Please carry this Catheter Guide and Logbook with you
Information for Patients
Your healthcare professional must discuss the contents of this booklet with you. This guide and logbook supports you (the patient) and healthcare professionals to work together. It does not replace standard trust documentation for record keeping (urinary catheter). You should accept responsibility for your personal hygiene and hydration as per the guidance suggested in this booklet. Good management of your catheter could improve your quality of life. However, catheters significantly increase the risk of urinary tract infections and these can seriously affect your health and well-being. Catheters are only inserted if there is a medical need.
Introduction
The purpose of this booklet is to give you advice on looking after your urinary catheter. If you have a catheter appointment at your GP surgery or hospital, you should take this booklet with you. The second half of this booklet will be completed by nursing staff to ensure your continuity of care.
What is a urinary catheter?
A catheter is a flexible hollow tube used to drain urine from the bladder. The catheter is inserted into the urethra (the opening of which is situated at the tip of the penis or just above the vagina) or through a hole made in the abdomen (suprapubic catheter). The catheter is then guided into the bladder, allowing urine to flow through it and into a drainage bag which will be attached to your leg. Some people may have a catheter valve at the end of the catheter instead of a drainage bag.
Why do I need a catheter?
You may need a catheter for many reasons, including:
• To let urine drain if you have an obstruction in the tube that carries the urine out of the bladder.
• To allow you to urinate if you have bladder weakness or nerve damage that affects your ability to pass urine.
• To drain your bladder before, during and/or after some types of surgery.
What should I do if I have pain or discomfort?
Lower abdominal or tummy pain can be experienced when a catheter is first inserted. If this continues, contact your nurse for advice.
When will my catheter need changing?
Your nurse will advise you on how often your catheter will need changing and also how to obtain further supplies of catheter equipment.
How do I look after my catheter on a daily basis?
• Empty the bag when it is two thirds full of urine.
• If you have a valve attached to your catheter instead of a leg bag, you should open the valve and empty your bladder:
• When you feel that it is full
• Before going to bed
• First thing in the morning
• During the night if necessary
• At least every 3-4 hours during the day
• Before opening your bowels
• Replace the leg bag or valve once a week.
• To help prevent infection, only disconnect the leg bag or catheter valve weekly when it is replaced with a new one.
• Attach a night bag to the leg bag or valve every night, to prevent having to empty the bag overnight. Remember to open the valve from your leg bag or catheter valve, which is connected to the night bag.
• Close the leg bag or catheter valve and remove the night bag every morning and dispose of it.
• If you have a suprapubic catheter and there is a small leakage around the insertion site, you will have a dressing for the first few days until the leakage has stopped. The area can be washed as described below when the dressing has been removed.
How can I reduce the risk of getting an infection?
• Wash your hands before and after touching your catheter.
• Wash the skin in the area where the catheter enters the body with mild soap and water at least twice a day.
• Men should carefully wash under their foreskin (unless you have been circumcised). Dry the area thoroughly and ensure the foreskin is replaced over the end of the penis.
• Woman should always wash the genital area from front to back to prevent contamination from the back passage. Dry the area thoroughly.
• Avoid the use of talc, antiseptic, bubble bath or salts and creams. These can cause irritation.
• Do not remove your leg bag when you have a bath or shower.
What should my urine look like?
• Urine should be a light yellow colour. If it is orange / dark brown, you may not be drinking enough fluid.
• You should drink approximately 1.5 – 2 litres which is 8 cups or 5 mugs of fluid in 24 hours.
• Avoid caffeine as this may irritate your bladder. There is caffeine in tea, coffee, cola and drinking chocolate. Try decaffeinated drinks.
• Some medication and foods may cause discolouration of the urine. Your nurse will be happy to discuss this with you.
• If your urine is cloudy and doesn’t improve after drinking more, contact your nurse.
• If your urine is bloodstained or has specks of blood in it, contact your nurse.
