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1. Introduction ² including standard statement
2. Education of patients, carers and staff
3. Assessing the need for catheterisation
4. Risk of infection following insertion of an indwelling urinary catheter
5. Catheter drainage options
6. Catheter insertion
7. Catheter maintenance
8. Catheter maintenance solutions
9. Obtaining a catheter specimen of urine
10. References and Bibliography




This policy should be known and used by all staff dealing with urinary catheters.
It is based on guidance from the National Institute for Clinical Excellence and the Epic
Project funded
by the Department of Health.
 
 


Policy Objectives:
[?Every member of PCT staff dealing with urinary catheters will be able to appropriately
manage them to minimize the risk of infection
[? anagement will regularly review the use and management of equipment used in urinary
catheterisation, seeking advice from the Continence Team
Standard Statement: All staff dealing with urinary catheters do so in a manner which
minimizes the risk of infection and prevents cross-infection
Training Requirements: All staff dealing with urinary catheters should ensure that they are
2
competent to do so. The Continence Advisory Service recommend nursing staff attend
training
on urinary catheter insertion and management on a yearly basis
Independent Contractors
All Independent Contractors are wholly responsible for the management of risks within their
practice. To support Independent Contractors in satisfying this duty the PCT urges full
compliance with the PCT·s governance policies and procedures. Governance policies and
procedures cover clinical, risk and infrastructure issues.
The provision of directly managed PCT services within an Independent Contractor·s practice
may be dependent on full compliance with all the PCT·s governance policies and procedures.
Failure to provide evidence of compliance may result in the withdrawal of direct PCT
services.
` 

 

  

[?Patients and their carers should be educated about infection control aspects of catheter
management including good hand hygiene
[?Staff dealing with urinary catheters should have been trained to do so
^ 


 

 



[?An indwelling catheter should only be inserted following consideration of other
management alternatives
[?The patient·s need for a urinary catheter should be regularly reviewed and the catheter
should be removed when it is no longer needed
[?here a catheter is inserted, details of the date, size, type and reason for insertion should
be
documented in the patient·s catheter diary. It is also recommended that the lot number and
expiry date of the catheter are documented.
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80% of urinary infections (which make up 23% of all Health-Care Associated Infections) can
be
traced back to indwelling urinary catheters. The urethral catheter overcomes many natural
defences, including insertion, presence of a foreign body, absence of a flushing mechanism,
biofilm formation and epithelial damage. The morbidity and mortality risks to patients are
significant. This is supported by Kunin et al (1992) in an American study of catheterised
elderly
patients in a nursing home. They found that catheterised patients were 3 times more likely to
receive antibiotics, 3 times more likely to be hospitalised and 3 times more likely to be dead
by
the end of the year.
 ¢  

 


[?Intermittent catheterisation should be used in preference to an indwelling catheter if it is a
clinically appropriate and practical option for the patient
[?The choice of catheter size and material should be made based on an individual patient
assessment
3
[?Patient·s with latex allergy/sensitivity should be given a latex-free alternative catheter (such
as silicone) and catheter products. Please refer to PCT Latex Sensitisation policy for further
information
[?The catheter balloon should be a 10ml size in adults and 3-5ml in children unless otherwise
indicated
[?here appropriate, a catheter valve may be used instead of a drainage bag
i 
 

 

  
[?Catheterisation is an aseptic procedure
[?Staff inserting urinary catheters should have been trained to do so and should ensure that
they maintain their levels of competence
[?Intermittent self catheterisation is a clean procedure
[?Intermittent catheterisation performed by nursing staff is an aseptic procedure
[?The meatus should be cleaned prior to insertion of the catheter
[?A lubricant from a single use container should be used to minimise urethral trauma
Ñ ¢ 




[?Following catheterisation, the catheter should be connected to a sterile closed urinary
drainage system or valve
[?The connection between the catheter and drainage bag should only be broken for a good
clinical reason
[?Hands should be washed and a pair of clean (non-sterile) gloves should be worn for
catheter
manipulations
[?†rinary drainage bags should be kept below the level of the bladder and off the floor
[?In order to maintain the system, overnight bags when used should be attached in a link
system rather than replacing the day bag
[?Items which carry the single use symbol should not be reused, even on the same patient
[?The patient and/or carer should be advised that the meatus should be cleaned daily with
soap and water as part of the patient·s daily hygiene routine
[?Catheters should only be changed when clinically indicated or according to manufacturers·
instructions rather than routinely
[? ost patients will use single use intermittent catheters. But some patients still prefer
reusable intermittent catheters, these should be cleaned according to manufacturers·
instructions and stored dry
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The use of maintenance solutions is beyond the scope of this policy, other than to state that:
[?They should only be used as part of the treatment of the catheter and not to be used
routinely
[?And that the use of anti-microbial or antiseptic bladder washouts, for example,
chlorhexidine is not advocated for treating bacteriuria, catheter blockage or preventing urine
infections since they are of little benefit
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4
[?An aseptic technique should be used
[?The sampling port should be used to obtain urine specimens
[?The port should be swabbed with a 70% alcohol preparation prior to obtaining the sample
using a new needle and syringe
[?The urine specimen should be transported in the PCT provided specimen storage box and
should be sent to a collection point (i.e GP  edical Practice) within 2 hours of obtaining the
sample, this guidance is given by the microbiology department at Sheffield Teaching
Hospitals
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Craven, Harrogate and Rural District Primary Care Trust (2004) ¢


 





   
DOH (2003)    
 

 
  
  



   
 London
DOH (2006) 
  

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Epic (2000)  
  
 

  
  
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Thames Valley †niversity, London
Kunin et al (1992) ! 
 

     

 
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   " IN Roe, B. 1993, catheter associated urinary tract
infection a review,
Journal of Clinical Nursing, 2 (p197-203)
NICE (2003) ¢   

 
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   NICE, London
Oxfordshire Continence Advisory Service (2006) 
  
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Royal  arsden Hospital (2005) %    ¢   
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estern Sussex Primary Care Trust (2005) 
  
 
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