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GSTT and Kings Community Health Services

Continence Management Guide and Preferred List of Products

|KEY MESSAGES |

|The goal is to simplify prescribing of continence prescription appliance products across Lambeth and Southwark. |

|Products have been selected on the basis of patient requirements, commonly used products and value for money. |

|The intention is that this guide should be used for all new patients and for current patients when a re-assessment of their needs is completed. |

|Patient and carer’s needs should always be accommodated if the suggested products are not satisfactory. |

|To prevent excessive quantities being prescribed, a “dose and quantity” should be prescribed |

|e.g. Twin Suby G Catheter maintenance solution 60 ml sachet every 7 days x 5 |

|Products on FP10 prescriptions should be prescribed for individual patients and not as stock items |

|Prices are taken from May 2016 Drug Tariff |

|Patients can choose whether to have prescriptions sent to a community pharmacy or a Dispensing Appliance Contractor (DAC). |

|Prescriptions are posted from the GP surgery to the DAC and items delivered directly to the patient’s home. |

|Always ask the question ‘Does that patient need that catheter?’ If in doubt…take it out. |

|Which Product? |

|CLINICAL DIAGNOSIS |AIM |RECOMMENDED PRODUCT |

|Retention of urine |To drain bladder | Foley catheter and/or Intermittent catheter |

|Voiding difficulties |To drain bladder | Intermittent catheter/Foley catheter |

|Urinary Incontinence |To collect urine and promote continence | Urinary sheath; Actibrief; penile pouch; Contiform. |

|Faecal Incontinence |To promote continence and to prevent | Faecal collector; Anal irrigation; Anal plugs |

| |incontinence associated dermatitis (IAD) | |

|Blocked catheters/bypassing |To reduce/ prevent/resolve encrustation | Citric acid catheter maintenance solution |

|Constipation/overflow |To promote continence and regular bowel | Anal irrigation |

| |motion | |

|Incontinence associated dermatitis (IAD) |To promote healing and manage IAD | Barrier cream, barrier spray. |

| |

|URINARY CATHETERS |

|Initially, three catheters should be prescribed, one for use and two for spare. From then on, only one catheter should be prescribed at a time. |

| | | | | | |

|IMAGE |PRODUCT |ORDER CODE |PACK SIZE |PRICE/£ |COMMENTS AND PRECAUTIONS |

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|[pic] |Silicone Foley, catheter (1 |Standard: | | |12 week use |

| |pre-filled syringe & empty |08501205G (5ml) 12 Ch |1 |5.52 |Suitable for patients with latex allergy |

| |syringe & a syringe of |08501405G (5ml) 14 Ch |1 |5.52 |Suitable for patients requiring >28 days catheterisation |

| |lidocaine & chlorhexidine for|08501610G (10ml) 16 Ch |1 |5.52 |Silicone wider lumen than latex. It may drain a little better with reduced blockage |

| |lubrication ) | | | |Silicone material lacks elasticity and may be less comfortable |

| |LINC Medical, |Female length: | | |Catheter must be secured to the skin or leg to prevent trauma |

| | |085012051G (5ml) 12Ch | |5.52 |Glycerine for inflation to reduce osmotic water loss from balloon |

| | |085014051G(5ml) 14Ch |1 |5.52 |Standard length for male or female supra pubic |

| | | |1 | |Female length for female urethral only |

| | | | | | |

|[pic] |Open ended silicone catheter |Standard: | | |May be a useful alternative for patients who have repetitive bypassing and blocking problems |

| |(1 pre-filled water syringe |balloon 5-10mls | | |Standard Male length suitable for male and female catheterisation |

| |for balloon inflation and | |1 |5.50 |Silicone material lacks elasticity and may be less comfortable |

| |supplementary syringe for |34230212 12Ch |1 |5.50 |Catheter must be secured to the skin or leg to prevent trauma |

| |balloon deflation) |34230214 14Ch |1 |5.50 |12 week use |

| | |34230216 16Ch |1 |5.50 | |

| |MacGregor Healthcare Ltd |34230218 18Ch |1 |5.50 | |

| | |34230220 20Ch |1 |5.50 | |

| | |34230222 22Ch |1 |5.50 | |

| | |34230224 24Ch | | | |

| | | | | | |

| | | | | | |

|[pic] |Hydrogel Foley, catheter |Standard length: |1 |6.18 |12 week use |

| |SympaCath Aquaflate | | | |Male or Female catheterisation |

| |Teleflex |DH310112 12Ch | | |Urethral and suprapubic use |

| | |DH310114 14Ch | | |Not suitable for patients with latex allergy |

| |(with 10mls balloon and |DH310116 16Ch | | |Suitable for patients requiring >28 days catheterisation |

