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Page 1 of 25
APPENDIX 1
THE URINARY SYSTEM
LEARNING PACK
This pack may be used a as learning aid for
Care/ Support staff
This Learning Pack contains a brief outline of the following
areas:
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The Urinary System
Understanding Urine and the Bladder
Urinary Incontinence
Neurogenic bladder
Urinary tract infections
Medication
Indications for Urinary catheterisation
Intermittent Urinary Catheterisation
Urethral Catheterisation
Suprapubic Catheterisation
Catheter Maintenance Solutions
Key points for Catheter management
Appendices
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THE URINARY SYSTEM
The Urinary System, also known as the urinary tract, is the body’s filtering
system. As blood passes through the kidneys, waste products are removed
and together with excess fluids are excreted as urine. The urinary system also
regulates the volume and composition of fluids in the body, keeping an
internal chemical balance.
The urinary system consists of:
Two Kidneys: Each kidney is about 10-12.5cm long and as blood passes
through them they filter out waste products that will be excreted from the body
as urine.
Two Ureters: Each kidney has a ureter, which carries urine away from the
kidney into the bladder.
The Bladder: The bladder is a hollow muscular organ made up of three types
of muscle that stores urine until it is convenient and the muscles at the
bladder outlet (urethral sphincter) relax allowing urine to be expelled from the
body through the urethra.
The Urethra: The female urethra is short (4cm) which causes frequent
urinary tract infections. It lies just in front of the vagina.
The male urethra is about 20cm long and is made up of three sections:
The male urethra transports both urine and semen out of the body. The
prostate gland lies at the upper end of the urethra as it leaves the bladder. In
older men the prostate gland can enlarge compressing on the urethra and
cause problems with urination. The male urethra runs through the penis to an
outlet at its tip.
Please see the diagrams below.
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UNDERSTANDING URINE AND THE BLADDER
The kidneys make urine all the time. A trickle of urine is constantly passing to the
bladder down the ureters (tubes from the kidneys to the bladder). You make different
amounts of urine depending on how much you drink, eat and sweat.
The bladder is mainly made of muscle and stores the urine. It expands like a balloon
as urine comes down the ureters. The outlet for urine (the urethra) is normally kept
closed. This is helped by the muscles beneath the bladder that sweep around the
urethra (the pelvic floor muscles). When a certain amount of urine is in the bladder
one becomes aware that the bladder is getting full. When one goes to the toilet to
pass urine, the bladder muscle contracts (squeezes) and the urethra and pelvic floor
muscles relax.
Complex nerve messages are sent between the brain and the bladder and pelvic
floor muscles. These make one aware of how full your bladder is and tell the right
muscles to contract (squeeze) or relax at the right time.
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URINARY INCONTINENCE
“Incontinence is treatable and not inevitable and all healthcare staff
must be aware of the huge social stigma attached to it”
Noreen Clifford, Jan 2011, Continence Promotion Unit ,HSE East Coast.
If you have urinary incontinence it means you pass or leak urine when you do
not want to. Treatment is aimed at enabling the bladder to empty completely
and regularly, preventing infection, controlling incontinence, and preserving
kidney function. There are different types, depending on the cause.
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Stress incontinence. Urine leaks when you cough, laugh, jump, etc.
Urgency is the sudden desire to pass urine that is difficult to put off. If
one cannot get to the toilet in time then incontinence may occur
Urgency incontinence is the involuntary leakage of urine after
urgency .As a consequence one will go to the toilet more often.
Overactive bladder (OAB) is combination of stress and urgency
incontinence and is as result of overactivity of the bladder muscle.
Frequency is the complaint of passing urine eight or more times a day.
Nocturia is the complaint of waking at night one or more times to pass
urine.
Neurogenic bladder is due to damage to nerves supplying the
bladder. Various nerves converge in the area of the bladder and serve
to control the muscles of the urinary tract, which includes the sphincter
muscles that normally form a tight ring around the urethra to hold urine
back until it is voluntarily released. It is often associated with diseases,
injuries, multiple sclerosis, and neural tube defects including spina
bifida.
Symptoms include the following:
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Urinary incontinence, characterized by either involuntary release of
large volumes of urine or continuous dribbling of small amounts. Bedwetting may occur.
Frequent urination
Persistent urge to urinate despite recent voiding; a constant feeling that
the bladder is not completely empty.
Pain or burning on urination.
