continence care management formulary

1

Continence Care Management Formulary

Document Description

Document Type Formulary

Service Application All Clinical Staff and Care Staff

Lead Author

Name Position within the Organisation

Gill Davey Continence Services Manager , DGNFT

Jag Sangha Pharmaceutical Adviser (v1.3 onwards), Dudley CCG

Louise Storey Nurse Prescribing Lead, DGNFT

Caroline Whitehouse Community Nurse, DGNFT

Caroline Clarke Older Persons Specialist Pharmacist, Dudley CCG

Presented for discussion, approval and ratification to

Area Medicines Management Committee

October 2012

Area Clinical Effectiveness Committee Approved November 2016

Review Date November 2019

Change History

Version Date Comments

1 October 2012 Ratified at AMMC

1.1 February 2013 Hydro-Caine Lubricating Gel removed

1.2 February 2015 Qufora product information included, Bowel Aids, updated to include review date

1.3 Sept 2016 Contiform included, Ugo fix, bladder infusion kit, Prosys all silicone catheter

1.3 October 2016 Consultation on full document with Urology (including Hospital to Home urology Team, Geriatrician, Community Nursing Teams, Practice based Pharmacists, Pharmaceutical Public Health Team, Older Persons Specialist Pharmacist, Office of Public Health Infection Control Team.

2.0 November 2016

Approved November 2016

Link with Care Quality Commission Essential Standards of Quality and Safety

Regulation 10, Outcome 16 - Assessing and monitoring the quality of service provision. Regulation 13, Outcome 9 - Management of medicines.

Link with Trust Purpose and Values statements

We will work to continuously improve services ‘We will support, deliver and develop our staff’

2

Continence Management Formulary Group / Authors

Gill Davey Continence Services Manager, DGFNT

Louise Storey Nurse Prescribing Lead, DGFNT

Caroline Clarke Older Persons Specialist Pharmacist, Dudley CCG

Jag Sangha Pharmaceutical Adviser, Dudley CCG

Caroline Whitehouse Community Nurse, DGFNT

Jane Ashmore-Hall Deputy Head of Procurement, DGFNT

Margaret Cooksey Clinical Skills Lead, DGFNT

Nadine Edinborough-Edwards Clinical Nurse Specialist – Infection Prevention Control, Office of Public Health, Dudley MBC

Raj Khunkun Community Nurse, DGFNT

Contacts

Continence Service Brierley Hill Health & Social Care Centre (01384 321516)

Infection Control Team Dudley Group via RHH Switchboard (01384 456111)

Infection Control Team Office of Public Health (01384 321854)

Clinical Nurse Specialists (Urology) Dudley Group via RHH Switchboard (01384 456111)

Contents

Products Page

Long term urinary catheter (3 – 12 weeks) 3 - 4

Short/Medium term catheters 5

Silver Coated Catheters 6

Intermittent Self Catheters (ISC) 7 - 9

Lubricating Local Anaesthetic Gel 10

Catheter Maintenance Solutions 11 - 12

Penile Sheaths 13 - 15

Catheter Bags (Leg) 16 - 17

Night Drainage Bags 18

Accessories 19 - 20

Catheter Valves 21

Additional Accessories – (Specialist) 22 - 23

Bowel Aids 24 - 25

References 26

3

Long Term Urinary Catheter (3 - 12 weeks)

Silicone Elastomer- this is a latex catheter with silicone bonding to the outer and inner surface, making the surface smooth and reduces encrustation. This has the combined advantage of silicone and latex (ACA, 2007, RCN, 2012) All Silicone: - a latex free catheter. It has a large lumen and the walls of the catheter are thin, these help with minimizing encrustation. (ACA, 2007, RCN, 2012) Polymer-coated Latex - It is latex with a coating of polymer hydromer; the manufacturers state this is more compatible with body tissue (Robinson, 2001). The hydrogel will absorb a small amount of body fluid to keep it smooth, reduce friction between catheter and urethral surface and less encrustation. (ACA, 2007, RCN, 2012) What to choose?