| |pre-filled syringe & empty | | | |Softer than silicone catheter thus easier to remove but can block more easily than silicone catheter|

| |syringe) |Female length: |1 |6.18 |Catheter must be secured to the skin or leg to prevent trauma |

| | | | | |Standard length for male/female/supra pubic |

| | |DH210112 12Ch | | |Female length for female urethral only. |

| | |DH210114 14Ch | | | |

| |

|CATHETER VALVES |

| | | | | | |

|[pic] |Care-Flo Catheter Valve |CF1 |5 |7.53 |Maintains bladder capacity and elasticity |

| | | | | |Encourages mobilisation and regular toilet function |

| |L.I.N.C Medical | | | |Might help reduce urinary infections and catheter complications |

| | | | | |Can be used prior to TWOC to assess bladder sensation |

| | | | | |Not suitable for patients with significant cognitive and dexterity deficit |

| | | | | |If discharged with a valve ensure patient is fully educated to appropriate use |

| | | | | |Date valve to ensure replacement after 7 day use |

| |

|LEG BAG HOLDERS |

|[pic] | | | | | |

| |GB Fix-it strap | | | | |

| | | | | |Suitable for all catheters |

| |40 cm-long strap with |Short 10646C |5 | |Strap secures catheter to patient leg/abdomen |

| |non-slip silicone and Velcro | |5 |14.10 |Ideal if frequent swapping of securement between legs is required |

| | |Adult 10644A |5 |14.10 |Re-usable, wash when visibly soiled, discard when elasticity compromised |

| |Great Bear Healthcare | |5 |15.43 |May not be suitable for patients with leg wounds, oedema |

| | |Abdominal 10645B | |17.78 |Can slip down if secured too lose causing catheter pulling |

| | | | | |If secured too tight can exacerbate oedema |

| | |Adjustable 150cm 10647D | | | |

| | | | | | |

| | | | | | |

|[pic] |Leg bag straps with |10637T |10 | |To be used with leg bags ( leg straps are supplied with most orders of leg bags only order if extra |

| |non-silicone backing (thigh) | | |13.94 |are required) |

| |Libra | | | | |

|[pic] | | | | | |

| |Ugo Fix Gentle catheter | | | |Revolving clip motion allows natural movement |

| |clip |3004 |5 | |No skin preparation required. |

| |Optimum Medical | | | |Easy to apply, remove and reposition |

| | | | |12.35 |Minimal trauma upon removal and no sticky residue |

| |Adhesive fixation | | | |Recommended as first line for catheter fixation |

| | | | | |May not be suitable if patient very sweaty and hairy |

| | | | | |Only change once not effective. |

|[pic] | | | | | |

| |Ugo fix Sleeve Leg Bag Holder| | | | |

| | | |4 |7.28 | |

| |Optimum Medical | |4 |7.28 |Used for patients unable to tolerate leg bag straps due to oedema circulatory issues etc. |

| | |Small (29-39cm) 3005 |4 |7.28 |Appropriate for patients unsuitable for leg straps e.g. oedema |

| | |Medium (36-55cm) 3006 |4 |7.28 |Caution for patients allergic to materials |

| | |Large (40-70cm) 3007 | | | |

| | |XL (65-90cm) 3008 | | | |

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|URINARY CATHETER DRAINIAGE BAGS |

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| |Urine drainage 500ml leg bag | |10 |22.09 | |

|[pic] |LINC Medical |Lever tap |10 |22.09 |Change every 7 days |

| | |Direct tube LM500SD-L |10 |22.09 |Date bag to ensure replacement |

| |Option of T tap or lever tap |10cm tube LM500MD-L |10 |21.84 |1 box of 10 bags will last for 2 months |

| | |30cm tube LM500LD-L | | |Worn on the thigh or calf and this will determine length of inlet tube |

| |Includes Velcro straps Includes|Adjustable LM500AD-L | | |Bag must be secured safely to the leg with two Velcro straps (provided with each bag) |

| |scissors with adjustable tubes | |10 |22.13 |Suitable for mobile patients to encourage mobility and self-care |

| | |T tap |10 |22.13 |Consider patient suitability for a catheter valve |

| | |10cm tube LM500MD-T |10 |22.13 | |

| | |30cm tube LM500LD-T | | | |

| | |Adjustable LM500AD-T | | | |

|[pic] | | | | | |

| |LINC Flo - 2 litre overnight | |10 |12.05 |Indicated for patients that are mostly bed bound or transferring from bed to chair only and do not |