Overflow incontinence is due to a blockage of the urine outlet which upsets
the normal control of passing urine. Urine pools in the bladder behind the
blockage, but small amounts of urine bypass the blockage and trickle down
the urethra. The most common example is incontinence caused by an
enlarged prostate gland in men which partly blocks the bladder outlet.
Page 6 of 25
Also urine leaks via the urethra due to bladder spasm and this usually occurs
when the urethral closing pressure is less than the bladder pressure or
contraction. Bladder infection, stones, bladder outlet obstruction, neurogenic
bladder can cause the retrograde (backwards) flow of urine from the bladder
into the ureters which occurs when the unidirectional valve-like flow between
the ureters and bladder fails, (this is called the vescoteric reflex).
What are the treatments for OAB/overflow incontinence?
Bladder retraining is usually advised at first. This can work well in up to half of
cases. Medication may be advised instead of, or in addition to, bladder
retraining. Surgery is not commonly advised for incontinence, but may be a
last resort in some cases. Surgery may be performed to widen the sphincter
to decrease resistance in the bladder outlet and thus maximize bladder
emptying. In other cases, the sphincter or lower pelvic muscles may be
surgically tightened to improve bladder control. In very severe cases, surgery
may be done to reroute the flow of urine so that it empties into an externally
worn receptacle creating a stoma.
Medication
Various medicines are available and include: oxybutynin, tolterodine, trospium
chloride, and propiverine. (These also come in different brand names.) They
work by blocking certain nerve impulses to the bladder which 'relaxes' the
bladder muscle.
Oxybutanin also helps decrease bladder spasm , leakage and the reflex
mechanism (vesicoteric reflex). This reflex mechanism can be treated initially
with antibiotics but long term if the problem gets worse it may require surgery..
Various medications may help improve bladder muscle control and prevent
involuntary muscle contractions. Muscle relaxants, antispasmodics and
anticholinergic drugs are also helpful.
Bethanechol is the most commonly prescribed drug to help stimulate bladder
contractions in service users who retain urine.
Side-effects are quite common with these medicines, but are often minor and
tolerable. Read the information sheet which comes with the medicine for a full
list of possible side-effects. The most common is a dry mouth, and simply
having frequent sips of water may counter this. Other common side-effects
include dry eyes, constipation and blurred vision. However, the medicines
have differences, and one may find that if one medicine causes troublesome
side-effects, a switch to a different one may suit one better.
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Urinary Tract Infection UTI’S
Urinary tract infections don't always cause signs and symptoms, but when
they do they can include:
Symptoms of Urinary Tract Infections:
Passing frequent, small amounts of urine
A strong, persistent urge to urinate
A burning sensation when urinating
Passing frequent, small amounts of urine
Urine that appears cloudy
Urine that appears bright pink or cola colored - a sign of blood in the urine.
Strong-smelling urine
Chills
Loss of appetite
nausea ,vomiting
Lower abdominal pain
Lower back pain or discomfort.
Some service users experience UTIs again and again — these are called
recurrent UTIs. If left untreated, recurrent UTIs can cause kidney damage
Types of urinary tract infection
Each type of urinary tract infection may result in more-specific signs and
symptoms, depending on which part of your urinary tract is infected. Common
types of UTIs include;
Cystitis,(bladder) the most common type of UTI, is a bladder infection that
can occur when bacteria move up the urethra (the tube-like structure that
allows urine to exit the body from the bladder) and into the bladder.
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Symptoms include; Pelvic pressure, lower abdomen pain, discomfort,
frequent, painful urination, blood in urine.
Urethritis, when bacteria infect the urethra causing burning with urination.
Pylonephritis, a kidney infection that can occur when infected urine flows
backward from the bladder to the kidneys, or when an infection in the
bloodstream reaches the kidneys. Symptoms include; Blood in urine, upper
back and side (flank) pain, high fever, shaking and chills, nausea.
Catheterisation
A neurogenic bladder usually causes difficulty or full inability to pass urine
without use of a catheter or other methods. Catheterisation methods range
from intermittent catheterisation, which involves no surgery or permanently
attached appliances, to the creation of a stoma, which bypasses the urethra to
empty the bladder directly.There are three methods of catheterisation that are
commonly used with persons with physical disabilities:
1..Intermittent Self Urinary Catheterisation
2.Urethral Catheterisation
3.Suprapubic Catheterisatiion
Catheterisation Training and Policies
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Cheshire policies and appropriate training available for staff in catheter
management,medication administration,infection control,catheter
flushing/irrigation, autonomic dysreflexia , intermittent catheterisation.
