Finding the Right Catheter Webinar Slides

Finding the Right Catheter

Ca p it a l Nu r s in g Ed u c a t io nMa d e p ossib le b y a g ra n t from Sh ie ld He a lt h Ca re

Pre se n t e d b y Ke lly Sp a rks, RN, BSN, CWOCN, CFCN

• Review the urinary tract system

• Discuss the different medical conditions that lead to catheter use

• Look at different types and models of urinary catheters

• Learn the best practices for each catheter type

PROVIDER APPROVED BY THE CALIFORNIA BOARD OF REGISTERED NURSING/Provider Number 16028, approved for 1 CE contact hour/Provider: Kathleen J. Ellis 2

Te rm s• UAB - Underactive Bladder

• DU - Detrusor Underactivity

• OAB - Overactive Bladder

• DOA - Detrusor Overactivity

• COUB - Coexisting Overactive –Underactive Bladder

• BOO - Bladder Outlet Obstruction

• LUTS - Lower Urinary Tract Symptoms

• TURP - Transurethral Resection of Prostate

• PVR -Post -Void Residual

• DSD - Detrusor Sphincter Dyssynergia

• PMD – Post -Micturition Dribble

• CISC - Clean Intermittent Self -Catheterization

• IUC - Indwelling Urethral Catheterization

• CRBD – Catheter -Related Bladder Discomfort

Re v ie w o f Ur in a ry Tra c t Sy s t e m

• Filter blood

• Eliminate liquid waste (urea)

• Keep chemicals in balance

• Create urine

• Expel urine

Ure t h raDistal And Proximal Urethra

Urinary Incontinence

Urin a ry re t e n t ion

Su rg e ry on p rost a t e o r g e n it a ls

Mu lt ip le sc le ro sis

Sp in a l co rd in ju ry

De m e n t ia

Me d ic a l Is s u e s Th a t Ma y Le a d t o Ca t h e t e r Us e

Ur in a ry In c o n t in e n c e

Urgency

Fre q u e n cy

Noc t u ria

In con t in e n ce

St ra in in g

Te rm in a l d rib b le

Slow st re a m

Sp lit t in g /sp ra yin g

In t e rm it t e n t st re a m

He sit a n cy

Post -m ic t u rit ion d rib b le

In com p le t e e m p t yin g

St o ra g e Vo id in g Post Mic t u rit ion

Du r in g t h e St o ra g e P h a s e

Neurogenic detrusor (ove ra c t ive o r u n d e ra c t ive )

Re d u ce d b la d d e r com p lia n ce

De t ru so r sp h in c t e r d yssyn e rg ia

Sp in a l co rd in ju ry

• Decreased strength/duration of bladder contraction

• Prolonged bladder emptying

• Failure to empty well

Multiple SclerosisTra u m a t ic Bra in In ju ryPa rkin son 's Dise a seCe re b ra l Va scu la r Acc id e n tSp in a l Co rd In ju ryDia b e t ic Cyt op a t h y

• Lesions on the spinal cord• Bladder and spinal cord do

not communicate effectively

• Irreversible nerve damage• Inability of spinal cord and

bladder to communicate effectively

• Involuntary contractions• Increased pressure• Decreasing bladder volume• Causing leakage of urine

Ca u s e s o f Ne u ro g e n ic De t ru s o r Ov e ra c t iv it y

1 Neurological injury

2 Neurological diseases

3 Prostate enlargement or cancer

4 Prostate surgery, or other surgery to the area around the bladder

5 Trauma

6 Weakened pelvic floor and transverse abdominal muscles

7 Poor bladder control

8 Bladder problems such as inflammation, bladder stones or cancer

• Volume/pressure relationship

• Measures the bladder stiffness

• Normal - pressure remains low, even when bladder volume increases

• When it overcomes the resistance by urethra —incontinence

But……..