Polymer coated or hydrogel as less likely to cuff on deflation. However if patient is allergic to latex then all silicone must be used (MDA, 2001 and Parkin, 2002, RCN, 2012)

Company/product Male code

Female code

Expected use

Teleflex Medical Sympacath

DH3101 (12-16)

DH2101 (12-16)

Urethral/supra pubic

3-12 weeks Hydrogel coated latex catheter

Pre filled syringe

Teleflex medical (formerly known as Rusch) Brilliant Aquaflate

DA3101 12 DA3101 14 DA3101 16 DA3101 18 Use the below sizes with specialist advise ONLY DA3101 20 DA3101 22 DA3101 24 (12-24)

DA2101 (12-18)

Urethral/supra pubic catheters

3-12 weeks

An all silicone catheter

Prefilled syringe

4


Female code

Expected use

Coloplast Folysil (open ended)

AA74 12 AA74 14 AA74 16 AA74 18

AA75 12 AA75 14 AA75 16

Urethral and supra –pubic all silicone

L.IN.C medical All Silicone Catheter with integral balloon

0850-12-05 0850-14-05 0850-16-10 0850-18-10

0850-12-051 0850-14-051 0850-16-101

For supra pubic and urethral use

Sticky labels (available for audit purposes)

Latex free

All silicone

Round tip

Clinisupplies Prosys

PCF12F10 PCF12M10 PCF14F10 PCF14M10 PCF16F10 PCF16M10 PCF18F10 PCF18M10

Female=F Male=M

Urethral

All silicone catheter 10 ml balloon

Two-way catheter

5

Short/Medium Term Catheters

For frequent changes consider these types of catheters. (RCN, 2012) These are not generally suitable in primary care unless the patient is a frequent blocker (e.g. high frequency of catheter change) which necessitates greater than 12 catheter changes per year. The rationale should be clearly documented within the relevant patient record (e.g. single assessment folder). Please ensure one additional catheter is available with the patient at all times should a need arise to change the catheter at short notice. The Hospital to Home nursing team operates from Urology Ward C6, DGH. Please note that this team only has input into the management of those patients under the care of a urology consultant. Details include:

Olivia Thornton

Tina Steventon

Monday to Friday 9am to5pm

Tel: 01384 456111 extension 2282/2692


Female code

Expected Use

Teleflex Medical (Rusch) Aquaflate

DP3101 12 DP3101 14 DP3101 16

DP2101 12 DP2101 14 DP2101 16

For urethral and supra pubic use

1 to 3 weeks

Comes with pre filled syringe for balloon inflation/deflation

1 in the pack

Two way adult Foley

Bard PTFE Aquamatic Coated Latex

D1265AL

Prefilled with sterile water

Two way adult Foley catheter

For urethral and supra-pubic use

1 to 3 weeks

10 ml balloon

I in the pack

Universal Hospital Supplies Ltd Silicone Elastomer (Male)

UN41151205 - UN41152005 Sizes 12-20

Not available

6

Silver Coated Catheters – For Specialist Use

These are suitable for patients prone to recurrent urinary tract infections, as silver coating provides an increase in antibacterial protection. Most of the research has been in short term use only, which is not deemed suitable for primary care. These catheters preserve the integrity of the urethral mucosa, preventing inflammation, loss of epithelium and formation of a biofilm. The silver ions inhibit formation and reduce the risk of infection. 4 weeks maximum in using these catheters EAU, (2012) RCN (2012) Seek advice before prescribing Silver Coasted Catheters. For DGH contact Clinical Nurse Specialist for urology.

7

Intermittent Self Catheters (ISC)

This method is well established and an accepted form of management of neuropathic bladder dysfunction, atonic bladder and often other causes of incomplete emptying. This can be used for stricture management to prevent the stricture reoccurring. Clean (patient to maintain adequate hand hygiene) Intermittent self-catheterisation of the urinary tract helps prevent reflux and reduces the threat of encrustation and infection. (RCN, 2012) Clean Intermittent self-catheterisation is a safe procedure for all ages. Manual dexterity does need to be considered, however there are aids to assist and facilitate easier handling. Patients are encouraged to empty their bladder by inserting a urethral catheter and hand hygiene is important with this procedure and should be emphasised at each review. Patients are discouraged from touching the catheter tip to avoid urinary infection. The quantity of ISC to be prescribed is dependent upon the medical indication, bladder charts and continence assessment:

Generally clean intermittent self-catheterisation can be from once a day up to six times per day.

This equates to one catheter per use (box of 30) and thus up to 6 x 30 ISC may be required each month

There are exceptional indications for use such as neurogenic and atonic bladder and for patients with spinal injuries. These patients could require emptying their bladder more frequently up to 8-12 per day (equivalent to between 8 and 12 boxes of ISC per month).