Clinical Practice Policies: CLG 19-28, ICOG1, ICOG2.
Management:
Assessment and decision to catheterise are clearly documented in service
user’s Best Possible Health records, including reason(s) for catheterisation
and type of catheterisation chosen and next catheter change date. (Use
Catheter diary).
Psychological needs are addressed as part of the full assessment and
access to specialist help/advice offered, if necessary. (Recognising the
psychological impact of catheterisation and potential difficulties with body
image and sexual functioning allows appropriate support to be offers to the
individual (Wilde, 2003).
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Infection Control:
Infection is an inevitable consequence of long-term catheterisation
(Winson 1997). Most infections are asymptomatic as a protective layer of
mucus on the bladder wall limits bacterial invasion and helps prevent
systemic invasion (Getliffe 2003).
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Antibiotic solutions are not effective in treating catheter-associated
urinary tract infection.
Good hygiene is essential for preventing catheter-related urinary tract
infections.
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Principles of good practice require that staff must use sterile equipment
and an aseptic technique when catheterising service users
Medication and catheterisation:
Many medications impact on catheter care
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Anticholerinergics ( For treating gastrointestinal disorders (e.g.,
gastritis, pylorospasm, diverticulitis, ulcerative colitis .Genitourinary
disorders (e.g., cystitis, urethritis, prostatitis) .Respiratory disorders
(e.g., asthma, chronic bronchitis) Parkinson's disease and Parkinsonlike adverse medication effects )can cause urinary retention
Analgesia can cause constipation which indirectly affects the function
of the bladder.
Antibiotics can cause bowel dysfunction
Warferin and aspirin can increase the risk of haematuria (blood in the
urine ) following catheter changes .
Intermittent Catheterisation
Intermittent catheterisation is recognised as a safe and effective procedure
(Bakke et al, 1997) and carries a reduced risk of infection compared to
indwelling urinary catheterisation. (Wyndaele, 1990; Bakke, 1991)
This is a clean (as opposed to sterile) technique that involves the episodic
introduction of a straight catheter into the bladder to remove urine. After the
catheter is removed the bladder is empty and the person is catheter-free for
intermittent periods. This process is usually done four to five times a day to
prevent urinary retention.
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Studies have shown that those using the clean as opposed to the sterile
technique did not encounter problematic urinary tract infection. The
advantages include improved quality of life, greater freedom to express one’s
sexuality and reduced urinary tract complications.
Intermittent catheterisation is a technique that may be carried out by the
individual themselves (intermittent self-catheterisation), by their carer(s).
Persons suitable for intermittent self-catheterisation include:
• Those who can comprehend the technique and who are highly
motivated.
• Those who have a reasonable degree of manual dexterity and who can
position themselves to attain reasonable access to the urethra.
• Those who have a willing partner or carer to who is trained to assist the
service user.
The catheters used for intermittent catheterisation can either be single use
pre-lubricated catheters or PVC reusable catheters.
Reusable catheters are designed to be washed in warm soapy water and
dried after each use and reused for a limited period of one week. The catheter
should be stored in a plastic container after each use. The bladder must have
the capacity to store urine adequately between catheterisations.
URETHRAL CATHETERISATION
Indwelling Catheters
Indications:
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To relieve incontinence when no other method is practical.
To relieve retention.
Relief of acute or chronic urinary obstruction.
Past medical history and current health status.
Urethral Catheterisation is the introduction of a latex or silicone tube into the
bladder via the urethra using aseptic technique. The catheter is anchored
inside the neck of the bladder by a water filled balloon and is attached to a
drainage bag.
Catheters come in various sizes and lengths depending on whether one is
male or female. Silicone catheters are used for long-term catheterisation.
Drainage bags also come in various sizes i.e. 1 and ½ litre bags that can be
attached to the leg via straps for daytime use and 2 litre bags for use at night.
Leg bags can be attached to the larger night bag for convenience at night.
Most bags come with a self-sealing sleeve that can be used to obtain samples
of urine without introducing infection.
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Supra pubic catheter
Suprapubic catheter is a tube that's inserted through the abdomen to connect
directly into the bladder to drain urine. This type of catheter is commonly used
for individuals who have experienced some type of bladder or spinal cord
injury and sometimes in men who suffer from prostate problems.
