Catheter Care for Health Professionals
Expert: Merrill McPhee
Merrill McPhee is a Registered Nurse with over 20 years’ experience in the field. Prior to working in continence management, she worked as a midwife and Associate Nurse Manager. She specialised in continence nursing in 2002 while assisting with Urodynamics at the Royal Women’s Hospital Urogynae Out Patients ward. Merrill joined the Continence Foundation of Australia’s National Continence Helpline (NCHL) in 2006 and currently shares the role of NCHL Co-Ordinator and sits on Victorian Continence Resource Centre board.
Watch the video
This video looks at the common problems clients experience with catheterisation and offers some practical solutions to be given or followed up by health professionals. It highlights the importance of having a clear and detailed catheter care plan for clients to ensure good ongoing management.
Q&A with Continence Nurse Advisor Merrill McPhee
Q: I have heard about products that can attach to the body to hold the catheter in place? Are they helpful and worthwhile? Where can I find them?
A: The benefits of a catheter fixing device are as follows:
- they allow security for the client;
- prevents the indwelling catheter from moving and causing displacement of the catheter, and
- allows for increased movement of the catheter within the urethra.
The fixing devices are available in two sizes, paediatric and adult, and come as a disposable adhesive device that remains in place on the body for 7 or 10 days, depending on the actual device used. There are also leg straps which are re-usable.
The products are available from several national product suppliers and information about these suppliers can be obtained from the National Continence Helpline (NCHL) (Freecall 1800 33 00 66). Funding support and referral to appropriate services are available through discussion with the nurses at NCHL or your local continence service.
Q: I’ve had issues with clients where an indwelling catheter has frequently leaked. Do you have any tips for managing bypassing problems?
A: Bypassing generally doesn’t occur in all clients who have indwelling catheters or suprapubic catheters but can regularly occur in some clients. The two main reasons why catheters become blocked are encrustation and recurrent blockage.
To avoid bypassing, the urine drainage system which includes catheter, bag and tubing should be well supported below the level of the bladder. For clients in wheelchairs, thigh bags are often used and if not positioned properly (i.e. the bag is positioned higher than the bladder) this will affect the drainage of urine as it would be draining against gravity. Conversely, the bag should not be more than 30cms below the bladder as the negative pressure may cause the bladder mucosa to be sucked into the eyelets of the catheter.
Make sure to choose a bag with the appropriate length as tubing as excessive length can twist and kink. Sudden blockage of the catheter can be a distressing common emergency because it can occur at any time. If there is no nurse available to change the catheter then the client should be referred to the nearest Emergency Department.
Q: What is the cause of Urinary Tract Infections in clients with indwelling catheters?
A: Urinary tract infections are often associated with clients who have an indwelling catheter. This is because indwelling catheters are an attractive site for breeding bacteria. Bacteria can migrate along the outer surface of the catheter or l up the internal surface of the drainage tube and catheter. Bacteria on the catheter surface form a biofilm, which is a living layer of cells. These cells produce a sticky polysaccharide-glycocalyx that adheres to the surface of the catheter and protects the bacteria of the antibiotics
The biofilm may start as a small colony of bacteria that rapidly coats the whole catheter surface. Certain types of bacteria, especially those that produce urease such as Proteus Miribilis, can cause significant problems.
Generally asymptomatic urinary tract infections are not treated with antibiotics, treatment is only for clients who are symptomatic.
Q: Do you have any advice on how to manage a client who has a long-term catheter and also suffers from chronic constipation?
A: Bowel management is a must to prevent constipation which can also cause blockage. This is due to the over distended bowel pressing on the catheter and preventing urine flow. Practical ways to manage constipation are with a good diet including vegetables, fruit, sometimes prunes, pear juice and kiwi fruit can be helpful. Ensuring adequate amounts of fluid are consumed. 1 .5- 2 litres of a variety of fluids, which should include water, is recommended.
Finally, adding fibre to the diet can be helpful, so speak to a GP or pharmacist about the most appropriate kind to use. It’s also important to remember that the amount of fibre used depends on the client’s response to the product, it is best to commence use with a small amount and increase according to the client’s needs.
Q: I’ve had issues with catheters falling out. Why does this happen?
A: There are a few reasons why this might occur:
- if the balloon deflates
- no water was put into the balloon on insertion of the catheter.
- the catheter has not been attached with a fixing device and if the catheter is caught on clothing or a chair or when moving a client.
- bladder spasm which forces the catheter out
In the case of a suprapubic catheter which has fallen out, a medical practitioner or continence nurse should be contacted immediately so that the suprapubic catheter can be reinserted. If there is no-one available then the client should go to the nearest emergency department. The stoma/ orifice through which the catheter is inserted into the abdomen will start to close over after a very short time (check time) if the suprapubic catheter is not reinserted. Emergency plans should be written in the clients catheter care plan.
Q: How do I find the best drainage system for my client who lives in the community and is there funding options I can apply for?
A: On occasion products do change and it is best to use a product that is beneficial to your client. Sample products are available and the sourcing of appropriate products can be assisted by Continence Nurses on the NCHL. The products are available from several national product suppliers and information about these suppliers can be obtained from the National Continence Helpline (Freecall 1800 33 00 66). Funding support and referral to appropriate services are available through discussion with the nurses at NCHL or your local continence service.
Q: I was interested in your video that you recommend to wash overnight bags. With the recent changes to the recommendations of not re-using self-caths, I was under the impression overnight bags were also single use items. Can you please clarify?
A: Firstly, it is important to maintain a closed system. The catheter is usually connected to a day bag. Unless there is a medical recommendation not to do so, day bags can be left place for up to 7 days before replacing. As a one way drainage system, the overnight bag can be attached to the bottom of the day bag and removed each morning. The overnight bag itself can be reused for up to 2 weeks unless it becomes stained or odourous. When washing the bags it is usually suggested that warm water is used with a very small amount of mild liquid detergent. It is recommended to follow manufacturer’s instructions in the use of all these products.