CATHETER LEAKAGE
(Bypassing)
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Check Plumbing
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Is the catheter or tubing kinking - check bag and/or valve connections, check line and connection of tubing. Use catheter securing device.
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Faecal Impaction / Constipation
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Assess, alleviate and prevent by review of bowel management.
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Catheter too large
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A urethral catheter that is greater than 18Fg may need to be gradually downsized.
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Women IDC: 12 -14Fg/10ml balloon
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Men IDC: 14- 16Fg /10ml balloon
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SPC: 16 -18
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Balloon too large
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A 5-10ml balloon is advised. Authorisation from an Urologist is required for long-term use of a catheter with a 30 ml balloon, given it may contribute to bladder neck erosion.
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Catheter blockage
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If a catheter is blocked and has been insitu for >2 weeks it may be replaced and documented on Urinary Catheter Management Chart. Determine the blocking agent and consult with Medical Officer re indications for antibiotic therapy or refer for a urological review.
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Bladder spasm
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See BLADDER SPASM
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BLADDER PAIN
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Bladder spasm
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Consider concentrated urine – increase fluids
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Bladder Distension
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Assess and action as per NO URINE DRAINING
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Traction on Catheter
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Secure with tape or strap
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Bladder infection - Symptomatic
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See INFECTION
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Balloon too large or Catheter too large
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5-10 ml balloon advised (as per manufacturer’s recommendations
IDC – less than 18Fg advised
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BLADDER SPASM (Cramps)
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Traction on catheter with movement
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Ensure catheter is not under tension. Recommend use of catheter strap.
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Faecal Impaction / Constipation
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Alleviate and prevent. Review bowel
management.
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Bladder infection
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See INFECTION
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Overactive bladder
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Discuss use of anticholinergic medication with Medical Officer. Consider use of topical oestrogen for urethritis in females
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New Catheter in situ
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Spasms should settle within 24-48 hours, Reassure patient they should resolve.
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BLEEDING
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Trauma
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Ensure catheter is not under tension, check securement devices. Some clients may experience a small amount of bleeding following SPC change.
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Infection
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See INFECTION
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Persistent Haematuria
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Urgent referral to medical officer / Urological consult
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NO URINE DRAINING +/- urinary leakage
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Kinked tubing
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Check for correct lie and connection of tubing
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Low fluid intake
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Recommend fluid intake of between 2-3 litres daily unless otherwise stated by Medical Officer.
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Faecal Impaction / Constipation
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Assess, alleviate and prevent by review of bowel management.
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Drainage bag above bladder level
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Lower bag, ensure bag is below bladder level to assist gravity.
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Catheter is blocked with mucous or debris
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If a catheter is blocked and has been insitu for >2 weeks it may be changed. Determine the blocking agent and consult with Medical Officer re indications for antibiotic therapy or a urological review.
Catheter Flush:
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may be indicated if a client has a history of blocked catheter
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is prescribed by a medical practitioner and requires a treatment order
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is a short term management option only and the cause of the blockage should be investigated. A Urology review must be in place. (See Catheter Flushing SOP)
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NO DRAINAGE OF URINE AFTER SEVERAL HOURS
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Check as above.
| -
Check for palpable bladder i.e. blocked catheter. Check the catheter position in the bladder by deflating the balloon and slightly rotate and push catheter in.
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Check for sediment and document characteristics.
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Replace catheter.
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If anuria is identified (urinary output of less than 100-250mls in 24 hours), immediately refer client to nearest local hospital emergency department.
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INFECTION
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| -
Review catheter management; ensure closed link system is being maintained.
Clients with symptomatic catheter related infection should be treated as per local prescribing procedure or the latest version of the Therapeutic Guidelines: Antibiotic if not available
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Concerns regarding persistent infective symptoms should be referred to a Medical Officer.
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PAIN AND DISCOMFORT AROUND THE CATHETER, BLEEDING, ITCHING AND SORENESS
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Bladder and/or urethral irritation
| -
Alleviate urethral traction trauma and potential for pressure necrosis; secure catheter with catheter retaining strap.
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Liaise with Medical Officer.
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See INFECTION
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Discuss with medical officer possible use of
topical oestrogen for urethritis (in post-menopausal women) with Medical Officer.
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Allergy to catheter material
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Change catheter type
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Hyper granulation of supra pubic site due to pulling or tension.
| -
Prevent catheter traction and alternate the side the catheter is taped to on a weekly basis.
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Keep stoma clean and dry.
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Silver nitrate treatment may be required (See Wound Care Manual).
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Infection of stoma
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Arrange for wound swab, treat as required (See Wound Care Manual)
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CATHETER FALLS OUT
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Catheter balloon deflates prematurely Balloon faulty
Balloon intact
| -
Insert new catheter. Nelaton catheter to
keep site open until Foleys available
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Check balloon of dislodged catheter for
faults.
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Anchor inadequate, or trauma at transfer
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URINE IS CLOUDY, OFFENSIVE SMELLING
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Infection
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See INFECTION
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Low fluid intake
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Recommend fluid intake: 2-3 litres daily unless otherwise stated by Medical Officer.
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Difficult removal
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Ridging of deflated balloon or hysteresis’
| -
Allow balloon to spontaneous deflate
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Select appropriate catheter materials: all-
silicone catheters have a tendency to cuff,
consider all-silicone catheter with
integrated balloon (Releen In-Line Foley
catheter or hydrogel coated catheter
(Bard Biocath). Consider latex allergy
status of clients.
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Where cuffing is suspected, consider
instilling 1ml of sterile water back into the
balloon (after complete deflation).
Consider the use of anaesthetic gel prior
to the removal of the catheter.
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Difficult removal
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Bladder Spasm
Anxiety
| -
Apply lubricate to stoma site.
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A fair degree of pull may be required,
holding the catheter close to stoma, apply
consistent firm pressure whilst supporting
the abdomen with the non-dominant hand
until the catheter releases.
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Encourage relaxation, allay anxiety
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UNABLE TO INSERT SPC
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Spasm of tract/bladder
| -
Apply anaesthetic gel (Lignocaine 2%) to
stoma site.
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Place catheter in stoma, apply firm constant
pressure to catheter whilst waiting release
of spasm.
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Insert Nelaton intermittent catheter to
maintain tract, then remove and quickly
insert usual catheter, or try smaller size
Foley catheter.
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Report to medical practitioner,
antispasmodic/muscle relaxant therapy may
be required.
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Where unsuccessful, send patient to hospital
within 30 to 45 minutes for management.
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| Not following tract | -
Re-attempt at correct angle. Always observe
the angle of tract during catheter removal.
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NO DRAINAGE AFTER CATHETER INSERTION
| Catheter /balloon not in bladder | -
Advance catheter a little further. Once in the
bladder SPC should not be advanced more
than 10 cm in total.
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Check/consider the tip of catheter is not
located in the urethra.
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No urine in bladder
| Dehydration | -
Give extra fluids.
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Ensure drainage before inflating balloon.
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Advise increased fluids prior to planned
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catheterisation.
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