• If you are passing bright red blood you should contact your doctor.
• Some patients with urinary catheters have frequent blockages and therefore may find benefit from consuming citric based drinks such as lemon and orange. For further information discuss with your nurse.
What should I do if my catheter is not draining or it is leaking?
• Check the drainage bag is below the level of the bladder, particularly when sitting in a low chair.
• Make sure that the tubing is not twisted or restricted by tight clothing.
• Make sure that the tubing is not pulled tight or stretched as this may restrict urine flow.
• Check that the drainage bag is connected correctly. Make sure that the straps, which secure the leg bag to your leg, are positioned behind the leg bag tube.
• Urine will not drain if the bag is full. Empty the bag when it is two thirds full.
• Constipation can prevent your catheter from draining. Ask your nurse about eating a healthy diet to avoid constipation.
• Change your position and walk around if possible.
• Make sure that you are drinking enough fluid (1.5 to 2 litres which is 8 cups or 5 mugs in 24 hours).
• If you experience any urine leakage, please contact your nurse.
• Check that your catheter is draining well at regular intervals throughout the day.
• Make sure that the catheter valve or leg bag tap is open when connected to the night bag.
How do I dispose of used catheter bags?
• Empty the contents into the toilet.
• Double wrap the bag (either in newspaper or a plastic bag).
• Place into your household waste bin.
What about sex?
Sexual intercourse is possible even if you need a urinary catheter, please discuss with your nurse who will help give advice on the best approach for you.
When should I ask for help?
Your catheter should remain comfortable and pain free. However, you should ask for help when:
• You experience acute lower abdominal or tummy pain.
• Urine is not draining and you have followed the simple self-help measures within this booklet.
• Your catheter falls out and you are unable to pass urine.
• Your catheter falls out and you can pass urine, contact the nurse for advice.
• There is blood in your urine.
• Urine is cloudy, smelly or you have a burning sensation, which does not improve after drinking extra fluids.
• Urine is leaking around the catheter, enough to make your clothes wet.
Catheterisation records
All details of urinary catheterisation should be recorded in the sections below as well as the appropriate nursing / medical notes.
Completion of the booklet will enhance continuity of care for the patient between both community and hospital settings.
Measures to be taken by Health Care Professionals and the Patient to reduce Catheter Associated Urinary Tract Infections (CAUTI)
Assess need for the catheter on every shift / visit
Think HOUDINIO
H Haematuria – clots and heavy
O Obstruction - mechanical
U Urology / gynaecology / perianal surgery / prolonged surgery
D Decubitus ulcer – to assist wound healing in an incontinent patient
I Input, output monitoring
N Nursing at the end of life
I Immobilisation due to unstable fracture / spinal injury or neurological deficit (where all other methods of toileting are contraindicated)
O Other
• Use proper hand hygiene before and after handling a catheter.
• ANTT procedure must be used for catheter insertion.
• Clean the catheter at the meatus and the perineum daily or after a passing stool.
• Do not break the catheter management system.
• Ensure that the catheter is secured to the leg to prevent traction.
• NEVER use a female length catheter for a male patient.
• The drainage bag must be below the level of the bladder (during transport and activity).
• Correct and avoid constipation.
Bacteriuria can occur within 72 hours of catheterisation and bacteria levels increase as long as the catheter remains in-situ. Up to 50% of patients who are catheterised for longer than 7-10 days will develop symptoms of a UTI.
Signs and symptoms associated with a CAUTI:
• Feeling unwell
• Fever with or without shaking
• New pain at lower lower abdomen or back
• Becoming agitated or newly confused
• Pain around the area where the catheter has been put in and / or cloudy like discharge in the urine
• Unusual lethargy and tiredness
A change of urinary catheter is recommended when a CAUTI is suspected. If this cannot be done immediately, change within 72 hours.
Do not use a urine dipstick to diagnose a CAUTI.
