Catheter Care - Royal College Of Nursing
Catheter CareRCN Guidance for Health Care ProfessionalsCLINICAL PROFESSIONAL RESOURCEThis publication is supported by industry
CATHETER CARE: RCN GUIDANCE FOR HEALTH CARE PROFESSIONALSAcknowledgementsRoyal College of Nursing (RCN) Continence Care Forum Committee:Ali Wileman, Sharon Holroyd, Anne Carroll, Jane Fenton, Karen IrwinJulie Taylor, Bladder and Bowel Specialist Practitioner, Humber Teaching NHS Foundation TrustSue Hill, Independent Continence Specialist NurseSarah Bee, Senior Continence Specialist Sister, Rotherham, Doncaster and South Humber NHSFoundation TrustAmanda Cheesley, RCN Professional Lead for Long Term Conditions and End of Life CareRose Gallagher MBE, RCN Professional Lead for Infection Prevention and ControlThe RCN would also like to thank all the authors and contributors of previous editions of thisguidance.This publication is supported by:This publication is due for review in October 2022. To provide feedback on its contents or on yourexperience of using the publication, please email publications.feedback@rcn.org.ukPublicationRCN Legal DisclaimerThis is an RCN practice guidance. Practice guidance areevidence-based consensus documents, used to guide decisionsabout appropriate care of an individual, family or population in aspecific context.This publication contains information, advice and guidance tohelp members of the RCN. It is intended for use within the UKbut readers are advised that practices may vary in each countryand outside the UK.DescriptionThe information in this booklet has been compiled fromprofessional sources, but its accuracy is not guaranteed. Whilstevery effort has been made to ensure the RCN provides accurateand expert information and guidance, it is impossible to predictall the circumstances in which it may be used. Accordingly, theRCN shall not be liable to any person or entity with respect toany loss or damage caused or alleged to be caused directly orindirectly by what is contained in or left out of this websiteinformation and guidance. The sponsors have not had anyeditorial input into the content, other than a review for factualinaccuracies.This guidance has been developed as a resource and frameworkfor health care professionals who undertakes urinarycatheterisation as part of their role.Publication date: February 2019 Review date:October 2022The Nine Quality StandardsThis publication has met the nine quality standards of thequality framework for RCN professional publications. For moreinformation, or to request further details on how the nine qualitystandards have been met in relation to this particularprofessional publication, please contact publications.feedback@rcn.org.ukPublished by the Royal College of Nursing, 20 Cavendish Square,London, W1G 0RN 2019 Royal College of Nursing. All rights reserved. Nopart of this publication may be reproduced, stored in aretrieval system, or transmitted in any form or by anymeans electronic, mechanical, photocopying, recording orotherwise, without prior permission of the Publishers. Thispublication may not be lent, resold, hired out or otherwisedisposed of by ways of trade in any form of binding or coverother than that in which it is published, without the priorconsent of the Publishers.EvaluationThe authors would value any feedback you have about thispublication. Please contact publications.feedback@rcn.org.ukclearly stating which publication you are commenting on.2
ROYAL COLLEGE OF on, policy and good practice73.Competence104.Documentation125.Anatomy and physiology156.Consent187.Reasons for, and decisions influencing, catheterisation208.Risk assessment229.Catheter-related equipment2510.Suprapubic catheterisation2711.Trial without catheter3012.Intermittent self-catheterisation3313.Catheter care review and follow up3714.Patient education4115.Catheter maintenance solutions, bladder washouts and irrigation4316.Infection control and catheter care4517.Catheter guidance for the end of life48References and further reading49Appendix 1: Urinary catheter and related equipment52Appendix 2: Urethral catheterisation procedures for male and female patients53Appendix 3: Guidance at a glance – urinary catheters573
