Catheter care and infection control

Table of Contents

1. Introduction
2. Catheter Care and Infection Control
   1. Meatal Cleansing
   2. Managing drainage systems
   3. Catheter Valves
   4. Taking catheter specimens of urine
   5. Catheter Care Bundles
   6. Troubleshooting catheter problems
   7. Bypassing
   8. Encrustation and blockage
3. Summary
4. References

Managing drainage systems

Different systems are available for urine drainage for patients with long-term urinary catheters.

Task 2

1

Identify the three main systems that may be considered for managing drainage from a long-term indwelling urinary catheter. Enter your answer in the box below and then select Check answer. The three main systems are: - Closed drainage system using a 2 litre drainable bag - Link drainage system using a combination of a leg bag and 2 litre drainage bag - Catheter valve

Closed drainage system - (c)Sue Woodward

Link drainage system - (c)Sue Woodward

Catheter valve - (c)Sue Woodward

Whichever system is used, the device that is attached to the catheter should remain in situ and the connection should not be broken for five to seven days, or according to the manufacturers' instructions. Maintaining a sterile, continuously closed drainage system has been shown in a number of studies to reduce the risk of CAUTI (NICE, 2012) and NICE recommends staff should "Leave the closed system alone!" (NICE, 2012: p138).

Consider for a moment if you have ever seen a patient mobilising with a zimmer frame and a 2 litre urine drainage bag hanging from a stand on the front of the frame. Sadly this is not an uncommon sight in a variety of care settings and yet this is wholly inappropriate - urine will not flow uphill, so the drainage is ineffective and it does nothing to protect the patient's dignity!

Task 3

2

Under what circumstances should a 2 litre drainage bag be attached directly to the catheter or a link system be used? Enter your answer in the box below and then select Check answer. When the patient is bedbound or only able to transfer from bed to chair and is not mobilising then a 2 litre drainage bag may be attached directly to the catheter. If a patient is mobile or undergoing rehabilitation, for example, a link system should be used and the two litre drainage attached to a leg bag for night time drainage.

Reflux of urine is associated with infection, so drainage bags should be positioned in a way that prevents back-flow urine (NICE, 2012). Two litre drainage bags contain a "flutter valve" where the tubing is inserted into the bag. This consists in essence of two pieces of plastic (blue colour in figure 4) that are held together by surface tension. If the level of urine reaches the level of the flutter valve, it can float open and reflux can occur.

Flutter valve - (c) Sue Woodward

Task 4

3

How should a drainage bag be positioned to prevent reflux of urine and other complications? Enter your answer in the box below and then select Check answer. The two litre drainage bag should always: - Be positioned below the level of the bladder - Be positioned off the floor on a stand - Be secured with a securement device to reduce tension on the catheter and trauma

The bag must never be put onto the bed or trolley with the patient, for example if a patient is being transferred or transported to another department - this increases the potential for reflux and backflow of old urine into the tubing.

Emptying the drainage bag also requires consideration, although again recommendations are made on the basis of expert consensus rather than research evidence (NICE, 2012).

Task 5

4

How often should a 2 litre drainage bag be emptied? Enter your answer in the box below and then select Check answer. The bag should not be emptied routinely every four or six hours as every time the tap is opened the risk of entry of bacteria into the closed drainage system is increased. However the bag should be emptied before the level of urine reaches the flutter valve to prevent reflux.

Staff emptying a drainage bag must ensure that correct hand decontamination technique is followed before and after manipulating any urine drainage bag (NICE, 2012). Non-sterile gloves and a clean plastic apron should be worn to protect the nurse or carer from contamination with body fluids as well as to protect the patient from cross-infection. A clean jug should be used for each patient.