If sphincter is strong, or there is blockage —

reflux to kidneys and ureters

• Acute : Suddenly unable to urinate

• Chronic : Urinary retention develops over time (can urinate but not completely empty)

• Affects older men more than any other group

Inability to voluntarily empty the bladder completely or partially

Frequently correlates w it h com p le t e n e ss o f

SCIIs re sp on sib le fo r

b la d d e r ou t le t ob st ru c t ion

Dia g n ose d b y u rod yn a m ics

Ele va t e d e le c t ro m yo g ra p h ic

a c t ivit y o n u re t h ra l/a n a l sp h in c t e r d u rin g

d e t ru so r co n t ra c t io n

P o s t Mic t u r it io n P ro b le m s

• Weak pelvic muscles allow for the urethra to open

• Strong pelvic muscles hold up on the bladder neck and keep the urethra closed

1 UTI - bacteria is not flushed out

2 Can lead to Pyelonephritis

3 Bladder damage due to stretching

4Pressure on kidneys due to Hydronephrosis that can lead to chronic kidney disease or failure

5 Overflow incontinence (“peeing off the top”)https://www.niddk.nih.gov/ -/media/Images/Health -Information/Urologic/Sidebyside_600x413_04.jpg?la=en&hash=12A33A153C48591F54749E426325E2C8

P ro s t a t e o r Ge n it a lia Su rg e ry

Nerve damage resulting in pelvic floor muscle re la xa t ion /d ysfu n c t ion

Mu lt ip le Sc le ro s is , Sp in a l Co rd In ju ry

Having to urinate frequently

Ha vin g t o g o t o t h e b a t h room a t n ig h t fre q u e n t ly

Fe e lin g like t h e b la d d e r w on ’t e m p t y com p le t e ly

Difficu lt y st a rt in g a u rin e st re a m

Difficu lt y h o ld in g u rin e

Medications - a n t ich o lin e rg ics t o re d u ce con t ra c t ion s (Dit rop a n ,

To fra n il, De t ro l, e t c .)

Pe rcu t a n e ou s t ib ia l n e rve st im u la t ion - fo r ove ra c t ive

b la d d e rPe lvic floo r p h ysica l t h e ra p y -

e n h a n ce t h e st re n g t h o f p e lvic floo r m u sc le s

In t e rst im - im p la n t e d d e vice t o h e lp w it h ove ra c t ive b la d d e r,

b ow e l in con t in e n ce a n d u rin a ry re t e n t ion

Bo t ox in je c t ion s in t h e b la d d e r m u sc le s

Tr e a t m e n t s fo r MS Bla d d e r P ro b le m s

Intermittent self -ca t h e t e riza t ion

Ca re fu l flu id in t a ke

De m e n t iaIndwelling ca t h e t e rs a re in a p p rop ria t e fo r p e op le

w it h d e m e n t ia u n le ss t h e y h a ve h ist o ry o f re t e n t ion

His t o ry o f Ca t h e t e r s

FoleySu p ra p u b ic

Me n 'sWo m e n 's

In d w e llin g Ure t h ra l Ca t h e t e r iz a t io n

A urinary catheter is inserted into the urethra and a d va n ce d in t o t h e b la d d e r a llo w in g fo r t h e co n t in u o u s,

p a ssive d ra in a g e o f u rin e fro m t h e b la d d e r

Siz e s , Ma t e r ia ls a n d Ty p e s

Silicon e

Te flon

St ra ig h t

Cou d é t ip

Close d Kit syst e m s

Ma n y d iffe re n t size s

Sh o r t -Te rm Ve r s u sLo n g -Te rm Ca t h e t e r iz a t io n

• Short -term catheterization:

1 to 14 days of u se

30 days or le ss

• Lon g -t e rm ca t h e t e riza t ion :