Caring for a suprapubic catheter is the same as that of a urethral catheter.
Once the insertion site is healed the site and catheter can be cleansed during
bathing using soap and water.
Why is a Suprapubic Catheter better than a Urethral Catheter?
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When a urethral catheter is used, the urethra may become damaged
over a period of time, resulting in urinary leakage around the catheter.
Additionally the balloon of a urethral catheter can cause damage to the
bladder neck, leading to urinary leakage. A catheter that is forced
through the external sphincter can cause damage.
The catheter is less likely to be sat on and accidentally ‘pulled’.
If a suprapubic catheter becomes blocked, urine can drain via the
urethra (although this may not be possible for everyone). This can act
as a‘safety net’ if a person is affected by autonomic dysreflexia when
the catheter blocks.
A larger size catheter can be used suprapubically, reducing the risk of
blocked catheter. (The larger the catheter, the larger the drainage
holes, which reduces the frequency of catheter blockages.)
Urethral catheters should not exceed size 14Ch, whereas a
suprapubic catheter can be gradually increased over a period of time
from a size 16Ch up to a size 20Ch.
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Disadvantages of a Suprapubic Catheter:
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A few people experience hypersensitivity around the suprapubic
catheter site, but this often reduces with time.
If a person is very overweight it may be difficult to site the catheter.
The catheter site may produce a discharge. In some people this dries
up after a few weeks, but in others it may be persistent. It may be
necessary to wear a simple dressing over the site.
Spasm may increase for a few weeks after the procedure.
All indwelling catheters are more likely to cause urinary tract infections
and bladder stones, than other bladder management methods such as
intermittent catheterisation or sheath drainage.
Key Points for Catheter Management
To reduces risk of cross-infection and catheter-related infection;
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Daily bathing or showering is encouraged.
Gloves are worn to empty drainage bags and changed after hand
washing between each individual
A closed drainage system is maintained as far as possible. Maintaining
a closed drainage system reduces the risk of catheter-related infection
(Kunin, 1997)
Encourage to drink at least 3 litres of fluids (8 glasses) per day to flush
through the kidneys and bladder, and to prevent urinary tract infections.
If the urine is cloudy, has a bad smell, or has blood in it, seek medical
help as there is probably have a bladder infection.
Be careful with drinks that have caffeine or alcohol. They can make the
bladder fill up suddenly and cause one to get dehydrated.
A separate clean container is used for each individual at the time of
bag emptying. Contact between drainage tap and container is avoided.
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Leg bags may also be emptied directly into the toilet. Leg bags should
be changed every 5-7 days but if it becomes disconnected from the
catheter it should be changed or is visibly dirty /damaged .
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Night bags ;there are 2 types drainable and non drainable If it is non
drainable a new, single-use 2 litre beside bag is used and is emptied
and discarded each morning. whereas drainable bags can be reused
for up 5-7 nights.
Regular observation for:
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Constipation.
Incorrect positioning of drainage tube/kinked tubing. Beside-type
drainage bags should be supported above floor level which ensures the
maintenance of flow of urine and maximum drainage by gravity, and
helps to prevent harmful reflux.
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Drainage bag over full .Trauma to the neck of the bladder may be
caused by downwards pull of the catheter if the bag is left to become
too full or is not adequately supported. Empty when three quarters full.
Balloon under or over inflated. It is usual to have 10mls of water in the
catheter balloon. If it is found that the amount of water in the balloon
has reduced when the catheter is next changed, do not worry, it is not
unusual.
If the catheters are falling out before their change date, it will be
necessary to replace the water in the balloon i.e. remove the amount
in the balloon and insert 10mls of sterile water back into the balloon.
Encrustation (Up to 50% of all users of long term catheters)
Debris- If a service users intake is low the urine becomes concentrated
and any debris is less likely to be flushed from the bladder
Catheter size may be too large.
Caring for a suprapubic catheter:
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Use a thigh strap and, if necessary, tape the catheter to the abdomen.
This will reduce the likelihood of the catheter being ‘pulled’.
It is advisable to alternate the leg one wears the leg bag on. This helps
the catheter to lie in a different position each day, minimising soreness
at the catheter site.
Some people use a catheter valve with their suprapubic catheter which
enables them to turn their urinary drainage off and on. This may also
mean that you may be able to manage without a urinary leg bag.
Consult the Continence Promotion Unit.