| |drainage bag with lever tap |TZ02-L | | |use a leg bag |

| |LINC Medical | | | |Bag/bag valve must hang from the bed without touching the floor |

| |120cm tube | | | |A bag stand can also be considered to keep the bag off the floor |

| | | | | |Change every 7 days |

| | | | | |Date bag to ensure replacement |

| | | | | |1 box of 10 bags will last for 2 months |

| | | | | | |

|[pic] | | | | | |

| |LINC Flo – 2 litre overnight |LM2LS |10 |2.63 |Single use only |

| |non-drainable bag | | | |Attach to the bottom of the leg bag. |

| |LINC medical | | | |Recommended for all patients with indwelling catheters that require extra drainage capacity |

| | | | | |overnight |

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| |

|CATHETER MAINTENANCE SOLUTIONS |

|[pic] | | | | | |

| |Uro –Tainer Twin Suby G | |2 x 30ml |4.81 |Dissolves crystals that form in catheter lumen and eyelets |

| |(containing 3.23% citric acid) |Suby G 9746609 |2 x 30ml |4.81 |Indicated in some patients to prevent the build-up of encrustation and catheter blockage and so |

| |Uro-Tainer Twin Solution R |Solution R 9746625 | | |extend catheter life |

| |(containing 6.0% citric acid) | | | |Individual treatment plan needed |

| |B.Braun | | | |Solutions should not be ‘forced in’ to unblock a blocked catheter |

| | | | | |Requires breakage in closed drainage system to be administered |

| | | | | |Two sequential instillations of a small volume more effective than a single administration. |

| | | | | |Using twin delivery system, administer first chamber, allow to drain, then administer second chamber|

| | | | | |and allow to drain |

| | | | | |Stronger citric acid solution used for more persistent crystallisation |

| | | | | |Limited clinical evidence of maintenance solutions efficacy |

| |

|MISCELLANEOUS CATHETER SUPPLIES |

|[pic] | | | | | |

| |OptiLube Active Lubricating |6ml syringe 1160 |1 |1.08 |Licensed for catheterisation |

| |Jelly |11ml syringe 1161 |1 |1.13 |Use 11 ml for male patients (longer urethra) |

| |Optimum Medical | | | |Use either 11 ml or 6 ml for female catheterisation |

| | | | | |Allow 5 min for anaesthetic effect to take place |

| |Contains lidocaine | | | |Not suitable for patients allergic to lidocaine/chlorhexidine |

| |hydrochloride 2% and | | | | |

| |chlorhexidine | | | | |

|[pic] | | | | | |

| |OptiLube Lubricating Jelly | |1 |0.90 |Licensed for catheterisation |

| |Optimum Medical |6ml syringe 1125 |1 |0.95 |Use 11 ml for male patients (longer urethra) |

| |Lubricating gel, |11ml syringe 1126 | | |Use either 11 ml or 6 ml for female catheterisation |

| | | | | |Lubricant only - no anaesthetic or antimicrobial added |

| | | | | |Suitable for patients allergic to lidocaine/chlorhexidine |

|[pic] | | | | | |

| |Urine drainage bag bed hanger | |1 |free |For use with 2-4 litre drainage bags |

| | | | | |Dual use enables to keep bags and valves off the floor |

| | | | | |Dual use hanger: can be hung from bed using hooks or bent at the base of hooks and tucked between |

| | | | | |mattress and bed frame |

| | | | | |Night bag holders are provided free on request from direct delivery companies. |

|[pic] | | | | | |

| |Urine drainage bag hanging | |1 |free |For use with 2-4 litre drainage bags |

| |stand | | | |Floor stand, available on request free from direct delivery companies. |

|[pic] | | | | | |

| |Nurse it Sterile Dressing pack |Small/medium gloves |1 |0.54 | |

| |Containing 1 pair Vitrex |Medium/large gloves |1 |0.54 | |

| |gloves, 7 swabs 10cmx10cm, 1 | | | |Suitable as a catheterisation kit £0.60 each |

| |tray, forceps, 2 sterile | | | | |

| |fields, 1 apron, 1 paper towel,| | | | |

| |1 bag, | | | | |

| |

|INTERMITTENT URINARY CATHETERS |

|Patients may need up to 6 catheters per day, although this quantity can change as they become more skilled at intermittent catheterisation |

|[pic] | | | | | |

| | | | | |Discreet and easy to use |

| |Curan Lady |CL08 8Ch |30 |41.79 |Good first line in community |

| |Clinimed |CL10 10Ch |30 |41.70 |Pre-lubricated and so ideal if using facilities without an integral water supply |

