Urinary Catheter Support Procedure

Participant Support Procedures > Urinary Catheter Support Procedure

Authorised by Chief Executive Officer

Approved date: 19 October 2023

 

Statement

Kyeema is committed to ensure workers delivering urinary catheter support meet the needs of each participant. Kyeema ensures the workers are aware of and understand the relevant health support plan. The support plan for urinary catheter support has been developed and is overseen by a relevant health practitioner, and each participant is involved in the assessment and development of their health support plan (HSP). The support plan is up to date, reviewed annually or as needed, readily available, clear and concise and clearly identifies and describes the support needs and preferences of the participant.

 

This procedure supports Kyeema to apply the NDIS practice standards Module 1 – High Intensity Daily Personal Activities Module

 

Scope

This procedure applies to relevant managers, participants and the workers who support participants with urinary catheters.

 

Relevant legislation

NDIS Practice Standards

NDIS Practice Standards: High Intensity Support Skill Descriptors current version

 

Definitions

Urinary Catheter Support is the process of cleaning and maintaining a urinary catheter.

 

Urinary catheter is a small, flexible tube that is used to collect urine from the body.

 

Catheter bag is the container that collects the urine.

 

Stoma site is the location where a catheter is inserted into the body.

 

In-out / Intermittent catheter is when a new catheter is inserted each time you need to drain urine. It is then immediately removed. This is done at intervals similar to those at which you would go to the toilet to pass urine. This process may be referred to as ‘clean intermittent self-catheterisation’ or CISC (performed by a nurse). In some cases, male participants who are incontinent but not urine retentive may be able to wear a catheter attached to a condom. Females may wear a wick or similar device (performed by support workers).

 

In-dwelling/inserted urinary catheter (performed by a health practitioner) is a catheter which is inserted into the bladder, via the urethra and remains in situ to drain urine.

 

Suprapubic catheter (performed by a health practitioner) the catheter accesses the bladder directly through the abdomen.

 

Autonomic dysreflexia can occur in people with spinal cord injuries above the T6 level. Sudden and uncontrolled increase in heart rate and blood pressure which can lead to stroke, heart attack or death. Can be caused by a full bladder, bowel or skin irritation which the brain cannot control.

 

Procedure

Before supporting a participant with high intensity needs, the worker is required to:

•   agree to and sign their own Individual Training Plan (ITP)

•   attend all training requirements as per their ITP

•   read and understand the participants Health Support Plan – Catheter Care CCF-50 or the relevant health practitioners care plan

•   after reading the health support plan or care plan, sign and date the Staff Acknowledgement – Health Support Plans CCF-59, kept in the participants file

It is important to follow the specific instructions in the participants support plan and to consult with the supervisor/health practitioner for clarification. Before starting the bag changing procedure, confirm that the support plan is the correct and current plan for the participant.

 

CATHETER BAG

PPE

Always wash hands with warm soapy water, wear eye protection and gloves when: 

•   Cleaning around the catheter site

•   Emptying or changing the urine collection bag

•   Connecting/disconnecting overnight bag

•   Cleaning any equipment used

 

Steps for changing the catheter bag

You will need these supplies:

•   A clean washcloth or gauze

•   Night bag or leg bag (as appropriate)

•   alcohol pads x 2

 

1.   Wash your hands thoroughly with soap and water

2.   check for the participants consent, expectations, capacity and preferences for being involved in the delivery of the support

3.   Explain the procedure to the participant

4.   Help the participant to a comfortable position to change the bag

5.   Follow specific procedures listed by the health practitioner

o   Empty the urine from the drainage bag into the toilet. Make sure that spout of the drainage bag never touches the side of the toilet or any emptying container.

o   Place the clean cloth or gauze under the connector to catch any leakage.

o   Pinch off the catheter with your fingers and disconnect the used bag.

o   Wipe the end of the catheter with an alcohol pad.

o   Wipe the connector on the new bag with the second alcohol pad.

o   Connect the clean bag to the catheter and release your finger pinch.

o   Check all connections. Straighten any kinks or twists in the tubing.