30 days or m ore

Use d t o m a n a g e u rin a ry re t e n t ion a n d

in con t in e n ce w h e n o t h e r m e t h od s a re

n o t e ffe c t ive o r p ra c t ica l

• Severe urine retention and obstruction

• Comfort measures for patients who are terminally ill

• Non -healing sacral, buttock, or perineal pressure injuries

• Perioperative use in prolonged surgery

• Operative patients with urinary incontinence

• Hemodynamic monitoring during surgery

• Continuous bladder irrigation

• Measurement of urinary output in critically ill patients

• Urodynamic testing

• Imaging studies of the lower urinary tract

In d ic a t io n s fo r IUC

• 100% Silicone Foley Catheter

• 2-way Foley catheter

Bard Bardex Catheter

Ure t h ra l Ca t h e t e r Ba rd ia ® Cou d e

Olive Tip Re d Ru b b e r 18 Fr. 16 In ch

Sm oo t h e r in se rt ion a n d com fo rt

w it h h yd rog e l coa t in g

• Bard Coude Tip Catheter with hydrogel coatings and raised indicator to identify the direction of the catheters medium olive coude tip

• Bard Lubricath Foley Catheter with 2 -way specialty Foley catheter with hydrogel coatings creating hydrophilic cushion between catheter surface and the urethra

An t ib io t ic Co a t e d Ca t h e t e r sFoley Catheter 2 -w a y Silicon e 100% , An t ib a c t e ria l Coa t e d - Ca t h e t e r, Fo le y

• Do not inflate the balloon to test for inflation

• Balloon inflation: In fla t e t h e b a lloon w it h st e rile w a t e r a cco rd in g t o t h e m a n u fa c t u re r’s g u id e lin e s. Do n o t u se sa lin e o r o t h e r e le c t ro lyt e so lu t ion s, w h ich ca n ca u se c ryst a lliza t ion in t h e b a lloon ’s p o rt

In s e r t io n

• Indwelling catheters should be secured to avoid traction on the catheter, which causes irritation and trauma to the urethra (e.g., urethritis, necrosis, erosion, stricture), and/or the bladder trigone muscle resulting in pain, spasm, and incontinence .

• Securement is needed to prevent inadvertent dislodgement of the catheter

Se le c t io n o f Se c u re m e n t De v ic e s

Us e a n d Ch o ic e o f In d w e llin g Ca t h e t e r s

Anesthetic To Manage Pain

Sm a ll cu t in a b d om e n

Su p ra p u b ic ca t h e t e r p la ce d d ire c t ly in t o t h e b la d d e r

Ba lloon in fla t e d t o ke e p it in

At t a ch e d t o a g ra vit y d ra in a g e b a g o r a le g b a g

When urethra is d a m a g e o r in ju re d

Aft e r su rg e rie s in vo lvin g t h e b la d d e r, u t e ru s, p ro st a t e o r n e a rb y o rg a n s

If p e lvic flo o r m u sc le s a re w e a ke n e d ca u sin g u re t h ra l c a t h e t e r t o fa ll o u t

To m a in t a in se xu a l a c t ivit y b u t n e e d s ca t h e t e r fo r a lo n g e r p e rio d o f t im e

Lo n g t e rm u se a s it m a y b e m o re co m fo rt a b le a n d e a sie r t o ch a n g e t h a n u re t h ra l c a t h e t e r

Sterile technique through urethra t o b la d d e r

Urethral Catheter

Ba llo o n e xp a n d s t o h o ld in p la ce

At t a ch e d t o a g ra vit y d ra in a g e b a g

In d w e llin g Ca t h e t e r Ca re Co m p lic a t io n s

Ca t h e t e r -Re la t e d Bla d d e r Dis c o m fo r t (CRBD) Symptoms include sensations of suprapubic, u re t h ra l, a n d b la d d e r b u rn in g a n d p a in , t h e u rg e t o vo id , a n d b la d d e r sp a sm s