| | |CL12 12Ch |30 |41.79 |Female use only |

| | |CL14 14Ch |30 |41.79 |Useful for patients performing intermittent catheterisation while away from the home as it is |

| | | | | |compact (short) and may help reduce contamination during insertion. |

| | | | | |Avoid using where health care professionals are performing intermittent catheterisation in hospital.|

| | | | | |An integral catheter-bag system is more appropriate to reduce infection risk. |

| | | | | | |

|[pic] | | | | |Discreet and easy to use |

| | |228010E 10Ch |30 |43.50 |Female use only |

| |Actreen mini |228012E 12Ch |30 |43.50 |Useful for patients performing intermittent catheterisation while away from the home as it is |

| |B.Braun |228014E 14Ch |30 |43.50 |compact (short) and may help reduce contamination during insertion. |

| | | | | |Avoid using where health care professionals are performing intermittent catheterisation in hospital.|

| | | | | |An integral catheter-bag system is more appropriate to reduce infection risk. |

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|[pic] | | | | | |

| |Actreen mini set B.Braun |239010E 10Ch |30 |68.72 |Pre-lubricated, non-touch with integral bag |

| | |239012E 12Ch |30 |68.72 |Female use only |

| |with integral bag |239014E 14Ch |30 |68.72 |Ideal for patients with significant UTI history, and where health professionals are performing |

| |hydrophilic coating | | | |occasional intermittent catheterisation on behalf of the patient |

| | | | | |Useful when learning technique |

| | | | | |Useful where access to lavatory is restricted |

| | | | | |Only use if bag required as costly |

|[pic] | | | | | |

| |Flocath Quick Teleflex |851221 10-14 Ch |30 | |Pre-lubricated and so ideal if using facilities without an integral water supply |

| |With hydrophilic coating and | | |36.41 |Easy and practical to use |

| |integral sodium chloride 0.9%| | | |Female use only |

| | | | | |Standard size, for patients that may prefer hydrophilic coating |

| | | | | |Useful for patients performing intermittent catheterisation while away from the home. |

| | | | | |Avoid using where health care professionals are performing intermittent catheterisation in hospital.|

| | | | | |An integral catheter-bag system is more appropriate to reduce infection risk. |

|[pic] | | | | | |

| |Intermittent male catheter, |630010 10Ch | | | |

| |standard length (40cm), |630012 12Ch |60 |84.00 |Male use |

| |hydrophilic coating with |630014 14Ch |60 |84.00 |Tapered tip suitable for patients with enlarged prostate or urethral strictures |

| |integral water |630016 16Ch |60 |84.00 |Non touch sleeve |

| |Liquick Base Teleflex | |60 |84.00 |Easy and practical to use |

|[pic] | | | | | |

| |Intermittent male catheter, |851241 08ch – 18ch |30 | | |

| |standard length (40cm), | | |36.41 |Standard size for male patients |

| |hydrophilic coating with | | | |Useful to teach patients intermittent catheterisation |

| |integral water | | | |Integrated sterile saline solution pouch |

| |Male catheter | | | |Non touch sleeve |

| |Flocath Quick Teleflex | | | |Easy and practical |

|[pic] | | | | | |

| |Intermittent catheter |Male | | |To prevent recurrent UTI’s |

| |40cm hydrophilic coating MALE|70104 10Ch |30 | |Discreet and easy to carry |

| |20cm FEMALE |70124 12Ch |30 |51.37 |An introducer tip protective tip |

| |Vapro pocket Hollister |70144 14Ch |30 |51.37 |Spill free |

| | | | |51.37 |Non touch sleeve |

| | |Female | | | |

| | |70102 10Ch |30 | |Only to be used if recommended by specialist nurses |

| | |70122 12Ch |30 |52.07 | |

| | |70142 14Ch |30 |52.07 | |

| | | | |52.07 | |

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|ANAL PLUGS |

|[pic] | | | | | |

| |Anal plugs | | | |Designed for self-insertion to seal and help prevent the involuntary leakage of stool from the |

| |Renew Medical |Starter pack 702 | |21.70 |rectum |

| | |Regular : 706 |10 |65.11 |Ineffective for loose stool |

| | |Large code: 707 |30 |65.11 |Starter pack has 5 regular, 5 large to facilitate product selection |

| | | |30 | |Non-touch applicator |

| | | | | |Can cause false urge to empty bowels |

| | | | | |Mild irritation of anal area |

| | | | | |Do not use if allergic to silicone |

| | | | | |All Silicone |

|[pic] | | | | | |

| |Anal plugs Coloplast |small 1450 |20 |46.26 |Designed for self-insertion to help prevent the involuntary leakage of stool from the rectum Comes |