6.   The nurse will insert the urinary catheter tubing, support workers are required to change the catheter bag as needed

7.   Wash hands thoroughly with soap and water

8.   Measure and record the amount and consistency of urine on the Urinary Catheter Output Chart CCF-93 or the chart supplied by the health practitioner

9.   Record shift notes on carelink+

 

Cleaning the catheter bag:

You will need these supplies:

•   White vinegar

•   Cool water

1.   Wash your hands thoroughly with soap and warm water.

2.   Rinse the bag with cool water. Don’t use hot water because it can damage the plastic equipment.

3.   To decrease odour, fill the bag halfway with a mixture of 1-part white vinegar to 3 parts water. Shake the bag and let it sit for 15 minutes.

4.   Rinse the bag with cool water and hang it up to dry.

 

Changing the catheter bag: the catheter bag is the container that collects the urine. It should be changed every 24 hours, or more often if it becomes full.

 

Monitoring the catheter: this involves checking the catheter for leaks, kinks, or blockages. It is also important to monitor the skin around the catheter for signs of irritation or infection.

 

Emptying the catheter bag: the catheter bag should be emptied as soon as it becomes one-third full. This will help to prevent the urine from backing up and causing infection. Empty the collected urine using a portable urine holder and flush down the toilet.

Always fill in the urine record sheet.

 

Additional tips for catheter care:

•   Wash your hands thoroughly with soap and water before and after handling the catheter

•   Use a clean, dry towel to wipe the area around the catheter

•   Do not use harsh soaps or antiseptics on the skin around the catheter

•   Keep the catheter bag below the level of the bladder

•   Support the participant to drink plenty of fluids to prevent urinary tract infections

•   Report any problems with the catheter to the supervisor/doctor/health practitioner

It is important to follow the specific instructions for catheter care that are given by the doctor/health practitioner. These instructions may vary depending on the type of catheter and the individual’s needs.

 

Day time catheter bag and nighttime catheter bag placement

A diagram of a person's bodyDescription automatically generated

A closed drainage system should be maintained to reduce the risk of urinary tract infection. The prevention of urinary tract infections is critical. Prevention can be aided by using the correct hand hygiene and PPE whenever performing catheter support.

 

The overnight bag should be placed on an appropriate stand below the level of the bladder to ensure it does not come into contact with the floor. The leg bag should remain strapped to the person’s leg overnight to prevent it from pulling and becoming disconnected.

Empty the contents of the bag into the toilet. Record the amount if required.

After each use, rinse the long-term overnight bag or re-usable leg bag with warm tap water, soak for 20 minutes in the sterilising solution, and then dry in a well-ventilated area out of direct sunlight. When hanging to dry, place the cover over the plastic tip on the tubing.

The leg bag is usually worn under clothing and attached to the thigh with leg straps.

If the person uses a wheelchair, it may be worn on the calf or hung on the wheelchair. Some people use a drainage bag cover to maintain dignity in the community.

The leg bag should be emptied into a suitable container or directly into the toilet as per the person’s choice and preference by opening the drain tap on the lower end of the leg bag.

 

Ensure the catheter bag is well anchored to the person’s leg, with extra care taken when hoisting or transferring the person to ensure the catheter is not pulled out. Ensure catheter bag is secured to the leg to prevent damage to the stoma, urethra or bladder. Ensure the tubing is not kinked or twisted and the bag is below the bladder. Poor draining may lead to infection. 

 

  

Types of Catheter Care – bag care is the same for the different types of catheters

 

Catheter type

 

Definition

Who can insert and replace the catheter?

Support worker responsibility

External / intermittent catheter - male

 

Condom catheter over penis draining urine from catheter to drainage bag secured on leg with straps.

Unlike other urinary catheters, a condom catheter is not inserted into the urethra. Instead, a special condom is attached to a catheter to keep the catheter in place and to collect urine.

