NHS Ayrshire & Arran guidelines
Preventing catheter associated urinary tract infections - acute settings
Source: Health Protection Scotland/NHS National Services Scotland. September 2014.
Catheter care - for all catheter types
Daily bathing or showering is recommended. If this is not possible, the patient must be advised to clean the meatal/ostomy area with normal soap and water twice daily or following a bowel movement to reduce the risk of infection3. Encourage patient self care and good hand hygiene techniques.
Reducing catheter associated infections
To reduce the risk of catheter associated urinary tract infection (CAUTI), standard infection control precautions (SICPS) must be implemented at all times as per the National Prevention and Control of Infection Manual.
REMEMBER: Antibiotics should not be considered for catheterised patients asymptomatic of infection.
Preventing catheter associated urinary tract infections - community settings
Source: Health Protection Scotland/NHS National Services Scotland. September 2014.
Pain/discomfort
| Possible reasons | Possible solutions |
| Traction/pulling of catheter | Repositioning/ensure fixation device applied |
| Too large a catheter | Smaller gauge catheter/coated catheter |
| Latex allergy | Use all silicone catheter |
| Eyelets maybe occluded by urothelium | Raise the drainage bag above the level of the bladder for 10-15 seconds only |
| Catheter associated urinary tract infection (CAUTI). See section on Catheter associated urinary tract infection (CAUTI) |
|
Catheter bypassing
| Possible reasons | Possible solutions |
| Incorrect position of drainage system |
Ensure drainage bag below bladder level. Straighten tubing. |
| Constipation |
Rectal examination and appropriate treatment. Increase fluid intake and dietary fibre. |
| Encrustation/debris | See catheter maintenance solution information. |
| Trigone irritation | Review balloon size and ensure balloon is fully inflated as per manufacturer instructions. |
| Bladder overactivity/spasms |
Smaller gauge catheter if appropriate. Ensure adequate intake of non stimulant fluids. Check bowel history. Consider anti-cholinergic therapy. |
| CAUTI - See section on Catheter associated urinary tract infection (CAUTI) for diagnosis of CAUTI |
See section on Catheter associated urinary tract infection (CAUTI) |
No drainage
| Possible reasons | Possible solutions |
| Incorrect position of drainage system |
Ensure drainage bag below bladder level. Straighten tubing. Ensure bag stand and fixation device. |
| Faecal impaction |
Rectal examination and appropriate treatment. Increase fluid intake and dietary fibre. |
| Encrustation/debris | See appendix 3 and 4 |
| Anuria | Consult medical team |
Haematuria
| Possible reasons | Possible solutions |
| Trauma post catheterisation especially following chronic retention | Encourage fluid intake and if haematuria persists seek medical advice |
| Prostatic enlargement | Encourage fluid intake and if haematuria persists seek medical advice |
| Calculi | Encourage fluid intake and if haematuria persists seek medical advice |
| Carcinoma | Encourage fluid intake and if haematuria persists seek medical advice |
| CAUTI - See section on Catheter associated urinary tract infection (CAUTI) for diagnosis of CAUTI | See section on Catheter associated urinary tract infection (CAUTI) |
CAUTI is diagnosed when all of the following are identified:
- Urethral catheter in situ OR has been removed in the previous 48 hours.
- Temp <36oC or >37.9oC or >1.5oC above baseline, occurring on at least two occasions in the last 12 hours.
- One or more of the following:
- Shaking, chills, rigors
- New costovertebral (central lower back) tenderness or pain
- New onset or worsening delirium (confusion)
And - On antibiotic treatment for UTI
Leakage of urine per urethra when a suprapubic catheter is in situ
- It is important to check that the catheter tubing is not kinked and is draining freely.
- Ensure the catheter is anchored securely and that the urine drainage bag is emptied regularly.
- Check for constipation and treat as required.
- Excessive urine production may require a larger size of catheter to allow the internal diameter of the catheter to cope with the volume. Therefore 18-22Ch size may be indicated, alternatively, urethral leakage may be caused by bladder spasm and an anticholinergic drug can help reduce bladder contractions17.
- See individual’s hand-held record or nursing notes. If leakage continues advice should be sought from the Continence Service.
Over-granulation of insertion site
- This may be due to an oversized initial incision or a response to a foreign body i.e. the catheter.
- Advise to change the direction of the lay of the catheter against the abdomen by changing the position of the bag using a fixation device.
- Over-granulated areas can be treated with a dry dressing initially, however if problems persist contact the continence nurse advisors/Tissue Viability.
Bladder stones
- It is important to be aware of the possibility of some patients developing bladder stones.
- Strong alkaline urine is a precipitating factor18.
- Patients will complain of pain, particularly on walking and the catheter may block frequently18.
- If a bladder stone is suspected, KUB X-ray investigation is required to confirm its presence. May require cystoscopy for direct visualisation.
This should always be planned, based on an assessment of the patient’s history, circumstances and needs and this should always be documented. Urinary catheters should be removed as soon as possible guided by HOUIDINI. Consider intermittent self catheterisation (ISC) where possible.
- Refer to community nursing by Trak –inform of reason for catheterisation/type of catheter/size/balloon size/change date as well as if planned for TWOC – hospital or community.
- Provide a hospital to home pack which includes 7-10 day supply of night bags, short/long leg bags and patient information booklet.
- Give contact details for District Nursing team.