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A little care goes a long way

Improving the quality of life for residents with catheters. By Andrea Lord.

Mr Brown is a frail elderly 87 year old man, residing in your facility. He has a catheter in place to drain his bladder, because his enlarged prostate is blocking off his urethra. As his primary caregiver, what can you do to assist with the care of his catheter and reduce the risks of him getting a bladder infection?

There are three areas of attention: you, Mr Brown and the catheter and drainage system.

Firstly as a caregiver, you need to protect Mr Brown from any infection you may introduce by following infection control standard precautions. Any resident with a catheter, particularly if they are ill, is more susceptible to bladder infections. You need to pay close attention to hand washing, wear personal protective apparel, for example, gloves, gowns, goggles and masks, and use aseptic principles and isolation if necessary.

Good hand washing is the single most important thing in preventing infections. Hands must be washed before and after carrying out any task involving a catheter. A clean pair of gloves must be used for each resident and on each occasion you have to handle Mr Brown’s catheter or drainage bag.

The use of an apron reduces the risk of contaminating your uniform with urine. If you are concerned about urine splashes in your eyes, then think about the use of goggles. As Mr Brown is at increased risk of infection, he should not be in the same room as another resident with catheter, as cross infection is more likely to occur.

Mr Brown should be encouraged to drink enough fluids, at least 30ml of fluid per kg of weight each day. Looking at alternative ways of delivering fluids such as ice blocks, non-alcoholic cocktails, soups, and individualised drink bottles can help Mr Brown achieve this goal. To know if Mr Brown is drinking enough, the colour of the urine is a good indicator of fluid intake. If his urine is light yellow colour by the early afternoon, then you have helped Mr Brown to do a good job of drinking. If his urine is dark yellow by early afternoon, maybe he should have had more fluids during the morning shift.

Ensuring Mr Brown has a regular soft bowel habit is also important. Have a look at Mr Brown’s notes. They should clearly indicate what his bowel routine is, for example, daily after breakfast, every other day after lunch. You need to report any variations, such as not going as normal after breakfast, on the day it occurs, to the registered nurse.

There is no need for a special hygiene routine with Mr Brown because of his catheter. Routine hygiene measures are enough, the catheter and genital area needs to be washed once daily and after each bowel action. When assisting Mr Brown, wash along the length of the catheter, away from the body; taking care not to pull on the catheter. Always check the area where the catheter comes out of his penis, and the underside of his penis and genitals for any signs of irritation. Gently towel dry and do not use talcum powder.

After washing and assisting Mr Brown with dressing, or after taking him for a walk, check that the catheter tubing is not kinked, not tucked into his clothing or that Mr Brown is not sitting on the catheter tubing. There should be some “slack” between the catheter and the drainage leg bag. The catheter should be supported on the inside of Mr Brown’s thigh, with an additional leg strap. The leg drainage bag should be strapped to the Mr Brown’s leg. Leg drainage bags and catheter tubing should not secured to the bed, chair or walking frames, as Mr Brown or you could accidentally pull the bag or put tension on the catheter, causing him significant discomfort or urethral damage.

The catheter is a fine tube that goes directly from the outside world into the bladder and so is an excellent route for infection. To minimise the risks of infection, the catheter and drainage bag should be keep under closed drainage. This means that the connection between catheter and leg drainage bag should not be broken, unless the leg drainage bag needs to be changed. Drainage bags should always be kept below the level of the bladder.

Leg drainage bags should be changed weekly. Each evening, the night bag should be attached directly into the bottom of the leg drainage bag. In the morning, the night bag is disconnected from the leg drainage bag and should be thrown away.

Mr Brown’s leg drainage bag should be emptied every four or five hours or earlier if three quarters full. To best empty the bag, wash your hands, put on clean gloves and using a clean jug, position the outlet of the bag over the jug. Ensuring the outlet does not touch the inside of the jug, open the outlet and drain the urine. Always hold the jug at an angle, so that as the urine drains, bubbles do not form. If a urine bubble bursts, it spreads urine) up to three metres over you, Mr Brown and the room. After emptying the drainage bag, close the outlet, drying it with toilet tissue. Then wipe the outlet with an alcohol swab, reducing any spread of bacteria or bugs. Remove your gloves, wash your hands and if necessary record the volume of urine drained.

When emptying Mr Brown’s leg drainage bag or performing any personal cares, report any abnormalities to the registered nurse and document them into his notes. The things to look out for include offensive smell, strange colour and debris in the urine.

You can make a great deal of difference to reducing the risks of infection for Mr Brown and any of your residents. What seem like simple steps can make big differences to your residents’ health and happiness.

Andrea Lord is a continence nurse advisor with the New Zealand Continence Association.

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