• Catheter size - use smallest size that allows for adequate drainage

• Balloon too full or not full enough

• Blocked catheter - mucus and encrustations or constipation

• Improper catheter composition - silicone for long term

• Catheter positioning - avoid tension

• Bacteriuria - urine culture

• Antibiotic coated catheters

• Silver alloy coated catheter s

P o s s ib le Co m p lic a t io n s • Urethral damage

• Urethritis

• Erosion

• Fistula formation

• Epididymitis

• Bladder stones

• Bladder cancer

• Hematuria

P re v e n t io n a n d Ma in t e n a n c e

P re v e n t in g P ro b le m s w it h In d w e llin g Ca t h e t e r s• Choose small catheter and balloon

• Maintain good hydration

• Prevent constipation

• Routine cleaning with mild soap and water

• Sterile technique when inserting a catheter

P re v e n t in g P ro b le m s Co n t in u e d• Keep drainage system closed as much as

possible

• Copious lubrication of the catheter using to reduce urethral irritation

• Secure catheter to avoid traction

• Cleanse with antiseptic solution whenever tubing and catheter are disconnected

• Routine cleansing of drainage bags also helps with prevention with long term catheterization

• Clean the urethral area with soap and water 1 time daily

• Clean after every bowel movement to prevent infection

• Avoid pulling on the tubing when cleaning as this may injure the urethra

• Don't apply antibiotic ointment or any other antibacterial product to the urethra

• Don't use lubricant on the urethra

• Don't apply powder to the genital area or to the tubing

(Every Three Days)

1. Wash your hands well with soap and water.2. Disconnect the bag from the catheter tubing. Connect the

tubing to the backup bag or drainage device.3. Drain any remaining urine from the bag you just

disconnected. Close the drainage valve.4. Pour some warm soapy water into the bag. Swish the soap

around, being sure to get the corners of the bag.5. Open the drainage valve to drain the soap. Close the valve.6. Fill the bag with 2 parts vinegar and 3 parts water. Shake

the solution a bit and allow it to remain in the bag for 30 minutes.

7. Drain the vinegar solution and rinse the bag with cold tap water.

8. Hang the bag to drain and air -dry.

Cle a n In t e rm it t e n t Ca t h e t e r iz a t io n (CIC)

In d ic a t io n s Fo r IC

• Urinary incontinence - select cases

• Alternative to short -term or long -term IUC

• Acute urinary retention without bladder outlet obstruction

• Acute urinary retention with bladder

• Chronic urinary retention as an alternative to an indwelling catheter

• Installation of medications into the bladder

• Collection of random urine samples

• Apogee Intermittent Catheter Curved Packaging- This is a straight tip with smooth eyelets for comfort. Flexible funnel grip makes it easier for handling. Latex free.

• LoFric ® Hydro -Kit™ - An all -in -one hydrophilic catheter kit for intermittent catheterization

• Bard Intermittent Clean Catheter

• Rusch /MMG Intermittent Closed System Catheter with Introducer Tip

• Cultramer Red Rubber Urethral Catheter –Hydrogel coated making them very slippery for ease of insertion

• Urethral Catheter Bardia ® Coude Olive Tip Red Rubber 18 Fr. 16 Inch

Cle a n In t e rm it t e n t Ca t h e t e r iz a t io n

*Coloplast h a s a Sp e e d ica t h se lf ca t h e t e r w it h vid e o in st ru c t ion s on com fo rt m e d ica l.com

• UTIs

• Ure t h ra l st e n osis

• Prost a t it is

• Ep id id ym it is

• Urin a ry lit h ia sis

• Urose p sis

Co m p lic a t io n s

• Ch ron ic u rin a ry re t e n t ion

• Ne u ro log ic con d it ion s

Re a s o n s

• Inadequate/inaccessible bathroom facilities

• Inconvenience or difficulty in cleaning catheters; individual feels it is unaesthetic to carry and/or reuse catheters

• Cost and/or lack of optimal supplies

• Inability or unwillingness to perform frequent catheterizations

• Anatomical constraints: urethral strictures, false passages, or bladder neck obstruction

• Physical limitations: upper extremity impairment, visual problems, or difficulty in positioning (females)

• Co-morbid conditions: inability to feel the catheter being inserted, spasticity, and obesity