If there are any concerns or queries regarding inappropriate quantity of ISC use, please contact either Urology or the Continence Service for advice. Patients are required to choose the catheter that suits their needs and how they want to receive them i.e. via their community pharmacy or appliance contractor. Patients should be supported and educated to ensure they make an informed choice of catheter. Please refer to the continence service if a patient requires guidance.


Female code

Expected Use

Great Bear Healthcare Ltd Cub Cath

AVM08 -AVM16

AVF08 – AVF 14 20cm

Packs of 30

Single use

Water is needed to lubricate for 30 seconds

B Braun Actreen Glys

225208E Ch8 225210E 225212E 225214E

225306E 225308E 225310E 225312E 225314E

Single use

Pack of 30

Glycerine helps lubricate the Nelaton catheter

Softens and protects urethra

No touch

Actreen lite 228208E 228306E- Single use

8

228218E Ch 8/12

228316E Ch 8-12

Pack of 30

Hunters Anti Bac - Specialist

ABF08 to ABF18 Ch 8t o ch 18 20 cm Ch 10 & 12

Single use only

Nelaton catheter

Smooth ended with less trauma to urethra

Pack of 30

Coloplast Speedicath

28408 to 28418 10+12 ch

28506/ to 28516 female 10+12

Single use only

Pack of 30

Pre hydrated and ready to use

Speedicath Compact

28692 10+12ch

28578 8 28580 10 28582 12 28584 14 10+12ch

Booklets available from the Continence service.

Pack of 30

Size of a lipstick

Hydrophilic catheter

Wellspect (formerly Astra Tech) Lofric primo

Male 40 cm 968 0800 960 10 00 960 12 00 960 14 00 960 16 00 960 18 00 10+12

Female 15cm 4141025 10ch 4141225 12ch 4141425 14ch Female 20cm 10+12

Single use only

Pack of 30

Sachet of water attached

Lofric Primo can be folded over for 24hrs without damaging the catheter

Teleflex Medical Flocath Quick

Male 851241 Sizes 8 – 2 10+12

Female 85122 Sizes 8 – 20 10+12

Single use only

Saline attached

30 in pack

Manfred Sauer

Male IQ

Intermittent catheters for males

9

IQ 2004.12 -14 Male IQ+ 2104.12

Pack of 30

IQ requires water to activate lubricant

IQ+ has saline included in package good for gentlemen with prostrate problems

Rochester Hydrosil

63610-10ch 63612-12

71610-10ch 71612-12

Single use

Own sachet of sterile water

30 in box

10

Lubricating Local Anaesthetic Gel

This is a single use sterile gel/lubricant for the urethral mucosa. It must be used for female and male urethral catheterisation. (RCN, 2012) Contraindications to the use of Lubricating Local Anaesthetic Gel:

Must not be used in patients with known hypersensitivity to the active ingredients (amide-type anaesthetics, chlorhexidine and alkyl hydrobenzoated) or any of the excipients.

Should not be used in patients who have damaged or bleeding mucous membranes because of the risk of systemic absorption of the ligocaine hydrochloride. Special warnings and precautions for use: should be used in caution in patients receiving antiarrhythmic drugs, hepatic insufficiency, epileptics and impaired cardiac conditions.

Company/product Volume Expected Use

Instillagel Lidocaine 2% Chlorhexidine 0.25%

6ml 11ml

Local anaesthesia, disinfection and instrument lubrication in urethral catheterisation and cystoscopy

11

Catheter Maintenance Solutions

These solutions are NOT for routine use, but as part of an overall management plan. They assist in the patency of the catheter and the use of 50mls is as effective as 100mls in reducing encrustation. Two sequential uses of 50mls are more effective than a single instillation. (Getliffe, 2000) DEFINITION Manual bladder irrigation is used for clearing clot retention rather than clearing the catheter of encrustation. If the catheter is blocked with encrustation it will require changing. Catheter blockage is a very common complication in long term catheter users. Up to 50% of long term catheters are changed prematurely due to catheter blockages. (RCN, 2012; EAU2012) There are 3 main catheter solutions available:

1. Normal saline NOT TO BE ROUTINELY USED; only to clear blood clots, pus or debris In order to prevent premature catheter changes please could you ensure normal saline catheter maintenance solutions are available for all catheterised patients within their homes.