CATHETER CARE: RCN GUIDANCE FOR HEALTH CARE PROFESSIONALSForewordWe are indebted to the work done by both presentand past members of the RCN Continence CareForum Committee. We are also immenselythankful for the expertise and willingnessof other key members of the RCN and otherswho have suggested additions and changes –their help has been central to the successfulrevision of this document. I would like to thankSharon Holroyd for working with previous keycontributors to the earlier versions and leadingon this new edition.The Royal College of Nursing’s (RCN) cathetercare guidance has been used widely by manyhealth care professionals over the years. Theguidance has not only influenced practice andteaching, but has also been used, and quotedextensively, within local policies. It is with greatpleasure that the RCN is able to publish thisupdated edition.By providing a full understanding of the NationalOccupational Standards (NOS), this revisedpublication aims to encourage further adoptionof the standards across all NHS and independenthealth care sectors, leading to good quality carefor patients.I am also very grateful to Sharon Holroyd whowillingly took on the editorship, incorporatingthe suggested changes and additions, reviewingother parts and updating the reference section.Continence is one of the fundamentals ofnursing care and maintaining continence cansignificantly increase a patient’s quality of life.Many people may need the support of continenceproducts, such as catheters, to help them managetheir everyday activities. Catheters can providean effective way of draining the bladder, for bothshort and long-term purposes, and it is thereforeimportant that the NOS are available to guidepractice in catheter care.I hope practitioners will continue to benefitfrom this publication and, more especially,our patients, by fostering good evidence-basedpractice.I would also like to thank Skills for Healthfor ensuring the information on the NationalOccupational Standards is up to date.Ali WilemanChair, RCN Continence Care Forum CommitteeThe NOS relating to catheter care were developedthrough a partnership between the RCN andSkills for Health (SfH), with funding supportfrom B. Braun, BD Medical, Coloplast andWellspect. The previous edition of Catheter Carehas been updated, with input from the RCNContinence Care Forum, other RCN forumsand independent health care and academicprofessionals to give an up-to-date and easy-touse document.Sharon HolroydEditor4
ROYAL COLLEGE OF NURSING1. Introductionteaching and other developments withincatheter careIn 2006 the RCN and Skills for Health (SfH)jointly identified a need for competencesrelated to continence care. On completion ofscoping, development, field testing and approvalprocesses, a competence suite – containing sixcompetences for catheter care – was produced. Afull insight into the competency frameworks canbe found at the SfH website atwww.skillsforhealth.org.uk However, the document is not a compendium ofevidence and many of the statements are basedon clinical experience and expert opinion.How to use this publicationThe following six areas related to cathetercarewas included in the competence suite.1.recent evidence has been identified andselected to support this guidance.It is recognised that a diverse workforce ofboth registered and non-registered staff nowdeliver health care in a variety of settings.This publication is a resource and frameworkfor practice for any health care professional(HCP) who is required to undertake urinarycatheterisation as part of their role (this maybe a registered practitioner or an unregisteredpractitioner working under the guidance/supervision of someone on a professionalregister). It can be used in a number of ways,including:Insert and secure urethral catheters.2. Monitor, and help individuals to self-monitor,urethral catheters.3. Manage suprapubic catheters.4. Undertake a trial without catheter (TWOC).5. Enable individuals to carry out intermittentself-catheterisation.6. Review catheter care.The aims of this updated publication are thesame – to produce further clarity and depth tothe six competences related to aspects of cathetercare. As before, the design and development ofthis publication has been shaped by a number ofconsiderations and features: as a practical guide to take the NOS to auser-friendly clinical level within the widernursing workforce forming a catheter care benchmark to reflectand compare competence and practiceagainst, within the wider nursing workforce it is written and designed for a nursing audience it aims to link the six approved catheter carerelated competences within one documentand enhance core themesas a point of reference to support academicwork related to catheter care for health careprofessionals the order of content within the documentaims to reflect that used by SfH in the designof its competencesas a point of reference for the developmentof