CCM or RN will implement flushes, and carers will be trained and supported as necessary.
• Please see the Procedure for flushing IDCs.

• Understand the use and requirements for catheter care
• Carers to familiarise themselves with the client's basecamp file and any specific care instructions around their individual needs
• Attend training as recommended
• Documentation as stated below
• Empty bag (day and/or night), cleaning or replacing as necessary 
• Escalating concerns or abnormal findings to the CCM in a timely manner
• Assisting the client in maintaining a clean home environment 

• Maintain the safety and health of both the client and carer
• Provide education and training for both client and carers
• Provide RNs as required for clinical care
• Liaise with medical professionals such as urologists, community nurses and GPs. Confirm authority to change catheter if needed.
• Conduct regular reviews by HWH RNs to identify how risks, incidents and emergencies will be managed, including required actions and escalation
• Provide educational instruction and material to clients with SPCs
• Attend in-home assessment of clients with SPCs
• Escalate any non-resolved concerns or abnormal findings to GP or medical team in a timely manner.
• Ensure correct equipment is in the home

• Ensure a safe, clean environment 
• Monitor equipment levels and ordering requirements 
• Monitor their own health and work with the team towards agreed outcomes. 
• Engage in health promotion activities as required. Such as fluid intake.

• ensure workers have current knowledge and a training plan to teach the standards of care for clients with catheters
• regularly audit safe catheter management practises
• report specific abnormalities to a medical professional
• all personnel will understand how to report specific abnormalities to a medical professional
• ensure carers comply with the Manage Urinary Catheter process.

• CCMs are available to ensure the support workers feel safe and can provide good quality catheter care.
• Please notify the client's CCM if you have concerns about catheter management or urine quality.

• Document the date of catheterisation and the due date for changing IDC 
• before emptying the drainage bag, document the time and amount of urinary output and fluid balance—monitor the colour, odour and consistency of urine 
• date of removal of the catheter 
• note adverse events like pain or bleeding 

• type of catheter, size, amount of water in the balloon, expiry date of product
• if stock is low, re-order sterile stock and equipment.
• Carers to document the condition of the SPC site and escalate if further input required, such as signs of infection
• Note any complications, concerns, or abnormal urine specimens.

• Autonomic Dysreflexia (AD) is a medical emergency and requires immediate attention. 
  • Carers are to be trained in how to respond.
• If a client has a history of AD, this will be noted in their Care Instructions. 
• AD occurs in clients with spinal injuries. 
  • A trigger stimulus (such as a distended bladder, constipation or low irritation from constrictive clothing) causes a  widespread sympathetic nervous system reflex activity. 
  • This leads to uncontrolled and elevated blood pressure, which, if not treated, can cause death. 
• The first treatment is to eliminate the trigger if possible. 
  • Check for catheter blockages or kinks, assess clothing and ask the patient if they suspect a cause. 
• Call for emergency services and continue to monitor the blood pressure.
• Elevate the patient’s head and lower the legs (this will help lower BP while a cause is identified and help arrives).