2. Solution G (see table below)

3. Solution R (see table below)

Company/product Code Expected Use

Braun Uro-Tainer Suby G 2 X 30mls Citric Acid Uro-Tainer Solution R 6.0% Citric Acid 2 X 30ml

9746609 9746625

A twin chamber system containing 30ml of citric acid (3.25%) solution

Reduces /resolve crystallisation

Recommended regime following assessment is from once weekly to twice daily depending on severity.

Instil for 5-10 minutes per chamber

Twin chamber system containing 30 mls of citric acid (6%)

Dissolves persistent crystallisation in the catheter or can be instilled 5-10 minutes prior to catheter removal to minimise trauma

Uro-Tainer NaCl 0.9% Normal saline

FB99849 (50ml)

NOT FOR ROUTINE USE

For removal of

Expected Use clots, debris & pus to prevent preventative catheter change

Bard CSG 50 Citric acid (3.25%) dissolves

12

Optiflo G 50ml Single 3.23% Citric Acid Optiflo R 50 ml Single 6.0%

(50ml) CSG 100 (100ml) CSR 50 (50ml) CSR 100 (100ml)

/reduces crystallisation

Citric acid (6%)

Dissolves persistent crystallisation

Use 5-10 minutes prior to removing catheter

Optiflo S 50mls 0.9% Saline

CSS50 (50ml) CSS 100 (100ml)

NOT FOR ROUTINE USE

For removal of clots, debris & pus to prevent catheter change

13

Penile Sheaths

Penile sheaths must be fitted by an appropriately trained health care professional and a referral to a specialist should be made for the patients if fitting difficulties. (NICE, 2015) The problems usually encountered relate to poor skin preparation, poor fitting and the inappropriate choice of product. This results in increased susceptibility to urinary tract infections, sores on the end of the penis and/or damage to the surrounding skin caused by some adhesives. Sheaths are to be kept in place for no longer than 24 hours. Assessment For success of a correctly fitted sheath, the following need to be adhered to:

1. Non retracted penis

2. Healthy, unbroken skin

3. No risk of sheath being pulled off

4. Reasonable mental awareness, eyesight, manual dexterity and adequate carer

availability

The next step is to ensure that the patient is measured correctly to get the size of sheath to maintain continence. Each company provides individual fitting guides which can vary in size and if a different sheath is used, ensure the correct fitting guide is utilised. It is inappropriate to guess the correct size. Size is taken from the base of the penis, not the glans. A small sheath may constrict the penis and too long a sheath may disconnect, kink and leak. Length is important; if too long this may roll off. Generally if a patients penis measures 3cm in length, it is unlikely that a sheath device will be suitable and an alternative method for management needs to be considered. Do not use talc or cream before application. Generally one box of 30 penile sheaths will last one month. The P-Sure sheath (Manfred Sauer) is the only company which has a wide range of sizes which can be used for adults and paediatrics. If unsure contact the Continence Service. Samples can be obtained from the Continence Service.

14


Quantity Expected Use Advantages

Bard (previously Rochester) Clear advantage With Aloe Vera Style 1

1243 24mm 1283 28mm 1323 32mm 1363 36mm 1403 40mm

Box of 30

Pack of 30 Silicone self-adhesive 5 sizes Adult only Fitting guides and measuring devices included

For men with sensitive skin

Bard (previously Rochester) Pop on Clear advantage With Aloe Vera Style 2 Style 3 Wideband adhesive

2243-24mm 2283-28mm 2323- 2mm 2363- 6mm 2403- 0mm 3243-24mm 3283-28mm 3323-32mm 3363-36mm 3403-40mm

Box of 30 Box of 30

Pack of 30 Silicone and self-adhesive 5 sizes/adult only Fitting guides and measuring devices

For sensitive skin

Bard (previously Rochester) Transfix x 3 styles Silicone Style1 standard Self-Adhering Type 2 Short

25mm TF12530 29mm TF12930 32mmTF13230 36mm TF13630 41mm TF14130 25mm TF22530 29mm TF22930 32mm TF23230 36mmTF23

Box of 30 Box of 30

Box of 30 Fitting guides and measuring devices Silicone and self-adhesive

15

Type 3 extra wide adhesive

630 41mmTF24130 25mmTF32530 29mmTF32930 32mmTF33230 36mmTF33630 41mmTF34130

Box of 30

Manfred Sauer P Sure sizes

97-18mm 97-20mm 97-22mm 97-24mm 97-26mm 97-28mm 97-30mm 97-32mm 97-35mm 97-40mm

Box of 30 Range of sheaths Latex free and self-adhesive 18mm -40mm (includes paediatric) Includes 1 free pubic hair protective cloth Fitting guides Anti-blow back system Adaptable for retracted penis and can used for drip urinal