Sp e c ific Ch a lle n g e s fo r Th e P a t ie n t in P e r fo rm in g IC m a y in c lu d e :

Co m p lic a t io n s o f CIC

Bacteriuria

• 50% of CIC patients and is often referred to as “colonization”

• Rarely leads to UTIs • Majority have no symptoms and therefore

should not be treated with antibiotics

Urinary tract infections

• 20% annual incidence, most common cause of sepsis and mortality in patients. More prevalent in patients who have higher residual urine volumes (>400 cc) at the time of catheterization

• Chronic pyelonephritis rarely develops

Urethral d amage in m en include :

• Urethritis, inflammation of the urethral meatus, due to frequent insertion of catheters, especially if there is a forceful catheterization against a closed sphincter

• Urethral stricture is the result of urethral inflammatory response to repeated catheterization

o In c re a se s w it h t h e n u m b e r o f ye a rs p e rfo rm in g CIC

o Difficu lt y w it h in se rt ion is a sig n o f t h e p re se n ce o f a u re t h ra l st ric t u re

Ma le Ex t e rn a l Ca t h e t e r s

Male External Catheters• Active Cath - Self adhering 1-piece latex

catheter for active men who prefer extended wear

• Freedom Clear Long Seal External Catheter - Silicone and self adhering

• Men's Freedom Catheter – Petals fit on the tip of the penis then place the strip of adhesive

Conveen Male External Catheter Sport- Discreet, reliable and very easy to use

Golden Drain Male External Catheter- This is a one -piece latex non self adhering catheter with high supportive cup preventing twisting with a 1 -inch foam strap to hold it on

Ma le Ex t e rn a l Ca t h e t e r Ca re

Change t h e ca t h e t e r e ve ry 24 t o 48 h ou rs (m ore fre q u e n t ly in h o t h u m id w e a t h e r)

Trim t h e h a irs on t h e sh a ft a n d b a se

Wa sh in g a n d d ryin g t h e p e n ile sh a ft

Con sid e r a p p lyin g ab a rrie r film p rod u c t

Avo id u se o f b e t a d in e so lu t ion

Ph im osis ca n occu r a s are su lt o f ove r-con st ric t ion o f t h e p e n is from a con d om ca t h e t e r

Fe m a le Ex t e rn a l Ca t h e t e r s

• Simple, noninvasive urinary incontinence management for women

• Soft flexible to position between the female labia and buttocks

• It is put to low wall suction

• Can be used reclining, laying on side, lying down or while seated

• Primafit is another external catheter that fits between the labia and pulls the urine out to the canister

• Not appropriate for confused patients

• Not appropriate for patients that move around constantly

• Low wall suction is 40mmHg

• Change every 8 -10 hours

• Not appropriate with loose stooling

• At each change, cleanse skin

• Must have pad under due to leakage

• Must be placed correctly to function correctly

• Decreases CAUTIs

• Problem Solving and Troubleshooting : The Indwelling Catheter by K. Moore, RN, MN, R. Rayome , RN, BSN, CCCN. Journal of Wound, Ostomy andContinence Nursing : 9-1995 JWOCN

• TAGS Designs -Indwelling Catheters Uro Today January 2013 , https ://www .urotoday .com/tags/tiemann -catheter .html

• Journal of Wound, Ostomy and Continence Nursing : January/February 2013 - Volume 40 - Issue 1 - p 83–89 Continence Care

• Journal of Wound, Ostomy and Continence Nursing : January/February 2013 - Volume 40 - Issue 1 - p 83–89 doi : 10 .1097 /WON

• Carr , H. A. (2000 ). "A short history of the Foley catheter : from handmade instrument to infection -prevention device ." J Endourol 14 (1): 5-8.

• Ellis, H. (1988 ). "Therapeutic milestones . The Foley catheter ." Br J Clin Pract 42 (6): 248 -249 .