| | |Large 1451 |20 |45.31 |in two sizes – small and large |

| | | | | |Is easily removed by pulling the soft gauze string attached to the plug |

| | | | | |Ineffective for loose stool |

| | | | | |Can cause false urge to empty bowels |

| | | | | |Mild irritation of anal area |

| | | | | |Do not use if allergic to foam |

| | | | | |Made of Foam |

| |

|PENILE POUCH AND SHEATHS |

|[pic] | |Special sheath: | | | |

| |Penile sheath, silicone, one |(series 971) |30 |46.61 |Use in male patient as an alternative to indwelling catheterisation e.g. management of incontinence,|

| |piece, self-adhesive |25mm, : 97125 |30 |46.61 |sacral wounds or therapeutic immobilisation |

| | |29mm, : 97129 |30 |46.51 |Use short sheath in patients with semi-retracted penis/short penile shaft |

| | |32mm, 97132 |30 |46.51 |Do not use as an alternative to catheters if patients is: unable to void (obstructed) and/or has |

| |Hollister |36mm,: 97136 |30 |46.51 |significant residual urine with impaired renal function and/or significant UTI history associated to|

| | |41mm,: 97141 | | |retention |

| | | |30 |46.51 | |

| | |Standard sheath: |30 |46.51 | |

| | |(series 972) |30 |46.51 | |

| | |25mm,: 97225 |30 |46.51 | |

| | |29mm,: 97229 |30 |46.51 | |

| | |32mm,: 97232 | | | |

| | |36mm, 97236 | | | |

| | |41mm, 97241 | | | |

|[pic] | | | | | |

| |Penile pouch | | | |Use in male patient as an alternative to indwelling catheterisation e.g. management of incontinence,|

| |Hollister |9811 |10 |29.41 |sacral wounds or therapeutic immobilisation |

| | | | | |Suitable in patients with retracted penis/short penile shaft |

| | | | | |May be left in situ for up to 3 days |

| | | | | |Do not use as an alternative to catheters if patients is: unable to void (obstructed) and/or has |

| | | | | |significant residual urine with impaired renal function and/or significant UTI history associated to|

| | | | | |retention |

| | | | | |one piece collide dressing can be connected to a leg/night bag |

| | | | | | |

| |

|FAECAL COLLECTORS |

|[pic] | | | | | |

| |Faecal collector |500 ml 9822 |10 |45.55 |Use mainly for bedbound patients to divert stool from skin i.e.; for management of incontinence, |

| |Hollister |1000ml 9821 |10 |45.55 |sacral wounds |

| | | | | |Suitable for type 6/7 stool |

| | | | | |Faecal collectors do not stop loose stools so ensure a good bowel management care plan is in place |

| | | | | |Ensure skin is intact before applying and do not apply to broken skin |

| | | | | |500ml drainage bag can be connected to a 2 litre drainage bag |

| |

|ANAL IRRIGATION |

| | | | | | |

|[pic] |Qufora bed system |12mm : 53201-055 |5 |49.90 |The Qufora Bed system is a ‘closed’ irrigation system especially for patients who are unable to sit |

| |MacGregor Healthcare Ltd |21mm : 53001-055 |5 |49.90 |on an ordinary toilet and therefore need their bowel management to be carried out on the bed. The |

| | |30mm : 53101-055 |5 |49.90 |system allows water to be instilled into the rectum without leakage. The return water is collected |

| | | | | |hygienically and odour free into the collection bag. |

| | | | | |Will need good community support to manage this system |

| | | | | |1 water bag with pump, 5 rectal catheters, 5 collection bags |

|[pic] | | | | | |

| |Qufora cone toilet system |Starter kit : QTS | |77.80 |The Qufora IrriSedo Cone system is developed for people who are able to sit on or over a toilet. It |

| |MacGregor Healthcare Ltd |Monthly set : QTM | |101.66 |can be used by patients (or their carers) by holding a cone in the rectum while the water is being |

| | | | | |stilled. This simple to use system works by connecting a tube from the water bag to a cone. The |

| | | | | |water bag is hung up and a hand pump with easy to use valve is supplied. Water is then instilled |

| | | | | |into the rectum via the cone, which is easily inserted and removed. The process takes approximately |

| | | | | |15 to 30 minutes. |

| | | | | |Starter Kit – 1 pump, 1 water, 5 cones, 5 waste bags & 1 toilet bag |

| | | | | |Monthly Set – 1 pump, 1 water, 15 cones, 15 waste bags & 1 toilet bag |