Coloplast Ltd Optima Shorter length

21mm 22121 25mm 22125 30mm 22130 35mm 22135

Box of 30 Non latex ,self-adhesive with Anti-kink design Fitting literature And measuring guides For patients with a short penis Adult only

Standard Length 25mm 22025 30mm 22030 35mm 22035 40mm 22040

Box of 30

16

Catheter Bags – (Leg)

Leg bags are for the collection of urine from an indwelling catheter or penile sheath. They may be worn in different positions (thigh, calf, and belly). The leg bags differ with outlet taps, connectors, length of outlet tube and inclusion of straps. Patients need to be assessed on dexterity for tap closure/opening before prescribing. Leg bags must be changed using an aseptic non touch technique. They can remain in situ for up to 7 days (follow manufacturers guidance). (RCN, 2012; EAU, 2012)

Company/product Tap Bag Size/Code Expected Use

Clinisupplies Prosys

Lever Slide Action

500ml short P500S-LT 500ml long P500L-LT 350ml short P350S 350ml long P350L 500ml short P500S 500ml long P500L 750ml short P750S 750ml long P750L

Box of 10

Needle free port

Gloves come with catheter Latex free

Uno medical/Careline

T Tap Lever

Short 350ml 45-01-SVC 500ml 45-05-SVC 750ml 45-09-SVC Long 350ml 45-02-LVC 500ml 45-06-LVC 750ml 45-10-LVC Short 500ml

5 to 7 days duration of use

A ridged connector and needle free port

Overnight connector

Non return valve prevent back flow

1 pair of elastic and Velcro straps included per box of 10 bags

17

46-05 -SVC 750ml 46-09-SVC Long-500ml 46-06-LVC 750ml 46-10-LVC

Great Bear Libra Leg Bag

Lever

350ml short tube 10100 A 500ml short tube 10103C 500ml long tube 10104E 750ml short tube 10106 1000ml long tube 10120W

Pack of 10 Latex free 100% Needle free port Straps included 180 degree lever tap Overnight connector

Manfred Sauer Bendi bag

Swing 700ml direct inlet 70-33-045 12cm inlet 70-33-125 1300ml direct 12cm 70-47-045 20cm 70-47-205

Pack of 10 Useful for people in wheelchairs/chair bound Velcro straps included Overnight connector included

18

Night Drainage Bags

These are connected to the leg bag (day bag) and used in conjunction with a stand which may be obtained by contacting the company. The position of the bag should be below the bladder level to enhance gravity induced drainage, but no more than 30cm below as can have negative effect and cause suction effect to the bladder mucosa and will cause blockage of the catheter. (RCN, 2012) Please ensure a catheter stand is used; this prevents damage to the bladder neck.

Company/product

Drainable/ Non Drainable Tap

Code

Expected Use

Night Drainage Bags Unomedical Ltd Careline Easi MT

Non Drainable 2L

47-60-LBH 10 in pack

Single use

Twist off drainage outlet

Non return valve

Simpla S 2 Clinisupplies

Non Drainable 2L

320902 Single use only

Prosys Clinisupplies

Non Drainable 2L

PSU2 Single use only


Drainable 2L

P2000 Slide outlet Tap

Sterile


Drainable 2L

P2000-LT Lever outlet Tap

Sterile

Great Bear GB4

Drainable 2L

10400W Sterile night bag with tap, non-return valve, sample port and anti-kink tubing

For use when leg bag not indicated

19

ACCESSORIES

This is equipment to be used with the urinary catheter ensuring the catheter is anchored to the leg and thigh of the patient. There is a range available to meet individual need e.g. – large and oedematous legs or thin frail legs.