• Lapides , J., A. C. Diokno , A.C., et al . (1972 ). "Clean, intermittent self -catheterization in the treatment of urinary tract disease ." J Urology 107 (3):458 -461 .

• Marino, R. A., U. M. Mooppan , et al . (1993 ). "History of urethral catheters and their balloons : drainage, anchorage, dilation, and hemostasis ." JEndourol 7(2): 89 -92 .

• Mattelaer , J. J. and I. Billiet . (1995 ). "Catheters and sounds : the history of bladder catheterisation ." Paraplegia 33(8): 429 -433 .

• Nacey , J. and B. Delahunt . (1993 ). "The evolution and development of the urinary catheter ." Aust N Z J Surg 63(10): 815 -819 .

• D. K. Newman, The Indwelling Urinary Catheter Principles for Best Practice . J Wound Ostomy Continence Nurse . 2007 ;34(6):655 -661 . Publishedby Lippincott Williams & Wilkins .

• Suprapubic catheters : Uses, care, and what to expect

• Last reviewed Mon 25 September 2017 By Jennifer Berry Reviewed by Carissa Stephens, RN, CCRN, CPN

• Incontinence Products And Devices for the Elderly, Diane K. Newman UROLOGIC NURSING / August 2004 / Volume 24 Number 4

• Wound, Ostomy and Continence Nurses Society . (2016 ). Care and management of patients with urinary catheters : A clinical resource guide . Mt .Laurel : NJ. Author

• Review Date 1/31/2019 Medline Plus Medical Encyclopedia, Urinary catheters Updated by: Sovrin M. Shah, MD, Assistant Professor, Department of Urology, The Icahn School of Medicine at Mount Sinai, New York, NY. Review provided by VeriMedHealthcare Network. Also reviewed by David Zieve , MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

• Why would you use a foley catheter? Marc Kaplan Mar 12, 2018

• Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, U. S Corresponding Author: Christopher J Chermansky , M.D., University of Pittsburgh Medical Center

• Terminology report from the International Continence Society (ICS) Working Group on Underactive Bladder (UAB) Christopher R. Chapple Nadir I. Osman Lori Birder Roger Dmochowski Marcus J. Drake Gommert van Koeveringe Victor W. Nitti Matthias Oelke , First published: 11 September 2018 https://doi.org/10.1002/nau.23701Citations: 23 John Heesakkers led the peer‐review process as the Associate Editor responsible for t h e p a p e r.

• Ne u ro g e n ic Ca u se s o f De t ru so r Un d e ra c t ivit y, Bria n T. Ka d o w , M.D., Pra d e e p Tya g i, Ph .D., a n d Ch rist o p h e r J . Ch e rm a n sky, M.D.

• Nu rsin g Tim e s VOL: 99 , ISSUE: 29 , PAGE NO: 56 Ia n J . Po m fre t , RGN, NDN Ce rt , PWT, is d ist ric t co n t in e n ce a d vise r, Co n t in e n ce Ad viso ry Se rvice , Ch o rle y a n d So u t h Rib b lePrim a ry Ca re Tru st , La n ca sh ire

• Bla d d e r a n d Bo w e l Co m m u n it y Fo rw a rd Ho u se 17 Hig h St re e t He n le y-in -Ard e n B95 5AA Em a il: h e lp @b la d d e ra n d b ow e l.o rg

• [1 ] Ba rrisfo rd GW, St e e le GS. Acu t e u rin a ry re t e n t io n . In : Po st T, e d . Up To Da t e . Wa lt h a m , MA: Up To Da t e ; 2018 . w w w .u p t o d a t e .co m /co n t e n t s/a cu t e -u rin a ry-re t e n t io n Ext e rn a l lin k. Up d a t e d Ma rch 14 , 2018 . Acce sse d No ve m b e r 5 , 2018 .

• h t t p s://w w w .n a t io n a lm sso c ie t y.o rg / Om li R e t a l. Ag e Ag e in g . 2010 ; 39 (5 ): 549-5

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