Catheter maintenance solutions:
Irrigation is the continuous washing out of the bladders with sterile fluid
to prevent and dissolve crystallization in the catheter or the bladder, to
remove tissue debris and small blood clots and to prevent and reduce
bacterial growth
Some service users may benefit by using catheter maintenance solutions
to prolong the life of their catheter, avoiding the trauma of recatheterisation.
Catheter maintenance solutions are only used following medical advice,
prescription and thorough assessment
There are many potential causes of catheter blockage, and treatment
should be based on clinical evidence.
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Records maintained of catheter history including:
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Problems associated with bowel habit
Debris in urine
Crystals on catheter tip at removal
The pH scale
The pH scale is measured regularly to decide which type of Catheter
Maintenance Solution is required.
Urinary pH is a measurement of the acid –alkaline content in urine which
ranges from 0 to 14 and is measured using a dipstick/Uritest .
The 0 end of the scale is where the concentration is increasingly acidic.
Most biological fluids are between pH 6 and pH8, there are a few
exceptions to this like stomach acid. Braun recommends that if there is
debris but the pH is normal .9% saline can be used to remove debris. If
the pH is >6.8 and there is debris/crystals suby G is to be used and if the
person is a persistent blocker and the pH is >7.7 solution R is to be used.
Administration of catheter maintenance solutions requires breakage of the
closed drainage system increasing the risk of introducing infection and
infection control guidelines need to be adhered to:
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Where a catheter maintenance solution is used, the effect of the
treatment is assessed and ongoing care planned accordingly.
Records are advised the of solution used, effect on catheter drainage,
any adverse reactions and ongoing catheter history as before
Keep Best Possible Health Catheter Maintenance.
A Best Possible Health Specialised Bladder plan will include annual or as
required recommendations to;
Commence Bladder / Intake / Output Chart
Review need for aids/appliances
Healthy bladder information
Referral to GP/Physio/Urologist/Continence Promotion Unit.
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Bladder Assessment Tool:
The bladder assessment tool records if the service user has AOB, neurogenic
bladder incontinence or overflow incontinence. This will be recorded in the
Best Possible Health Continence care plan which will be supervised by a
Cheshire nurse/PHN/Continence Promotion Unit.
Checklist for bladder management
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Best Possible Health Specialised Bladder plan.
Catheter Diary.
Referral to a urologist with an interest in the Neurogenic bladder for
regular (preferably yearly) urodynamics to check bladder and kidney
function.
Access to Cheshire nurse, PHN, Continence adviser with knowledge of
the Neurogenic bladder.
An explanation of how good bladder management will protect the
kidneys.
Ability to recognise urinary tract infections and know how to deal with
them.
Discuss continence products management techniques with the PHN /
Continence nurse that may help the service user to effectively manage
the bladder problems.
Appendices:
Appendix 1. Spina Bifida and bladder problems
Most service users with Spina Bifida may experience problems with their
bladder. It is important to make an appointment with the G.P. or continence
nurse about bladder problems and ensure that service users affected can
manage their bladder problems successfully.
Latex allergy
23-50% of people have latex sensitivity and this Latex allergy can get worse.
It is recommended to avoid exposure to latex in hospital and home. Carry
non-latex gloves with you to doctor/dentist/Medic-alert bracelet/Epi-pen.
Page 16 of 25
Appendix 2 Multiple Sclerosis (MS) and Incontinence
Approximately, 3 in 4 people with MS will suffer with continence
problems, bladder and bowel problems can come and go and can be
more pronounced at some times than at other times.
It is difficult for service users to discuss continence problems but it is
important to talk to a health professional as there is help and support
available. .Incontinence can also develop as a ‘secondary symptom’ which
means that incontinence can be caused by another symptom and not directly
by MS nerve damage. These symptoms can include:
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Getting to a toilet in time. MS makes moving about difficult which can
cause problems in getting to a toilet. A visit to an occupational therapist
may be able to help with these problems.
Restricted physical activity can often lead to constipation and poor
muscle tone which can then lead to bladder and bowel problems. A
physiotherapist could help and set an exercise programme which could
help to alleviate problems.
Appendix 3.Autonomic dysreflexia (AD)
All staff need to identify if the service user is affected by autonomic
dysreflexia when caring for people with spinal cord injuries. Autonomic
dysreflexia, occurs at injury levels above T-6 (mid chest). It can develop
suddenly and is potentially life threatening and is considered a medical
emergency.