Company/ product

Size Code Expected Use Guidance on correct use

Flexicare Medical Atraps

One Size 00-0032

Coloplast G Strap Thigh

Adult Abdominal 80cm

383001 383003

Pack of 5 Washable and Reusable Order one pack only Replace when strap becomes unserviceable Elasticated retainer strap helps steady the catheter and assists in keeping bladder neck up. Around thigh

2 to 3 packs per year is adequate

Hollister Thigh

58.5cm 9343 Deluxe leg straps 2 in a pack Measure the leg Wrap around thigh Good for large thighs


Manfred Sauer P Grip

Leg 38mm x 600mm Waist 38mm x 900mm

CS.01 CS.02

Assists with clean ISC, an aid to raise the penis so the catheter can be directed down the urethra

Single use should be sufficient

Unomedical Care Sleeve

Small (30-45cm) Medium (45-65cm) Large (55-80cm)

46-LS-01 46-LS-03 46-LS-


20

Extra Large (65-90cm)

05 46-LS-07

Ugo fix Gentle clip for catheters

One size fits all

3004 Pip-394-9054 5 in the box

Gentle clip that fixes at bifurcation On for 7 days Can be used in the shower

Follow instructions to ensure it fits correctly

CathIT advance pack

n/a n/a Catheterisation pack- first layer is the removal kit and the second layer is the insertion

Facilitates aseptic non touch technique to reduce the risk of urinary tract infections associated with catheters

Pelvic toner Female use Helps to engage and strengthen the pelvic floor muscle Only one needs to be prescribed

Must see a specialist physiotherapist (Continence Service) Pelvic floor muscle needs to assessed first before use

Contiform Female use Vaginal pessary lasts 45-60 days Correct fitting is essential Moulded elastomer resembles a hollow tampon which makes insertion easy

Must see a specialist physiotherapist from the continence service to check pelvic floor muscle before use

21

Catheter Valves

Patients (or carer) can use these with long term catheters who have sufficient manual dexterity to be able to turn the valve to empty the bladder when required. This then will reduce the need for a day bag. The patient also needs cognitive awareness and adequate bladder capacity to use this system. This can be used on urethral and supra pubic catheters. (RCN, 2012; EAU, 2012)

Avoids the need for day bags and does not restrict what the person wears.

Valves should be replaced weekly (1 x 5 per month) An assessment is needed for bladder function and the Continence Service can be contacted for further assistance and guidance on prescribing. Contraindications to their use:

Reduced bladder capacity.

Not to use on patients who have under gone a radical prostatectomy and bladder reconstruction.

No bladder sensation.

Cognitive impaired.

Insufficient manual dexterity to operate the valve.

Company/product Pack Size code Expected Use

Unomedical Ltd Careline

5 Lever 90821 15-20 Tap 90805 15-20

L.IN.C Care flow catheter valve

5 CFI

Manfred Sauer Smart flow valve

5 CVS

Will connect to any catheter

Twist connector

22

Additional Accessories - Specialist

For more information please contact the continence service. Retracted penis pouch is an alternative when the patient has a small penile length and a sheath cannot be attached. Flow directors can assist patients aim their flow into the toilet more fluently. Male and female are available. A meatal penile sheath can be applied to the small area of the glans around the meatus which differs from a standard penile sheath which is applied over the whole penis. The hydrocolloid petals adhere to the glans of the penis. The butterfly application helps seal around glans. This type of sheath can be valuable for patients who have spinal injuries or neurogenic bladders. Please seek advice from the Continence service if this type of sheath may be required.


Female code

Practical Use Clinical Scenario

Hollister Retracted penis pouch

9811 9873

Single use only; one needed per 24 hours

Beambridge Male Flow directors Jug urinal

6-35mm

Washable and re-usable; Male use; Only one needs to be prescribed for any individual

Good for gentlemen with Parkinson’s or Bed bound. They direct the flow of urine into a toilet/bottle/ Receptacle.

Beambridge Female flow director Pod there are two types Extension tube Saddle urinal Bridge urinal

6-60T (Tap) 6-60 (No tap) 6.39

6-60T (Tap) 6-60 (No tap) 6.39 6.26 6.29 6-18 6-18T

Washable and re-usable; Female use; Use sitting on edge of bed/chair or standing; Can use a connector to attach to a bag; only one needs to be prescribed per individual; Can use connector to attach a night bag.

Hip replacement - these devices assist ladies in managing to direct the flow of urine into the toilet if they feel they are unable to bend.

23

Clinimed Bio derm – Meatal Sheath

Pack of 5; Hydrocolloid skin friendly; Fits on to the glans of the penis; Has drainable plug which will fit most leg /night bags; Alternative to sheaths; On for 2 to 3 days and therefore 1 to 2 packs per month only.

