Catheterisation for children and young people girls

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Catheterisation for children and young people
(girls)

• Teaching pack 4
• Liz Herd

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Introduction
What do you know
about catheterisation?
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Ground rules

• We value the young people we care for, we would
  never put them or you at risk
• Always ask any questions when they occur to you,
  weve all asked questions that may seem
  silly-there is no such thing as a silly question!
• Stop me if you dont understand- the chances are
  others dont either
• Tell me if you need a break

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110

• The children and young people rely on the
  assessors to ensure we deliver high standards of
  care-the assessors take this responsibility very
  seriously
• These high standards protect you as well as the
  young people
• We are incredibly privileged to be part of their
  lives we owe them 110

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Do you have any concerns

• about catheterising a child?

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Parent Experts

• All parents know their child/young person best
  They care for them daily
• Listen to them-act on what they say!!
• As a resource they are second to none Use
  Them-get to know the child as the parent does

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Patient dignity

• Always ask child/young person for consent when
  considering interventions
• Ask how they would like it done
• Catheterisation is an extremely intimate
  procedure be aware of this at all times
• Treat children/young people as you would like to
  be treated, respecting their beliefs and values

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Patient Privacy

• This procedure invades privacy!!!
• Think of ways to try and support child/young
  person through this
• Privacy means that the family, including the
  child, may not be discussed with people who do
  not need to know or with whom you have no consent
  to share information.

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Definition of intermittent catheterisation

• IC (intermittent catheterisation)
• IC means passing a thin hollow tube into the
  bladder to drain urine (Simpson 2002)
• Simpson does not add remove the tube when the
  bladder is empty but in IC we remove the catheter
  when bladder is drained

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Abbreviations relevant to catheterisation

• IC intermittent catheterisation
• means the catheter is passed by a carer and only
  left in place until the bladder is empty then
  removed

• ISC intermittent self catheterisation
• means the catheter is passed as across but it is
  passed by the patient themselves

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History of catheterisation

• Been done by ancient civilisations for thousands
  of years
• Used gold, silver and reed, Ouch!
• ISC and IC first introduced Lapides 1972

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Female anatomy

• System includes
• 2 x kidneys
• 2 x ureters
• 1 bladder
• 1 urethra

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Transverse view of female anatomy

• Yellow area bladder and urethra
• Pink areas sexual organs
• Blues areas bowel and anus

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External anatomy

• The urethra is situated in front of the vaginal
  opening usually approximately 1 centimetre from
  vagina
• The third opening is the anus

anus
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ISC/IC procedure

• This is a clean not a sterile procedure
• It can be done in many positions and we will
  always support patient preference where possible
• It can be done directly into the toilet but this
  may not always be possible
• It is about promoting patient choice and dignity

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Hand hygiene

• As with all care hand hygiene is extremely
  important
• Please follow the 8 point plan and repeat steps 5
  times
• Wash hands as required through out the procedure

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Hand hygiene

• You may use alco gel if required but this must be
  on clinically clean hands only!

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Equipment required

• Appropriate catheter, correct size, in date and
  packaging intact
• Lubricant if required
• Hand washing facilities
• Area that affords privacy
• Toilet or receptacle for urine
• Swabs for cleaning genital area before and after
  catheterisation
• Clean pad if required

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Procedure IC

• Ask patient for consent at a time appropriate to
  them
• Collect equipment
• Help patient to undress if required
• Lubricate catheter as per manufacturer
  instructions

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Identify the area

• Using good light identify the urethral opening
• If you are teaching self catheterisation a mirror
  may be helpful
• Spread the labia to aid vision
• Have receptacle ready to collect urine

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Insert the catheter

• Following catheter manufacturers guidelines
  insert catheter slowly
• Stop if you feel resistance
• Insert the catheter only until you get urine
• Hold in place till urine stops draining

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Use Gravity!

• Drain urine into toilet or jug-by lowering the
  end of the catheter
• Observe the urine for
• Colour
• Smell
• Sediment
• Amount

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Catheterisation

• Slowly remove catheter to ensure all urine is
  drained from the bladder
• Pre lubricated catheters may be slippery!!!
• Observe urine

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Removing the catheter

• Ask child/young person to wipe away excess
  lubricant or clean it yourself

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Following catheterisation

• Ensure patient comfortable
• Help patient to dress if required
• Record any thing unusual
• Dispose of equipment

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Disposal of equipment

• Place catheter in bin provided with all used
  equipment that has been in contact with body
  fluids

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Record keeping specific to catheterisation

• Any observation of urine that is different from
  normal
• Colour
• smell
• Amount
• Sediment
• cloudy

• Time procedure was done
• Difficulty in passing catheter
• Advice given i.e. drink more fluid
• Difficulty in obtaining urine
• Any signs of trauma to urethra

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Concerns
Any
questions
???
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References

• Guide to intermittent catheterisation for
  healthcare professionals (2006) Dolman M
• White M Astra Tech Ltd
• ERIC water is cool Campaign 2003
• Nice guidelines DH 2002
• Essence of care DH 2001
• Coventry PCT Hand Hygiene Policy 2006
• Coventry PCT Consent Policy 2004