 

Trained workers can perform this task

24 hours with a maximum of 48 hours in-between changes

Empty catheter bag

Keep the skin around the catheter clean

Clean with a disposable gauze or clean wet cloth

 

Report to your supervisor if the tube is removed

External / intermittent catheter - female

 

External Female Urinary Catheter: Implementation in the Emergency  Department - Journal of Emergency Nursing

Unlike other urinary catheters, an external catheter is not inserted into the urethra. Instead, it is attached to a catheter to collect urine.

 

 

 

Trained workers can perform this task

 

Empty catheter bag

Clean with a disposable gauze or clean wet cloth

Report to your supervisor if the tube is removed

 

 

 

 

Indwelling catheter

 

Indwelling urinary catheter insertion 1: children and young people |  Nursing Times

A small, flexible tube inserted through the urethrae and into the bladder to support urine to drain.

 

 

 

 

 

 

Medical practitioner to insert & replace

 

Change approx. every 3 months

 

Empty catheter bag

Keep the skin around the catheter clean

Skin care at stoma site is required. Can become encrusted

Clean with a disposable gauze or clean wet cloth

Report to your supervisor if the tube is removed

 

A diagram of a person's bodyDescription automatically generated

Suprapubic Catheter (SPC)

 

Care of Suprapubic Catheter • preop.com

 

The first insertion is an invasive medical procedure where the catheter accesses the bladder directly through the abdomen.

Medical practitioner to insert & replace.

 

Change approx. every 6 to 12 weeks

Empty catheter bag

If the SPC stoma site has a discharge, report immediately to your supervisor.

Catheter becomes dislodged report immediately to avoid the stoma closing over

 

 

 External / intermittent / condom catheter procedure - male

1.   Wash and dry hands before starting, apply gloves throughout process, change as required.

2.   Ensure communication and seek consent with the participant, take all steps to ensure they are aware of what is going to happen and communicate each step as you go along. Identify participants preferred drainage process.

3.   If necessary, remove the current condom catheter, by rolling down the shaft of the penis (do not pull off) if using a sealant remover, use as directed on the bottle or tube.

4.   Using a small amount of soap and water or a medical body wipe, wipe the penis. Foreskin- gently retract and clean the head of the penis, gently guide forward post clean

5.   Rinse and gently dry until the penis is completely dry

6.   Check the shaft, head and surrounding area of the penis for irritation or open sores. If sores or irritation are present, complete the incident report and apply appropriate treatment as per individual plan- pad or reapplication

7.   If the catheter and participant choose to use sealant, apply it to the skin of the penis and surrounding pubic area, and allow it to dry- the penis should become smooth and slippery when dry. Maintain dignity when checking, do not over-check and touch a participant more than required.

8.   Place the condom catheter over the tip of the penis ensuring the tube area is located over the urethra, with an inch to two inches of the tubing free. Slowly unroll, stopping at the pubic area When using sealant, apply gentle pressure to the penis for 15 seconds to secure.

9.   Place the stealth around the base of the penis, do not secure too tight

10.  Connect the tubing to a collection bag, ensure the connection is secure

11.  Strap the drainage bag to the desired position- drainage bad must be below the waist to support effective drainage

12.  Record the amount and consistency of urine on the Urinary Catheter Output Chart CCF-93

 

External / intermittent / wick catheter procedure – female

1.   Check and follow the health practitioner’s care plan

2.   Wash and dry hands before starting, apply gloves throughout process, change as required.

3.   Ensure communication and seek consent with the participant, take all steps to ensure they are aware of what is going to happen and communicate each step as you go along. Identify participants preferred drainage process