Spinal injury; Young men with multiple sclerosis

Bullen Health Care Uri drain system

Use for retracted penis Must be measured use guide Hip/ waist required

For gentlemen who lead active lives and found sheaths had dislodged off due to daily functioning

L.I.N.C bladder infusion kit Designed to reduce the risk of urine infections

Pack of 10 To deliver catheter maintenance without breaking the closed system

Keeps the closed system intact. All that is required is to clamp off and instil the catheter maintenance solution.

24

Bowel Aids

These are for assisting in bowel function. The anal plugs are useful if continence pads are not suitable. They are good for neurogenic conditions (e.g. spinal injury, multiple sclerosis, advanced dementia etc.) with impaired sensation. Adequate bowel movement must be instigated to avoid bowel inactivity which may lead to obstructive symptoms. Peristeem is known as Tran’s anal irrigation or rectal irrigation for select patients whereby laxatives no longer work. It is a method of emptying the lower bowel and helps in preventing faecal incontinence, constipation or a lazy bowel. The user sits on the toilet whilst warm water is instilled into the rectum via a catheter which is secured by balloon. On deflation the water is emptied from the bowel with contents. Please seek advice from the Continence Service, who teach and demonstrate the use of these bowel aids.

Company/product Size Code Practical Use Clinical Scenario

Coloplast Anal plugs

2 Sizes

1450 -small 1451 -large

Porous soft absorbent foam Change every 12 hrs -mucus leakage small /moderate loss only

For faecal smearing

Spina bifida

Multiple Sclerosis

Neurogenic

Coloplast Peristeem Anal irrigation

Rectal irrigation Allows to empty the lower bowel assists in preventing constipation, faecal incontinence the water goes up into sigmoid colon and assists with causing a peristalsis thus a normal bowel action

Spinal injuries

Multiple Sclerosis

Parkinson’s Disease

Hollister Faecal collector

Box of 10

9822 – 500ml 9821 – 1000ml

Can be left up to 24hrs Bed bound

Cannot sit on this will cause skin problems careful assessment required

Qufora IrriSedo Irrigation System Mini Set

1 hand pump and 15 cones 30 cones

53601-015 53601-030

Warm water is slowly inserted via a cone into the rectum which assists in emptying the rectum

Multiple Sclerosis

Early dementia if family/carer assist

Parkinson’s Disease

Any dysfunction of the bowel that

25

Balloon system: base set (medium) base set (small) accessory set (medium) accessory set (small) catheter set (medium) catheter set (small) Bed system: 12mm 21mm 30mm Toilet system: Starter set Monthly set

1 control with Velcro strap, 1 water bag, 2 rectal catheters 1 water bag, 15 rectal catheters 10 rectal balloon catheters 1 water bag, 1 pump, 5 rectal catheters, 5 collection bags 1 pump, 1 water bag, cones and waste bags

58101-002 58102-002 58201-015 58202-015 58301-010 58302-010 53201-055 53001-055 53101-055 QTS QTM

2 medium catheters 2 small catheters 15 medium catheters 15 small catheters 10 medium balloon catheters 10 small balloon catheters 12mm catheter 21mm catheter 30mm catheter 5 cones, 5 waste bags, 1 toilet bag 15 cones, 15 waste bags

normal laxatives have not helped

26

References

Association for Continence Advice, (2007) Notes on Good Practice. European Association of Urologist, (2015) EAU pocket guidelines;[email protected] European Association of Urologists (2012) Catheterisation indwelling catheters in adults urethral and suprapubic;[email protected] Getliffe.K (2000) Dissolution of Urinary Catheter Encrustation. British Journal of Urology (85): 60 – 65. Medical Device Agency. (2001) Safety notice SN 2001 (02) Problems removing urinary catheters; London. National Institute for Clinical Excellence ,(2013) Management of Urinary incontinence; clinical guideline CG171: nice.org.uk/guideline/cg171. National Institute for Clinical Excellence (NICE, 2015) Lower urinary tract symptoms in men: management; clinical guideline 97,nice.org.uk/guideline/cg97. Parkin. J (2002) Urinary Catheter “deflation cuff” formation: clinical audit and quantities in vitro analysis. British Journal of Urology International; 90(7):666-671. Rebmann T et al. (2010)AJIC: doi 10.10116/j.ajic.2010.08.003. RCN guidance for Nurses, 2012 Catheter care RCN 17th May; London. Robinson (2001) Urethral Catheter selection. Nursing Standard, 15 (25)7/3/2001, 39 – 42.

continence care management formulary

Documents