Urinary catheterisation aftercare procedure

1 Aim

The aim of this procedure is to provide staff with the information required to manage and care for patients with a urinary catheter.

2 Scope

This procedure applies to all clinical staff including agency, locum and bank 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.

3 Link to overarching policy, and or procedure

Continence manual

3.1 Links to relevant policies or procedures

Infection prevention and control manual

4 Procedure or implementation

4.1 Patient aftercare advise

Following catheterisation patients should be given the following advice on:

how to care for the leg bag or catheter valve (please refer to appendix J)
how to change a leg bag (please refer to appendix M)
how to empty a leg bag (please refer to appendix N)
how to attach a night drainage bag (please refer to appendix O)
catheter passport should be given and discussed
how to order repeat prescriptions
how to contact single point of access (SPA) if they experience any problems or concerns. SPA Telephone: 03000 218996

4.2 Collecting a catheter specimen of urine (CSU)

Dipstick testing is not an effective method for detecting urinary tract infections in catheterised adults. This is because there is no relationship between the level of pyuria and infection in people with indwelling catheters (the presence of the catheter invariably induces pyuria without the presence of infection). To ensure that urinary tract infections are diagnosed accurately and to avoid false positive results, dipstick testing should not be used (NICE 2017).

samples of urine must be obtained from a sampling port using an aseptic technique
samples of urine must only be obtained when the patient is symptomatic, there should be no routine sampling
never disconnect the closed system to obtain a urine specimen
never collect a sample of urine from the drainage bag as this does not represent the bacteria in the bladder and could lead to over-prescribing of antibiotics

Urine samples for microscopic culture and sensitivity must be sent in a urine primary tubes (UPTs), red top containing boric acid which acts as a preservative. Refrigeration of urine is therefore rendered unnecessary and the sample will last for at least 48 hours at room temperature without any negative affect upon the final result. Urine samples for all other urine tests should still be collected in their currently used containers.

When report states ‘possible contamination’, it is because there are microorganisms in the sample but no white cells. White cells would be present if infection was present. Please refer to the Royal Marsden manual, urine sampling, catheter specimen of urine, Royal Marsden manual.

4.3 Catheter associated urinary tract infections (CAUTI’s) and when to change a catheter

If the urinary catheter has been in situ for more than 7 days and the patient is about to commence antibiotics for a confirmed CAUTI, if possible, change the catheter at the beginning of the course of antibiotics.

4.4 Discharge of patients from hospital

Patients that are newly catheterised and are to be discharged should be given the relevant equipment to take home.

These include:

1 prefilled catheter
1 tube of anaesthetic jelly
2 night bags
1 normal saline
1 dressing pack
2 leg bags or valves
catheter passport

A discharge form should be completed and sent through to the single point of access. A copy should go home with the patient.

Compliance with this will ensure patients are not re-admitted with blocked catheter before community nurses can obtain supplies. The Specialist Continence team should visit the patient as soon as possible after receiving the referral to ensure that the patient has the appropriate equipment and to identify any problems or concerns that the patient may have following discharge.

4.5 Catheter passport

Each individual patient or carer should be given a ‘my catheter’ passport document. This document provides the patient with written information about their catheter management (please refer to 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 J Catheter selection and equipment
Appendix M Procedure for changing a leg bag
Appendix N Procedure for emptying a catheter bag
Appendix O Procedure for connecting a single use night bag
Appendix P My catheter passport

Document control

Version: 2.
Unique reference number: 518.
Approved by: Clinical policies review and approval group.
Date approved: 7 February 2023.
Name of originator or author: Senior continence specialist sister.
Name of responsible individual: Executive director of nursing and allied health professionals.
Date issued: 14 February 2023.
Review date: 28 February 2026.
Target audience: All clinical staff within Doncaster mental health and Doncaster physical health care groups.
Description of change: Review as part of 3 year review cycle, scope updated to become more explicit.

Page last reviewed: April 24, 2024
Next review due: April 24, 2025

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