Indications for catheterisation and catheter selection

Table of Contents

1. Introduction
2. Assessing urinary incontinence
3. Indications for Catheterisation
   1. Contra-indications to catheterisation
4. Catheter Selection
   1. Intermittent versus Indwellling?
   2. Catheter Size
   3. Balloon Size
   4. Catheter Length
   5. Charrière size
5. Catheter Material
6. Summary
7. References

Assessing urinary incontinence

The nurse has a pivotal role in recognition, assessment and subsequent management of urinary incontinence (RCN, 2006). Urinary incontinence is a symptom and should be investigated like any other symptom by taking a detailed history, followed by physical examination and investigations.

Patients may be reluctant to discuss the problem due to embarrassment, or unable to due to dysphasia. Trigger questions should be asked during routine assessment to identify patients who might have a bladder problem (DH, 2010).

Task 1

1

Can you identify potential trigger questions that the nurse may use to identify patients who require further in-depth assessment. Enter your questions below and then select Check answer. Examples of trigger questions include: - How often do you go to the toilet to empty your bladder during the day? - How often are you woken at night by the desire to pass urine? - Do you ever feel an urgent need to rush to the toilet? If so do you make it in time? - Do you ever feel like you are not emptying your bladder fully?

If a patient responds positively to a trigger question then further in-depth assessment, using appropriate continence assessment tools, is crucial if an accurate diagnosis is to be made.

Ideally a continence assessment tool should then be used for in-depth assessment, as this provides an aide memoir for the assessor as well as facilitating accurate documentation. There are a number of essential components required for every continence assessment:

- history taking (cognitive and functional ability as well as lower urinary tract symptoms),

- physical examination and

- simple investigations.

Task 2

2

Can you identify key components to assess when taking a continence history? Enter your answer in the box below and then select Check answer. General health history - Past medical, surgical and obstetric history - Diet and fluid intake (volume and type of fluid, including bladder irritants e.g. caffeine, alcohol) - Drug history (check for medication that may have effects/side-effects on the bladder) - History of incontinence and urinary symptoms (refer back to table 1&2 the learning activity: Normal physiology and pathophysiology of the lower urinary tract) - Bowel habit - Functional ability (manual dexterity, mobility) - Cognitive ability - Quality of life for patient and family/carers

Task 3

3	Identify key components of physical examination required. Enter your answer in the box here and then select Check answer. Abdominal examination, pelvic floor, perineal and rectal examination.

Task 4

4	Identify key simple investigations that would be required. Enter your answer in the box below and then select Check answer. Urinalysis, Post-void residual urine measurement and frequency/volume charting.