| | | | | | |

| | | | | | |

| |Qufora balloon catheter system |Base set regular: 377-8586 | |70.00 |The Qufora Balloon Catheter system has a unique water filled rectal balloon catheter, allowing your |

|[pic] |MacGregor Healthcare Ltd |Base set small: 377-8594 | |70.00 |patient to easily retain the catheter in the rectum while the water is being instilled, thus |

| | |Accessory set small: 377-8602 | |115.00 |allowing ease of use. It is designed for rectal irrigation seated on or over a toilet. This system |

| | |Accessory set regular: 377-8610 | | |is very suitable for those who have difficulty keeping a cone in place or need a better seal to |

| | |Catheters (10) regular: 377-8628 | |115.00 |instil the irrigation water. |

| | |Catheters (10) small: 377-8636 | |79.00 |Suitable for patients with neurogenic bowel |

| | | | |79.00 |Base set contains 1 Velcro strap, 1 water bag, 2 rectal balloon catheters |

| | | | | |Accessory set contains 1 water bag, 15 rectal balloon catheters |

|[pic] | | | | | |

| |Qufora mini system |377-8545 |Single set |59.00 |The Qufora IrriSedo Mini system is suitable for people who need a small amount of water to irrigate.|

| |MacGregor Healthcare Ltd | | | |The "single use" cone now has a hydrophilic coating which means it is self-lubricating and there is |

| | | | | |no longer a need for patients to use gel to lubricate the cone before use. |

| | | | | |Patient needs good dexterity and a degree of mobility to self-administer |

| | | | | |1 hand pump 15 cones |

| |

|BARRIER CREAMS |

|[pic] | | | | |Cavilon Durable Barrier Cream has been carefully formulated to protect the user's skin from dampness|

| |Cavilon Durable Barrier Cream | | | |and, in turn, reduce the risk of discomfort and irritation. |

| |3M |3391G |1 |3.98 |The barrier cream forms a protective layer over the skin allowing liquids to pass over it without |

| | | | | |causing soreness |

| | | | | |can even be used to treat already damaged is ideal for people with incontinence associated |

| | | | | |dermatitis |

| | | | | |Please use as first line in prevention and treatment of incontinence associated dermatitis |

| | | | | |28g |

|[pic] | | | | | |

| |Proshield Plus Skin Protectant |: | | |Effective barrier - against skin irritation |

| |Barrier cream |8213030004 |1 |9.84 |Easy to apply to injured skin and adheres well to moist wounds. |

| |H&R healthcare | | | |Provides protection from diarrhoea and incontinence |

| | | | | |Moisturising - indicated to protect and moisturise clinically dry skin Does not clog absorbent pads |

| | | | | |or dressings |

| | | | | |Use extremely sparingly |

| | | | | |115g |

|[pic] | | | | | |

| |Proshield Foam and Spray |8213015008 |1 |6.54 |Gentle - a gentle, pH balanced no-rinse moisturising cleanser designed to leave the skin supple and |

| |Cleanser | | | |hydrated |

| |H&R healthcare | | | |Thorough cleansing - to help eliminate odour and break down dried stool |

| | | | | |Flexible - indicated for intact and injured skin associated with incontinence Wide range of |

| | | | | |indications Proshield Foam and Spray is also indicated for total body cleansing, for removal of |

| | | | | |antiseptic solutions, hard to remove debris and skin barriers such as Proshield Plus |

| | | | | |Can cause irritation and burning if skin is broken |

| | | | | |235mls |

|[pic] | | | | | |

| |S Skin barrier spray |FD153-50 |1 |9.95 |Effective barrier – against skin irritation |

| |F Finoderm Protect | | | |Easy to apply to injured skin and adheres well to moist wounds. |

| |H&R healthcare | | | |Provides protection from diarrhoea and incontinence |

| | | | | |Moisturising – indicated to protect and moisturise clinically dry skin Does not clog absorbent pads |

| | | | | |or dressings |

| | | | | |Use extremely sparingly |

| | | | | |50ml |

A catheter valve is a tap-like device that fits into the end of a urethral or suprapubic catheter, which allows urine to be stored in the bladder and emptied straight into the toilet or bag. The tap can be switched on to stop drainage or off to drain urine from the bladder thus allowing the bladder to fill and empty as normally as possible. Most people who have a long-term catheter now use a catheter valve (with or without a bag) because it is generally felt that the bladder should not be kept empty at all times as it reduces bladder capacity and tone. The catheter valve at the end of the catheter acts in a similar way to the tap at the bottom of the leg bag that is used to empty the leg bag when it’s full.