4.   The person may prefer to lay on their back with knees bent and thighs apart or lay on their side, frog legged

5.   Separate the legs, gluteus muscles and labia during placement and removal.

6.   Perform perineal care, wipe with soft gauze from top to bottom and assess skin integrity

7.   Gently tuck soft gauze side between separated gluteus and labia

8.   Ensure the top of the gauze is aligned with the pubic bone

9.   The urethra should be aligned approximately 1/3 of the way down the length of the product.

10.  Slowly place legs back together once the wick external catheter is in place

11.  The anatomy holds the wick in place with most people and mesh underwear may help secure the wick

12.  Clean the perineum after each loose bowel movement and replace the product if soiled.

13.  Assess skin for compromise and perform perineal care prior to placement of a new wick

14.  Replace the wick after at least every 8 to 12 hours or when soiled with faeces or blood

15.  Catheter tubing is attached to the canister or bag and emptied as per empty bag procedure

16.  Discard equipment and perform hand hygiene

17.  Record the amount and consistency of urine on the Urinary Catheter Output Chart CCF-93

 

In out / intermittent catheter – male / female

Only nurses can perform this task

1.   Check and follow the health practitioner’s care plan

2.   Wash and dry hands before starting, apply gloves throughout process, change as required.

3.   Ensure communication and seek consent with the participant, take all steps to ensure they are aware of what is going to happen and communicate each step as you go along. Identify participants preferred drainage process.

4.   Participant should be placed in a comfortable sitting position.

5.   Remove in out catheter from drawer, slightly pull back packaging with only green tubing exposed and connect drainage bag

6.   Open remaining packaging, using no touch technique (if touched you need to throw away and start again)

7.   Place small amount of lubricant onto the end of the tube (no touch)

8.   Collect wipes and gloves and check overnight bag is empty and not still draining (if needed)

 

Participant with a vulva:

    Instruct patient to separate the labia majora with the non-dominant hand to expose the urethral opening, and with the dominant hand, wash this area with warm water or moist towelettes.  Start at the top and work downwards

    With the labia still separated by the non-dominant hand, using the first and third fingers, the nurse uses the cotton bud and mirror to point out the anatomy of the clitoris, urethral opening and the vagina

    Patient then palpates the urethra with the second finger (feels like a small hole or donut) and leaves it over the urethral meatus.  The patient then takes the catheter in the dominant hand, holding it two to three cm away from the tip, and gently inserts into the urethra, sliding it under the palpating finger in a gentle upwards and backwards motion.

 

Participant with a penis:

    Instruct patient to grasp the penis at the sides (so as not to compress the urethra) with the non-dominant hand

    If the patient is not circumcised, instruct to gently retract foreskin

    Wash the end of the penis gently with a clean sponge or moist towelettes

    Hold the penis upright at 45/90o angle from abdomen, grasp the catheter about 7 cm from the tip and gently insert the catheter into the urethra until urine starts to flow.

 

9.   If there is an obvious urine flow, hold the catheter in place until the urine ceases to flow.  Withdraw the catheter gently until urine recommences flowing.  Once urine flow ceases gently withdraw catheter completely.

10.  Leave the patient comfortable and lower the height of the bed.

11.  Discard equipment and perform hand hygiene.

12.  Record the amount and consistency of urine on the Urinary In-out Catheter Output Chart CCF-97

 

Indwelling catheter – general care

1.   Check and follow the health practitioners care plan.

2.   Check that the required equipment and consumables are available and ready for use.

3.   Confirm how the person would like to be actively involved in their support, as outlined in their plan, and to their chosen level.

4.   Explain the procedure to the person and seek their consent to proceed.

5.   Check for any abnormalities, including bruising, injury or skin tears

 

For Female Anatomy

-    Hold the end of the catheter near the insertion site and wipe the tube with a clean,

          damp cloth starting at the insertion end and working away from the urethra (front to back).

-    Clean around the urethra and labia and wipe from front to back.

 

For Male Anatomy

-    Hold the end of the catheter near the insertion site, wipe the tube with a clean,

          damp cloth starting at the insertion end, and wipe from the tip of the penis

          downward.

-    Start from the top of the penis where the catheter goes in, ensuring the foreskin (if

          uncircumcised) is pulled back and gently cleaned. Wipe towards the anus.