KSF-friendly job descriptions related tospecialist HCPs working within catheter care it is written and endorsed by a group ofexpert practitioners, and represents theircollective views and opinionsin recruitment plans, advertising, staffselection and appraisals within the widernursing workforce each section focuses on a specific statementor group of statements taken from thecatheter care related competencyas a nursing resource to support thedevelopment of guidelines, policies andprotocols related to catheter care at a local level as a guide for the development of cathetercare related clinical procedures to support catheter care related nursingassessment and the effective use of thenursing process at all levels of practice each section of the document ‘maps out’ awide range of SfH competences that relate tothat specific aspect of catheter carethere is a need for an up-to-date RCNpublication on catheter care to help enhance5
CATHETER CARE: RCN GUIDANCE FOR HEALTH CARE PROFESSIONALS to inform integrated catheter care pathways(ICPs) as a framework on which to develop cathetercare related teaching material, programmesof learning and courses to stimulate nursing audit and researchactivity in catheter care.6
ROYAL COLLEGE OF NURSING2. Legislation, policy and goodpracticeAbrams P, Cardozo L, Wagg A, Wein A (Eds)Incontinence 6th Edition (2017) ICI-ICS.International Continence Society, Bristol: UK,ISBN: 978-0956960733.What you need to knowYou need to apply: legislation, policy and good practice, thecurrent international, European, UK andnational legislation, guidelines and localpolicies, protocols and procedures whichaffect your work practice in relation to thecare of individuals using urinary cathetersEuropean Association of UrologyNurses (EAU/ EAUN)Thurroff J, Abrams P, Andersson K, ArtibaniW, Chapple C, Drake M, Tubaro A (2011) EAUGuidelines on urinary incontinence, EuropeanUrology 59: 387–400.a factual knowledge of the currentEuropean and national legislation, nationalguidelines, organisational policies andprotocols in accordance with clinical/corporate governance which affect yourwork practice in relation to the care ofindividuals using urinary catheters.Geng V, Cobussen-Boekhorst H, Farrell J,Gea-Sánchez M, Pearce I, Schwennesen T,Vahr S, Vandewinkel C (2012) Catheterisation.Indwelling catheters in adults – Urethral andsuprapubic, Arnhem: The Netherlands.Vahr S, Cobussen-Boekhorst H, Eikenboom J,Geng V, Holroyd S, Lester M, Vandewinkel C(2013) Catheterisation. Urethral intermittent inadults, Arnhem: The Netherlands.The above statements appear in a significantnumber of NOS. In essence, they relate to keydocuments and publications which influencethis specific aspect of care, and outline yourareas of responsibility.Journal of Hospital InfectionNational Occupational StandardsLoveday HP, Wilson JA, Pratt RJ (2014)Epic3: national evidence-based guidelines forpreventing healthcare associated infections inNHS hospitals in England, Journal of HospitalInfection 86(1 Suppl): S1–70.Some key documents that relate to catheter careare listed below; this is not a comprehensive orexhaustive list. Please use it as a guide to influenceyou within your area of care and responsibility.Medicines and Healthcare ProductsRegulatory Agency (MHRA)British Geriatrics SocietyBritish Geriatrics Society (2018) Continencecare in residential and nursing homes. Clinicalguideline, London: BGS.Medical devices regulations: compliance andenforcement (updated 24 March 2017), London:MHRA.International Continence Society (ICS)Association for Continence Advice(ACA)Haylen B, de Ridder D, Freeman R, Swift S,Berghmans B, Lee J, Schaer D (2010) AnInternational Urogynecological Association(IUGA)/International Continence Society (ICS)joint report on the terminology for female pelvicfloor dysfunction, International UrogynecologyJournal, 21: 5–26.Association for Continence Advice (2016)Guidance for the provision of continencecontainment products to children and youngpeople. A consensus document.Association for Continence Advice (2017) Guidancefor the provision of containment products foradult incontinence. A consensus document.Feneley R, Hopley I, Wells P (2015) Urinarycatheters: history, current status, adverseevents and research agenda. Journal of MedicalEngineering and Technology 39(8): 459–70.7