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Living with a catheter valve:

• You should drink at least 2 litres per day if you have an indwelling catheter (urethral or suprapubic).

• You need to regularly open the valve over a toilet/jug or similar receptacle to drain the bladder , which can be every 4 to 6 hours during the day and be closed at night or attached to a drainage bag and left open on free drainage

• Change the catheter valve once a week, just the same frequency as most urine drainage bags

• Ensure that the tapered or ridged end of the catheter valve is inserted into the urinary catheter opening

• You may bathe or shower as usual

• A leg strap can be used to support the catheter tubing and catheter valve

• Catheter valves, leg straps and urinary drainage bags are available on prescription

• Dispose of catheter valves in your rubbish. Do not burn the valves.

PROPYLAXIS, DIAGNOSIS AND MANAGEMNT OF CATHETER ASSOCIATED URINARY TRACT INFECTIONS (CAUTI)

PROPHYLAXIS

DIAGNOSIS AND TREATMENT

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TRIAL WITHOUT CATHETER (TWOC) General Guide

Please ensure that an intake and output chart is accurately

completed for 48 hours post TWOC

-Document in urinary catheter passport -for further advice contact bladder and bowel service

02030494040

CATHETER COMPLICATIONS: IN/OUT OF HOURS

PLEASE REMEMBER ONLY SEND YOUR PATIENT TO ED IF IT IS A MEDICAL EMERGENCY

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Always review need for catheterisation

If in doubt take it out….

• Examine the patients past medical history and the reason for the catheterisation.

• If there is no documented, evidenced or indicated reason for the catheter to be in situ then remove catheter after consultation with GP or medical team.

• Consider alternatives to catheterisation! Can patient be taught clean intermittent self-catheterisation or can the family/community/district nurses perform ‘in/out’ catheterisation?

• If indwelling catheterisation is unavoidable on medical grounds then should it be a urethral or supra-pubic catheter? (the benefits of one over the other are determined by the patient’s diagnosis and quality of life issues. E.g. if the patient is wheelchair bound a supra-pubic catheter is preferable.

• If the patient has evident and documented indications for catheterisation as part of their treatment / recovery, then consider how best to manage their bladder effectively to avoid blockage/bypassing.

• With a newly catheterised patient, observe 2 or 3 catheter 'lives' - i.e. how long each catheter lasts between blockage and the reason for the blockage before planning any intervention.

• If the patient's catheter blocks then identify cause of blockage (see causes of blockage page 18), make a record of the frequency of catheter blockage, using catheter passport and also monitor fluid intake, diet and mobility.

• If the blockage is caused by mucus or debris or light haematuria then encourage the patient to increase intake of oral fluids and if not sufficient then use a gentle mechanical flush of the catheter - e.g.  Uro-Tainer PHMB as indicated above.

• If the cause of catheter blockage is encrustation of the catheter then consider use of Suby G catheter maintenance solutions to maintain patency and reduce frequent catheter changes.

Commence Suby G catheter maintenance solutions twice a week and monitor how long the catheter lasts between blockages. If the patient continues to block off frequently, the catheter maintenance solutions may be increased in frequency, or, alternatively they may be decreased dependent on the patients’ experience of blockages. Solution R may be used for persistent blockers for two weeks where indicated and on advice from the continence team.

Patients may also be taught to use the solutions themselves thereby managing their own catheter care, and their  own independence, and less reliance on the input of the district nursing service as well as less visits to A/E with blocked catheters.

CAUSES:

-kinked catheter/tubing

-catheter tip/drainage eyes poor position

-bladder mucosa possibly occluding catheter eyes

-patient sitting position

-Gravity problems (tilted chairs, bed-bound patients, catheter fastened to Zimmer-frame causing a “uphill” tubing effect)

-Overfilled drainage bag

OTHER CAUSES/PHYSICAL CAUSES:

-Empty bladder, inadequate fluids intake/dehydration

-Constipation/faecal impaction

-Abdominal spasms (particularly supra pubically and in spinal cord injury)

-Anxiety or patient poor positioning causing abdominal contraction

-bladder stones

-Pyuria

-Sediment

-Catheter-associated urinary tract infections (CAUTI)

-Encrustation)

Catheter stopped draining/blocked

ACTION:

-When inserting new catheter and no drainage:

for urethral catheterisation push the catheter further in the bladder

-for suprapubic catheterisation match length of insertion to the one of removed catheter (avoid pushing catheter in to avoid urethral damage)

-Always insert a “standard” length for male patients

-Always insert a standard length for suprapubic catheterisation

-Turn catheter by approx. 180 degrees

-Reposition/securely fasten catheter/tubing/drainage bag

ACTION:

-offer a glass of water and wait for urinary drainage. Provide fluid education

-Correct constipation/impaction, prevent re-occurrence and educate patient/carers

-monitor blockages in catheter passport report cause (e.g. encrustation) report interventions into passport

-review catheter material (silicone may improve flow but also remove complications)

-educate daily hygiene including catheter cleaning with water/soap, glans penis hygiene.