 

•   Gently pat the area dry with a clean cloth.

•   Secure the tubing to the leg taking care not to kink or block it.

•   Assist the person in adjusting any clothing and making themselves comfortable.

•   Check again that the tubing is not caught in clothing, bedclothes or equipment, i.e.

wheelchair, chair, bed.

•   Remove and dispose of your gloves and wash your hands.

•   Remove the remaining PPE and wash your hands again.

 

Suprapubic catheter

1.   Check and follow the health practitioners care plan.

2.   Check that the required equipment and consumables are available and ready for use.

3.   Confirm how the person would like to be actively involved in their support, as outlined in their plan, and to their chosen level.

4.   Explain the procedure to the person and seek their consent to proceed.

5.   Check for any abnormalities, including bruising, injury or skin tears

6.   Rotate suprapubic catheters daily to prevent it from sticking to the skin (check with the health practitioner an participant first)

7.   Do not use creams or powders on the site unless prescribed by the doctor

8.   Doctor orders to be followed for IDC changes (nurses) and bag changes

 

Participants with spinal lesions at or above T6 require monitoring for Autonomic Dysreflexia

Symptoms:

•   Severe headache

•   Sweating above the level of the spinal cord injury

•   Flushing of the face

•   Pounding in the ears

•   Blurred vision

•   Nasal congestion

•   Slow or rapid pulse

•   High blood pressure

•   Anxiety

•   Headache

 

Action:

•   call 000

•   call supervisor

 

Contacting your supervisor / health carer when:

•   You observe skin around the stoma site showing signs of infection or irritation

•   Blocked tubing

•   Abdominal distention

•   Pain, fever

•   Unusual colour or odour to the urine

•   Change in behaviour

•   Dislodged catheter

•   Skin changes

•   Check in with the participant for any concerns eg. pain or burning sensation in the bladder, lower back pain, bladder spasms, persistent blood in urine

•   Identify, document and report information where a support plan is not meeting the participants needs

•   Support the participant to provide feedback and request changes to their support plan as required

 

Catheter care emergencies

Call 000 immediately if

•   the urine output remains unusually low, or there is no urine output

•   there is persistent blood in the urine; urine is very dark or has an offensive smell

•   the person has a temperature or complains of pain

•   has a distended abdomen

•   has urine leakage around the insertion site

•   Stay calm and collected

•   Assess the situation and seek medical attention immediately

•   Call 000, your supervisor and the health practitioner

•   Record all observations and actions in the shift notes

•   Supervisors may require an incident report form to be completed

 

Reporting incidents

•   Write up the shift notes during the shift, not at home in your personal time

•   Report incidents to your team leader/supervisor/supports manager and document in the shift notes

•   Your supervisor may request an incident report form to be filled out

•   In an emergency call 000 and /or your supervisor

 

If you attend a shift and have a concern over the wellbeing/health of your participant, alert the office, team leader or on-call phone straight away.

 

Recording observations in Carelink+ shift notes & Urinary Catheter Output Chart

Write timely, detailed, and accurate shift notes that relate to the catheter care performed. This may include bag changing, recording of urine output and consistency on the record chart and any observations.

•   Write up the shift notes during the shift, not at home in your personal time

•   Urinary Catheter Output Chart CCF-93

•   Urinary In-out Catheter Output Chart CCf-97

 

Documentation

Relevant documentation includes:

•   Incident, Complaint, WHS Record Form CCF-65 (supervisor will advise)

•   Progress /shift notes – Carelink+

•   Urinary Catheter Output Chart CCF-93

•   Urinary In-out Catheter Output Chart CCF-97

•   Practitioners Care Plan or Health Support Plan – Catheter Care CCF-50

•   Handover

 

Awareness & Training

The support worker is trained in the following skills:

•   Infection control procedures

•   How to replace and dispose of catheter bags

•   How to maintain charts and records

•   How to monitor catheter position

•   How to monitor skin condition around the catheter

•   How to recognise and respond/report blockages, dislodged catheters, signs of deteriorating health and infection

In addition to the general training listed above, workers will be trained in the specific needs of each participant they support. Training should be delivered by an appropriately qualified health practitioner or a person who meets the expectations of this skills descriptor.

