Contents
1 Aim
To provide staff with best practice guidelines for performing female catheterisation.
2 Scope
This procedure applies to all clinical staff working in both the Doncaster mental health care group and Doncaster physical health care group of RDaSH who deliver or provide continence or catheter care to adult patients over the age of 18. For staff working in Rotherham and Scunthorpe, they will need to refer to their local guidelines.
It is recognised that primary care practitioners are also part of the organisation and as such this policy is offered for use by them to adapt to their own practices and organisations as appropriate.
The author of the policy is available to offer help and support to primary care practitioners who wish to use and implement this policy.
As part of good employment practice, whilst undertaking work for RDaSH. Agency workers are also required to abide by the RDaSH policies and procedures, as appropriate, to ensure their health, safety and welfare.
Adherence to the procedures within this manual is the responsibility of all trust staff, including agency, locum and bank staff.
3 Link to overarching policy, and or procedure
3.1 Links to relevant policies or procedures
4 Procedure or implementation
4.1 Female catheterisation
First time female catheterisation must only be performed by a qualified registered general nurse or non registered healthcare professional who is required to undertake catheterisation as part of their role and has had catheter training.
Catheters should only be used after all alternatives have been considered. Therefore, it is essential that a urethral catheterisation assessment is performed before carrying out the catheterisation procedure. Reason for catheterisation must be clearly documented within the catheter integrated pathway of care (IPOC) within SystmOne and catheter passport. Please refer to appendix H for urethral catheterisation assessment guidance.
4.2 Risk of catheterisation
Using any form of catheterisation has associated risks. Therefore it is essential that a risk assessment is an integral part of catheter care. Please refer to appendix I for risk assessment.
4.3 Choice of catheter and catheter equipment
Female patients are usually catheterised with a standard length catheter first, however the patient may then choose to have a female length catheter for discretion and comfort.
Choice of catheter and equipment used must be clearly documented within the catheter IPOC within SystmOne and catheter passport.
Please refer to appendix J for choice of Catheter and equipment.
4.4 Female re-catheterisation
Band 3 healthcare assistants who have attended the female re-catheterisation study day provided by the specialist continence service and have completed the relevant clinical skills package may perform simple female re-catheterisation on uncomplicated female patients who have been assessed by qualified nurse.
4.5 How to perform female catheterisation
Please see urinary catheterization, female, Royal Marsden manual (opens in new window).
4.6 How to remove a catheter
Please see urinary catheter removal, Royal Marsden manual (opens in new window).
4.7 Documentation
The catheter integrated pathway of care (IPOC) found within SystmOne provides a framework for best practice and follows Royal College of Nursing (RCN) guidelines for nurses on catheter care (2021). The IPOC supports the assessment process and should be followed by the healthcare practitioner to meet all the clinical and legal requirements for record keeping.
Each individual patient or carers should be given a ‘my catheter passport’ document. This document provides the patient with written information about their catheter management (please see appendix P).
There are 2 distinct sections within the passport, patient and clinical. The patient section supports effective care of the catheter in order to reduce the risk of infection and the clinical section includes essential information around the catheterisation itself and should contain the plan of care, reason for catheterisation and plans for trial without catheter. There is also a catheter maintenance section which can be completed by the health care professional, carer or patient themselves.
5 References
6 Appendices
Please see continence manual webpage for appendices attached to this procedure.
- Appendix H Urethral catheterisation assessment guidance
- Appendix I Risk assessment
- Appendix J Choice of catheter and equipment
- Appendix P My catheter passport
Document control
- Version: 2.
- Unique reference number: 515.
- Approved by: Clinical policies review and approval group.
- Date approved: 6 December 2022.
- Name of originator or author: Team or clinical lead specialist continence service.
- Name of responsible individual: Clinical polices review and approval group.
- Date issued: 9 January 2023.
- Review date: 30 December 2025.
- Target audience: All clinical staff working in both the Doncaster mental health care group and Doncaster physical health care group of RDaSH who deliver or provide continence or catheter care to adult patients over the age of 18. For staff working in Rotherham and Scunthorpe, they will need to refer to their local guidelines.
Page last reviewed: April 24, 2024
Next review due: April 24, 2025