-introduce a valve if appropriate (in neurological patients or patients with Detrusor Overactivity you must also consider an anticholinergic).

-refer to urology if long-term catheterised with no previous diagnostic/obsolete diagnostics or a history of stones/sediment and cystoscopies

-Treat only symptomatic CAUTI as per flowchart – (management and treatment of CAUTI

-consider regular (e.g. twice weekly) instillations of catheter maintenance solutions (CMS) only if all other interventions have failed and there is evidence of encrustations.

- Uro-Tainer G or for more persistent encrustation use Uro-Tainer Solution R.

CATHETER BYPASSING

Do not increase catheter or balloon size! Beware of neurological patients

Bypassing is not an emergency and does not require an ED attendance. If you cannot resolve please escalate to Bladder and bowel team for advice

Potential causes:

-Bladder spasm

-Neurological condition causing bladder spasms/catheter rejection

-Large gauge catheter or over-inflated/large balloon irritation the trigone/bladder

-Poorly supported drainage/bag putting pressure on trigone/bladder neck

-kinked catheter/drainage system

-Lack of gravity to promote drainage

-blocked catheter (see flowchart -)

Action:

-Consider anticholinergics therapy especially in patients with neurological conditions

-reduce catheter size/balloon size to a smaller. Less irritant catheter

-strap drainage system appropriately and provide training to carers

-Encourage gravity through mobilisation or appropriate sitting/drainage positioning (tilted chairs/bed-bound patients are on higher risk of poor drainage)

-consider using a valve if suitable. The use of a valve to enable the bladder to fill naturally and decrease the irritation by the catheter tip to the bladder tissue.(anticholinergic medications may be required in neurological patients)

-Check bowel for constipation/impaction

-Encourage patient to adjust diet/fluids to avoid bladder irritants

-If patient has been catheterised for years consider a referral to urology for cystoscopy to exclude underlying problems (Bladder stones; high sediment; bladder CA etc.)

-complete nursing interventions in patients catheter passport

Catheter valves

Catheter Valve with tap in open position (face down for open)

Catheter Valve with tap in a closed positon attached to a catheter (face up for closed)

Antibiotic prophylaxis is not recommended unless the patient has had a traumatic catheterisation or has known or relevant history of recurrent infections +/- urosepsis after catheter change which cannot be addressed by other interventions. If prophylaxis is indicated and unless otherwise advised give a stat dose of antibiotic in accordance with the local antibiotic guideline or Antibiotic Pocket Guide and App.

If a patient is already on a treatment course of systemic antibiotics for a urinary tract infection (UTI) or another infection is being treated with a broad spectrum antibiotic, then additional antibiotic prophylaxis is NOT needed.

After 28 days of indwelling catheterisation; all patients will develop some degree of urinary bacterial contamination (bacteriuria). Low count, asymptomatic bacteriuria must not be treated with antibiotics

Always review any available CSU or MSU culture results prior to catheterisation.

i. Patients having a primary catheter insertion only consider treatment with antibiotics in accordance with the local antibiotic guideline or Antibiotic Pocket Guide and App.

ii. Patients with long-term catheter Bacteriuria is almost universal in this group of patients; they should only receive antibiotic treatment if they have symptoms as stated in SIGN guidance (below)/systemically unwell/at risk of pyelonephritis.

Patients that develop a CAUTI

-If CAUTI is suspected always send a CSU for urine and sensitivity prior to starting any antibiotics. Urine samples must be obtained from a sampling port using aseptic technique. (NICE)

-Start course of oral antibiotics in accordance with the local antibiotic guideline or Antibiotic Pocket Guide and App.

- Change long term indwelling catheters prior to starting treatment for a symptomatic UTI (SIGN guidance)

-IDSA guidelines recommend: a seven day course of antibiotic treatment for patients with symptomatic CAUTI who have prompt resolution of symptoms; 10-14 days of antibiotic treatment where there is a delayed response, regardless of whether or not the catheter is withdrawn during that time; a three day course of antibiotics for women aged ................
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