Definition:
AD occurs when an irritating stimulus is introduced to the body below the level
of spinal cord injury, such as an overfull bladder, poor bowel care or skin
problems. The most common cause seems to be overfilling of the bladder.
This could be due to a blockage in the urinary drainage device, bladder
infection (cystitis), inadequate bladder emptying, bladder spasms, or possibly
stones in the bladder
Signs or Symptoms of AD are:
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high blood pressure
pounding headache
flushed face
red blotching on chest
sweating above level of injury
goose bumps
nausea
feeling anxious.
Page 17 of 25
Staff can help prevent AD by:
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Keeping the catheter equipment clean and draining freely.
Emptying the bladder routinely.
Following a regular bowel program.
Checking skin daily.
Wearing loose fitting clothing and checking for painful stimuli and
removing.
If signs of distress or autonomic dysreflexia occurs:
• Stop the any bladder procedure,
• Sit upright as this will bring blood pressure down slightly.
• Follow guidelines
•
Contact Accident & Emergency Department
• On arrival at hospital a person should be specifically coded for
immediate attention
• Remember - Carry a Card! Always remind service user to carry a
card which identifies AD. Give this to staff in an Emergency Room or
the doctor's office if the service user has an AD attack.
Page 18 of 25
Appendix 4. Bladder Assessment Tool and Catheter Diary
Does the Service User:
Leak urine when they: Laugh
Cough
Exercise
Have leaking or wetting accidents?
Appear to have an urgent need to pass urine?
Is the service user able to hold on for a few minutes?
Or do they have to go immediately?
Get up from bed
Yes
No
Yes
No
Yes
No
Yes
No
How Often:
Will the service user go to the toilet during the day? 5-7 Times
Get up during the night to use the toilet/urinal?
1
2
Does the Service User:
Know when they need to use the toilet?
Have difficulty in passing urine?
Have weak flow or post voiding dribble?
Complain they have a full bladder even after going to toilet?
Know when they want to go but are unable to go to toilet?
Have a history of UTI’s
Complain of: Pain
Yes
No
Bleeding
or 7 plus
3 or more
Yes
Yes
Yes
Yes
Yes
How many per year ________
Discomfort when passing urine
Result of Urinalysis _______________________________________
Result of MSU
No
No
No
No
No
________________________________________
Details of Urology / Other investigations _______________________
_________________________________________________________
Stress
OAB
Nocturnal
Enuresis
Neurogenic
Or
Outflow/
Obstruction
Functional
Infection
Page 19 of 25
Catheter Diary
Please ensure this booklet is completed
Each time your catheter is changed
Service user: ................................................................................................................
Address ........................................................................................................................
.....................................................................................................................................
G.P.Name and contact details . ...................................................................................
Consultant: ...................................................................................................................
Health Care Professional (PHN Nurse/Cheshire Nurse etc.) Name and contact
details:
.....................................................................................................................................
1a. Reason for catheterization: ..................................................................................
1b. Date of initial catheterization: ...............................................................................
2.
Recommended catheter:......................................................................................
Manufacturer: .......................................................................................................
Type: ....................................................................................................................
Charriére (Ch.) size:.............................................................................................
Balloon size:.........................................................................................................
3.
Residual: ..............................................................................................................
4.
How often catheter should be changed:……………………………………………..
5.
Known Allergies: ..................................................................................................
Page 20 of 25
Catheter Diary continued
Catheter Change Date:
Insertion Easy:
Yes/No
…………………………………………
Comments/Problems:.............................
..............................................................
..............................................................
Reason for change:
Routine
Fallen Out
Balloon Burse
Blocked
Catheter Maintenance Solutions/Antibiotic Therapy
Give Details: ......................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
CSU Yes
No
Name of Nurse/Doctor/Carer: ............................................................................................
Due Date of Catheter Change: ..........................................................................................
Recorded in BPH Daily Continuation sheet----------------------------------------
Catheter Change Date:
Insertion Easy:
Yes/No
…………………………………………
Comments/Problems:.............................
..............................................................
..............................................................
Reason for change:
Routine
Fallen Out
Balloon Burse
Blocked
Catheter Maintenance Solutions/Antibiotic Therapy
Give Details: ......................................................................................................................
..........................................................................................................................................
CSU
Yes
No
Name of Nurse/Doctor/Carer: ............................................................................................
Due Date of Catheter Change: ..........................................................................................