CATHETER CARE: RCN GUIDANCE FOR HEALTH CARE PROFESSIONALSDepartment of Health (2015) Health andSocial Care Act 2008: code of practice on theprevention and control of infections and relatedguidance, London: DH.Royal College of Nursing (RCN)Royal College of Nursing (2002) Chaperoning:the role of the nurse and the rights of patients,London: RCN. gitalFile cf6fdd33de28-4107-9386-a5120c71c3dd/National Institute for Health andClinical Excellence (NICE)Royal College of Nursing (2004) The future nurse– the RCN vision, London Hard copy availablefrom the RCN Library & Archive.National Institute for Health and ClinicalExcellence (2012) Healthcare-associatedinfections: prevention and control in primaryand community care CG139, London: NICE.Royal College of Nursing (2010) Pillars of thecommunity: the RCN’s UK position on thedevelopment of the registered nursing workforcein the community, London RCN.National Institute for Heath and Care Excellence(2012) Urinary incontinence in neurologicaldisease: assessment and management CG148,London: NICE.Royal College of Nursing (2011) Informedconsent in health and social care research,London: RCN.National Institute for Health and ClinicalExcellence (2014) Multiple sclerosis in adults:management CG186, London: NICE.Royal College of Nursing (2011) Principles ofnursing practice – the principles, London: RCN.National Institute for Health and ClinicalExcellence (2015) Urinary incontinence inwomen: management CG171, London: NICE.Royal College of Nursing (2017) Essential practicefor infection prevention and control, London: RCN.National Institute for Health and ClinicalExcellence (2015) Lower urinary tract symptomsin men: management CG97, London: NICE.Royal College of Nursing (2016) InfectionPrevention and Control Commissioning Toolkit.Guidance and information for nursing andcommissioning staff in England, London: RCN.National Institute for Heath and Care Excellence(2015) Urinary tract infections in adults QS90,London: NICE.Royal College of Nursing (2018) AdultSafeguarding: Roles and Competencies forHealth Care Staff, London: RCN.National Institute for Health and ClinicalExcellence (2017) Parkinson’s disease in adultsNG71, London: NICE.Royal College of Nursing (2018) Tools of the Trade:Guidance for health care staff on glove use andthe prevention of dermatitis, London: RCN.National Institute for Heath and Care Excellence(2017) Farco-fill Protect for indwelling urinarycatheterisation MIB121, London: NICE.Royal College of Nursing (2018) Older peoplein care homes: Sex, Sexuality and IntimateRelationships, London: RCN.National Institute for Health ResearchRoyal College of Nursing (website) HCA FirstSteps http://rcnhca.org.ukNational Institute for Health Research (2010)National Audit of Continence Care. Clinicalguideline, London: NIHR.Department of HealthNational Patient Safety Agency(NPSA)Department of Health (2010) High impactinterventions: central venous catheter carebundle, London: DH.National Patient Safety Agency (2009) Hospitalalerted to risks of inserting suprapubic cathetersincorrectly, London: NPSA.Department of Health (2010) High impactinterventions: urinary catheter care bundle,London: DH.8
ROYAL COLLEGE OF NURSINGNursing and Midwifery Council (NMC)Nursing and Midwifery Council (2007) NMCrecord keeping guidance, London: NMC.Nursing and Midwifery Council (2010) Lack ofcompetence, London: NMC.Nursing and Midwifery Council (2018) The Code:standards for conduct, performance and ethicsfor nurses and midwives, London: NMC.Royal College of PhysiciansRoyal College of Physicians (National Institutefor Health Research (2009) Privacy and DignityIn Continence Care Project Attributes ofdignified bladder and bowel care in hospital andcare homes, London: RCP.Other relevant documentsNHS England (2018) Excellence in ContinenceCare: practical guidance for commissioners, andleaders in health and social care, Leeds: NHSEngland.United Kingdom Continence Society (2014)Minimum Standards for Continence Care in theUnited Kingdom: Report of the Continence Caresteering group 2014, Hampshire: UKSC.All Party Parliamentary Group for ContinenceCare (England) (2012) Continence Care Study,London: APPG.Annette Bowron (2006) Essence of carecontinence care for people with Parkinson’sDisease, London: Parkinson’s Disease Society.Local documentationExamples may include: antibiotic policy catheter care policy infection control policy Continence Products Formulary.9
