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Infection Prevention and Control
Insertion of a Female Urethral Catheter
1 of 7 - Infection Prevention and Control Insertion of a Female Urethral Catheter
Infection Prevention and Control Inser&on of a Female Urethral Catheter Purpose To ensure all relevant staff are aware of the principles of insertion of a female urethral catheter and understand the rationale that informs the principle, to prevent cross infection between service users, staff and visitors and prevent Health Care Associated Infections.
Target Group This procedure is relevant to healthcare or care staff that have received specific training in the insertion of female urethral catheters.
Introduction Urinary tract infection (UTI) is the most common infection acquired as a result of health care, accounting for 19% of Health Care Associated Infections, with between 43% and 56% of UTI’s associated with a urethral catheter. This guidance has been formulated to give healthcare and care staff a step by step approach to the insertion of a urethral catheter with a rationale for each stage, based on the current national research and guidance. This guidance should be used in conjunction with other associated infection prevention and control policies and procedures such as Hand Hygiene, Waste Management, Use of Personal Protective Equipment (PPE) and Aseptic Non-Touch Technique (ANTT) Only appropriately trained and competent healthcare or care staff should carry out female urethral catheterisation using an aseptic non touch technique
Equipment • • • • • • • • • • • • • •
2 pairs of sterile single use gloves Hand sanitiser Disposable plastic apron Alcohol wipes or hard surface disinfectant wipes 10mls sterile water for catheter balloon Sterile syringe and needle or sterile filler Sterile dressing/catheterisation pack containing sterile receiver Sodium Chloride 0.9% Single use sterile lubricant/anaesthetic gel Catheter of appropriate size/length and type of material Appropriate drainage bag Leg bag straps or means of holding catheter Universal specimen container for specimen if required Clinical waste bag
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2 of 7 - Infection Prevention and Control Insertion of a Female Urethral Catheter
Infection Prevention and Control Inser&on of a Female Urethral Catheter Action
Rationale
Explain and discuss the procedure with the service user verbally and obtain consent
To ensure that the service user understands the procedure • Check service users identity • Check any allergies • Check valid consent
Assist the service user to get into the supine position with knees bent, hips flexed and feet resting about 60cm apart
To enable genital area to be viewed and accessible
Maintain service user’s privacy with covers at this stage and ensure service users comfort
To maintain dignity and comfort while equipment preparation takes place.
Ensure that visibility is adequate using additional light sources if required
To ensure that the genital area is visible
Perform effective hand hygiene by washing hands with soap and water or using alcohol gel if hands are visibly clean
To reduce the risk of infection
Put on a disposable plastic apron
To reduce the risk of cross contamination through contact with healthcare staffs’ clothing
Prepare equipment and ensure packaging is intact and products are within the expiry date
To ensure equipment is single use, sterile and within the expiry date
Using alcohol wipes or similar, clean To facilitate optimum clean working and prepare a dressing trolley / dressing conditions and minimise the risk of tray or prepare a clean working surface contamination
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3 of 7 - Infection Prevention and Control Insertion of a Female Urethral Catheter
Inser&on of a Female Urethral Catheter
Infection Prevention and Control Clean neck of ampoule with Sodium Chloride prior to drawing up sterile water
To reduce cross infection
Using an aseptic technique, open supplementary packs
To reduce cross infection
Remove privacy covers maintaining service user’s privacy and position disposable pad under service user’s buttocks/thigh area
To provide access to the area;
Perform effective hand hygiene by washing hands with soap and water or using alcohol gel if hands are visibly clean
To reduce the risk of infection, hands may have been contaminated by handling outer packaging
Put on 1st pair of sterile single use gloves
To reduce cross infection
Place sterile towel from pack under service users buttocks
To create a sterile working area
Take the sterile towel, place across the service user’s thighs;
To provide a sterile working area
Using non-dominant hand and gauze swab separate the labia minora so that the urethral meatus is visible; clean using downwards strokes with a sterile piece of gauze moistened with 0.9% saline for each single downward stroke
