Infection control manual - NHS Lothian

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5. Timing Only use an indwelling urinary catheter after full consideration of alternative methods of management. 6. Procedure Explain the procedure and the rationale for the catheterisation to the patient/formal carer and gain informed consent (Scottish Executive 2006). Check patient has no contra-indications that would prevent use of an anaesthetic lubricant. Where appropriate encourage the patient to have shower or bath prior to procedure. Apply plastic apron and perform a social hand wash as per NHS Lothian Hand Hygiene Guidelines (2008a). Prepare a trolley or appropriate surface with the required equipment and take to patient’s bedside. Ensure privacy, then prepare patient: preserve modesty by limiting exposure of patient’s body. Author(s): Carol Rae, Audrey Pringle, Mary Brown Version: 1 Page 6 of 11 Place non-sterile procedure pad under buttocks to protect bed. Wash hands as per NHS Lothian Hand Hygiene Policy (2008a) ensuring hand asepsis. Open the sterile dressing/catheterisation pack and aseptically place necessary equipment onto the prepared surface. Apply 2 squirts of alcohol gel and rub in well to hands. Apply first pair of sterile nitrile gloves. CLEANSING PROCEDURE Female patients Thoroughly cleanse the vulval area with Normal Saline (community patients could use cooled boiled water) swabbing from above downwards. Cleanse the labia minora vestible in turn swabbing from above downwards to prevent contamination from anal region. Use a separate swab for each stroke. Identify the urethral meatus and cleanse. Male patients Cleanse the glans penis with Normal Saline (community patients could use cooled boiled water). In non-circumcised patients, retract the prepuce (foreskin) slightly to enable the glans penis to be thoroughly cleansed and urethral meatus visualised. N.B. Do not fully retract a phimotic or tight foreskin. Remember to return the foreskin to its normal position following the procedure.
CATHETERISATION PROCEDURE Author(s): Carol Rae, Audrey Pringle, Mary Brown Version: 1 Page 7 of 11 Place non-sterile procedure pad on bed to protect bedding. Apply sterile drape beneath the patient. Apply sterile drape on top of patient leaving genitalia exposed. Insert anaesthetic lubricant e.g. Instillagel into the urethra and wait five minutes for local anaesthetic to work (6ml for women and 11ml for men). Catheterisation can take place immediately if plain lubricating jelly instilled. Discard first pair of gloves and apply 2 squirts of alcohol gel and rub in well to hands. Apply second pair of sterile nitrile gloves. Position sterile bowl/container to catch urine. Remove inner cover from the catheter and place the catheter in the sterile container. Some clinicians may prefer to attach the sterile leg bag to end of the catheter at this point. Gently insert the catheter into the urethra and observe the flow of urine. Extra precautions/tips: Female patients - Do not touch any part of the vulva with the catheter. If the catheter is accidentally inserted into the vagina, leave in situ and use a new catheter to be inserted into urethra. Remove catheter from vagina. Male patients - Hold the penis at a 90° angle to abdomen to help facilitate smooth insertion of the catheter through the prostatic bed and into the bladder. This should not cause the patient any discomfort. Hold catheter in place and instill sterile water into catheter balloon as per manufacturer’s instructions. Apply catheter retaining device to thigh and attach leg bag or mesh sleeve to calf or thigh as per patient’s preference. Ensure stand is available to hold night urine drainage bag whilst patient in bed. Check patient is cleaned of any lubricant and left dry. The patient should not experience any pain/discomfort from the catheter. Clear away any equipment, remove gloves and dispose of clinical waste as per NHS Lothian Waste Disposal Policy (2008b).
Page 1 and 2: INSERTION AND MAINTENANCE OF INDWEL
Page 3 and 4: 6. Correct disposal of all equipmen
Page 5: 3. Requirements Healthcare Professi
Page 9 and 10: 8. Obtaining a Urine Specimen Patie
Page 11: REFERENCES EPIC 2 (2007) National e

Infection control manual - NHS Lothian

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