CATHETER CARE: RCN GUIDANCE FOR HEALTH CARE PROFESSIONALS3. Competenceaspects of catheterisation and will needto demonstrate underpinning theoreticalknowledge and practical skills. Other HCPlevels will not automatically have competencein any form of catheterisation and will needto be assessed by an appropriate practitioner.What you need to know andunderstand The importance of working within yoursphere of competence and when to seekadvice if faced with situations outside ofyour sphere of competenceYour responsibilities and accountabilityin relation to the current European andnational legislation, national guidelinesand local policies and protocols andclinical/corporate governance.Skills for Health GEN 63National Occupational StandardsSkills for HealthKnowledge and understandingThe following statements help provide clarity aroundthe competence requirements as outlined in theNOS. As a health care professional (HCP) you will: work within organisational systems andrequirements as appropriate to your role recognise the boundary of your role andresponsibility and seek supervision whensituations are beyond your competence andauthority maintain competence within your role andfield of practice use relevant research-based protocols andguidelines as evidence to inform your practice promote and demonstrate good practice as anindividual and as a team member at all times identify and manage potential and actualrisks to the quality and safety of practice You should undertake a programme oflearning based on the NOS. Programmes of learning for HCPS, in linewith national occupational standards relatedto all aspects of catheter care, should befacilitated by competent registered staff atlocal level. Observation and supervision are required, asis assessment/evaluation of knowledge andskills in catheterisation and catheter care. Declaring competence requires you to havean agreed/approved level of knowledge,understanding and skill. You are required to have the relevant skillsand abilitie
health care sectors, leading to good quality care for patients. Continence is one of the fundamentals of nursing care and maintaining continence can significantly increase a patient’s quality of life. Many people may need the support of continence products, such as catheters, to help them manage their everyday activities. Catheters can provide
Examination of the catheter may reveal deposits within the catheter lumen, on the outer surfaces of the tip or on the balloon, where it is in contact with urine. These deposits on the outer surface of the catheter can cause pain and trauma when the catheter is removed. If the catheter is rolled between the forefinger and thumb the catheter may feel
Then, a 5-Fr catheter was advanced to the distal segment of SMA over the guidewire and a 7-Fr guiding catheter was advanced over the 5-Fr catheter. After removal of the 5-Fr catheter and guidewire, a 50 mL syringe was connected with the 7-Fr guiding catheter. Aspiration of the emboli was applied manually via the 7-Fr guiding catheter.
Introduction: 3 Instructions: 3 Module one: Scope of p ractice. Informed consent. Cultural safety. 6 8 8 Module Two: Decision to catheterise. 10 Module Three: Module Four: 17 Choice of indwelling catheter Equipment. 12 Infection prevention. Catheter care. Catheter bag emptying. Catheter bag Change.
Ureteral Catheter. Device Description: Cone Tip Ureteral Catheter The Cone Tip Ureteral Catheter is used for retrograde pyelogram. The product consists of a straight, tipped catheter. The distal tip is in a cone formation and intended to temporarily occlude the ureteral orifice. The catheter
Oct 23, 2020 · Preparing for your Pleural Catheter Placement - 3 - What is a pleural catheter? A tunneled pleural catheter (TPC) or indwelling pleural catheter (IPC) is a flexible tube that is placed in your chest so that you can drain fluid from around your lungs at home. Draining this f
Catheter PleurX tunneled peritoneal drainage catheters were used in all patients in the present series. The PleurX perito-neal drainage catheter is a 15.5-F, 66-cm fenestrated silicone catheter with a one-way valve mechanism and a polyester cuff. After the catheter is placed, patients or their caregivers (trained to perform fluid drainage by
pressure ulcers, urinary catheter presence was associated with 1.8 times risk of pressure ulcer compared to those without urinary catheter (p 0.03). The most significant association was between urinary catheterurinary catheter catheter use andcatheter use and stage 2 pressure ulcer. 34 Downloaded from www.catheterout.orgFile Size: 813KBPage Count: 54
from the body and flush the catheter through. If you are using a urinary catheter, there is a greater risk of ni fection, or catheter compcil ations such as blockages or catheter bypassing problems. Dehydration, which causes concentrated urine, increases the risk of catheter blockage, so increasing your fluid intake will