To reduce the risk of cross-infection and the introduction of skin and meatal flora into the urethra and bladder
Insert the sterile nozzle of the anaesthetic lubrication gel into the urethra; squeeze 6ml into the urethra, remove the nozzle and discard the tube; wait 5 minutes for it to take effect
Adequate lubrication helps to prevent urethral trauma
To ensure bodily fluids do not leak onto service users bed clothes
Inadequate preparation of the urethral orifice is a major cause of infection following catheterisation
Use of a local anaesthetic minimizes the service user’s discomfort
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4 of 7 - Infection Prevention and Control Insertion of a Female Urethral Catheter
Infection Prevention and Control Inser&on of a Female Urethral Catheter Remove used gloves; perform hand hygiene and put on a 2nd pair of sterile gloves
To reduce contamination following skin and meatal contact with 1st pair of gloves
Place the sterile urinary catheter, in the sterile receiver, between the service user’s legs
To provide a temporary container to maintain sterility prior to insertion and to catch urine as it drains
Gently introduce the tip of the catheter into the urethral orifice directing the catheter tip upward and backwards; Advance the catheter 5-6cm or until urine starts to flow, then advance it a further 6-8cm
Advancing the urinary catheter prevents the balloon from being trapped in the urethra when inflation occurs
Inflate the balloon according to the manufacturer’s instructions, having ensured that the catheter is draining adequately
Inadvertent inflation of the balloon within the urethra is painful and causes urethral trauma
Withdraw the catheter slightly until the balloon is sitting at the bladder neck, and connect it to the drainage system
Maintain service user comfort and prevent urethral trauma
Support the catheter; ensure it does not To maintain service users comfort and pull or become taut as the service user to reduce potential trauma to urethra mobilises and bladder neck Make the service user comfortable and ensure the area is dry
If the area is left wet or moist, particularly with bodily fluids, secondary infection and skin irritation may occur
Observe and measure how much residual urine drains and document after procedure
To ensure volume of urine in bladder at time of catheterisation is recorded especially when service user has presented with urinary retention or impaired renal function (During routine re–catheterisation there should be a minimal amount of urine in the bladder)
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5 of 7 - Infection Prevention and Control Insertion of a Female Urethral Catheter
If not using a pre-connect system, connect an appropriate drainage bag, ensuring this is below the level of the bladder. Affix urinary catheter fixation device; attach the drainage bag if using a leg bag to the calf, using straps, night bag or a catheter valve. If required collect and send a urine sample for investigation
To ensure unrestricted flow of urine into a closed system To prevent catheter “drag” which can results in trauma to urethra and bladder
To detect presence of bacteria and infection
Dispose of used equipment into correct To prevent environmental waste stream and clean trolley or tray contamination Remove gloves and decontaminate hands with either soap and water or hand sanitiser
To reduce the risk of cross infection
Explain to the service user the importance of maintaining cleanliness around the urethral orifice, by washing with soap and water daily and of avoiding touching or pulling the catheter
To reduce the risk of infection and trauma
Assist the service user to dress and return to their usual activity or living area
To enable the service user to continue with their activities of daily living
Give the service user written information leaflet
To support verbal instruction
Record all information including any untoward events, the catheter size, type, expiry date, batch / lot number of any products used and amount of water To ensure effective and accurate record in the balloon. keeping is maintained and Record expiry date of anaesthetic gels. documentation is complete Document the date of the next catheter change
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6 of 7 - Infection Prevention and Control Insertion of a Female Urethral Catheter
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Infection Prevention and Control Gordon House, Station Road Mill Hill, London NW2 2JU Telephone 020 8906 2777 Fax: 020 8906 2233 7 of 7 - Infection Prevention and Control Insertion of a Female Urethral Catheter www.infectionpreventionsolutions.co.uk