Recorded in BPH Daily Continuation sheet----------------------------------------
Page 21 of 25
Catheter Irrigation (Flushing) Record
Name: ________________
Date
Date of
Next
flush
Solution used
Cheshire Service _____________
Amount
PH
Signature
Cheshire Ireland
Document Name: Catheter Irrigation (Flushing) Record
Document Number: CR 01 Version Number: 0 Version Date: 1/6/11
Developed by: Practice Development Coordinator Approved by: National Risk Management Committee
Approval Date: 1/6/11
Review Date: 31/5/13
Observations
Page 22 of 25
Catheterisation Record
Name: ________________
Date of
Insertion
Date of Next
Change
Catheter
Type
Size
Balloon
Volume
Signature
Reason For Change
Cheshire Ireland
Document Name: Catheterisation Record
Document Number: CR 01 Version Number: 0 Version Dat1/6/11
Developed by: Practice Nurse Coordinator
Approved by: National Risk Management Committee
Approval Date1/6/11
Review Date: 01/6/13
Page 23 of 25
INTAKE AND OUTPUT RECORD
NAME: __________________
_____________
Time
Type of Fluids
Oral
PEG Vol
DATE:
Food Intake
Other
Output
Bowels
Flush
TOTAL
TOTAL IN :
TOTAL OUT :
PEG Feed Regime
Type of PEG Feed
Time Started
Rate
Time Finished
Urinalysis Record
Blood
Protein
Leukocytes
Glucose
Ketones
PH
Cheshire Ireland
Document Name: Input Output Recor Document Number: IOR 01 Version Number: 0 Version Date:
Developed by: Nurse Development Forum
Approved by: National Risk Management Committee
Approval Date: 1/6/11
Review Date: 31/05/13
Comment
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Appendix 5. What does the continence advisory nurse do?
There is usually open access to continence promotion clinics and details can
be found by contacting your local HSE area. People can also be referred by
GPs, practice nurses or public health nurses.
The services are for people who have all types of incontinence.
At the clinic a detailed assessment is carried out. This will include questions
about the nature of a service user’s problem and the symptoms. A urinalysis
will be carried out and bowel history if appropriate.
Other issues will be reviewed such previous surgery, underlying medical
condition, current medication, emotional aspects, and mobility problems.
Where appropriate, the continence nurse may refer for specialist advice.
Urologists, gynaecologists, physiotherapists, dietitians and occupational
therapists all have a role in treating various types of incontinence.
The continence service can give guidance and advice on issues such as:
•
•
•
•
•
•
•
•
•
•
•
Readjusting fluid intake
Bladder retraining
Pelvic floor exercises
Individualised toileting programmes
Bowel programmes
Self catheterization
Catheter management
Medication review
Environment changes
Counselling and advice
Electrotherapy
Diagnosis of Neurogenic Bladder
A thorough bladder history is essential to record 24-hour urination patterns,
including the actual volume of urine voided, how urgent the feeling is to
urinate and any factors that aggravate incontinence.
A t the Urology Assessment Unit a physical examination will likely include a
rectal, genital, and abdominal exam to check for enlargement of the bladder
or other abnormalities. A complete neurological examination is also essential.
Tests to measure urine output are conducted.
To determine whether urine is retained after voiding, the doctor may use an
ultrasound-like instrument that estimates the amount left in the bladder or
insert a catheter into the bladder.
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Urine or blood samples may be taken to look for abnormalities including
infection and underlying disorders that might be causing or aggravating the
condition.
References
Mallett, J. & Dougherty, L. (2000). The Royal Marsden Hospital Manual of
Clinical Nursing Procedures. Blackwell Publishing, Oxford.
Nicol. M., Bavin, C., Bedford-Turner, S., Cronin, P. & Rawlings-Anderson, K.
(2004). Essential Nursing Skills. Mosby, United Kingdom.
Robertson, B. & O’Kell, S. (1995). Study Guide for Health and Social care
Support Workers. First Class Books Pub., Bristol.
How to Take Care of a Suprapubic Catheter | eHow.com
An overview of Supra-pubic Catheter Care in Community Practice
Deborah Rigby, NHS, Bristol
Catheter Care RCN Guidance for Nurses 2008
Why is a Suprapubic Catheter better than a Urethral Catheter? Duke of
Cornwall Spinal treatment centre NHS Trust
Urinary tract Infections UTIS www.mayoclinic.com
Bowel and bladder foundation email info@bladderand bowelfoundation.org