 

Kyeema should ensure that workers understand the support needs outlined in the support plan and what risks to look for and actions required to respond to risks, incidents, and emergencies.

 

Workers are required to complete a skills review (generally annually) and participate in participant specific training with a health practitioner. The training officer and/or supports manager will let workers know when this will occur.

 

Where a worker has not delivered this support for a period of more than three months, or if a participant’s support needs have changed and/or they have an updated support plan in place, it is recommended the worker be reassessed before supporting the participant and undertake refresher training if required.

 

Training provided:

Individual training plan (ITP)

•   K:\Admin\Training\High Intensity Supports ITP\Individual Training Plan

•   First Aid & CPR

 

Participant specific training with a healthcare professional and the worker/s

•   Participant Specific Training Attendance Sheet HRF- 46

•   K:\Admin\Training – Participant Specific Training HISW

 

Sentrient online training:

•   Complex Care – Catheter Care

•   Complex Care – Catheter Care Refresher (annual refresher)

 

Form used for workers to reflect and identify gaps in skills and knowledge:

•   High Intensity Supports Skills review – Bowel & Catheter CCF-37

 

Responsibilities

The training officer will organise training for the workers.

The training officer will email a monthly reminder to team leaders to communicate any staffing and health plan changes.

 

The training officer and supports manager are responsible for ensuring workers have current skills and knowledge, and that the training of workers is documented and regularly audited.

•   High Intensity Supports Skills review – Bowel & Catheter CCF-37

 

The team leader is responsible for updating the health support plan every year or as needed. If the plan is unchanged after review by the speech pathologist, the team leader will add the revised date to the plan stating that the plan is unchanged.

•   Health Support Plan – Catheter Care CCF-50 or the health practitioners care plan

 

The team leader is responsible for filing CCF-93 on a monthly basis in the participant’s file.

•   Urinary Catheter Output Chart CCF-93 or the health practitioners urinary output chart

 

The team leader is responsible for communicating any staffing and health plan changes to the training officer.

 

The support worker is responsible for attending all allocated training sessions.

Support workers are responsible for reporting any changes to the participants urinary catheter, participants health and wellbeing to their supervisor.

 

Support workers are responsible for reading, understanding, and signing the participants HSP:

•   Staff Acknowledgement – Health Support Plans CCF-59

 

Review and Evaluation

Support plans are to be reviewed annually by the health practitioner. If the plan is unchanged, the team leader will add the revised date to the plan stating that the plan is unchanged.

 

The worker supports the participant to provide feedback and request changes to their support plan as required.

 

Record Keeping

Hard copies are filed in workers and participant files.

 

Electronic records are kept in participants’ file.

 

Training records:

•   Sentrient LMS

•   Individual Training Plan K:\Admin\Training\High Intensity Supports ITP\Individual Training Plan

•   K:\Admin\Training – Participant Specific Training HISW (working document)

 

Related Policies, Procedures and Documents:

NDIS Practice Standards

NDIS Practice Standards: High Intensity Support Skill Descriptors current version

Health Support Plans 

Saline & Citric Acid Flush Recording Form CCF-13

Participant Treatment Sheet - Over-the-Counter Medication CCF-36

High Intensity Supports Skills review – Bowel & Catheter CCF-37

Participant Specific Training Attendance Sheet HRF-46

Health Support Plan – Catheter Care CCF-50

Staff Acknowledgement – Health Support Plans CCF-59

Incident, Complaint, WHS Record Form CCF-65

Urinary Catheter Output Chart CCF-93

Urinary In-Out Catheter Output Chart CCF-97

High Intensity Supports Procedure