nhs trust - eastsussexformulary.co.uk

East Sussex HealthcareNHS Trust

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Bladder and Bowel Management

FORMULARYFor all nurses in the Acute and Community Setting Produced June 2016To be reviewed August 2018

Community Bladder & Bowel Advisory Service NHS Hastings and Rother CCG 01424 735688 NHS Eastbourne, Hailsham and Seaford CCG 01323 446990

Produced by the Community Bladder & Bowel Advisory Service, East Sussex Healthcare NHS Trust Produced June 2016 Review date: August 2018

REFERENCESAddison R et al. 2012. Catheter care: RCN Guidance for Nurses. London. Royal College of Nursing. Available at http://www.rcn.org.uk/__data/assets/pdf_file/0018/157410/003237.pdf.British Journal of Urology 85(1): 60-4Bull E, Chilton CP, Gould AL, Sutton TM (1991) Single-blind, randomised, parallel group study of the Bard Biocath catheter and a silicone elastomer catheter. British Journal of Urology 68(4): 394-99 Cox ASJ (1987) Effect of a hydrogel-coating on the surface topography of latex-based catheters: An SEM study. Biomaterials 8: 500-1 Fader M, Patterson L, Brooks R, (1997).A multi centre comparative evaluation of catheter valves. British Journal Nursing 6(7): 359-67 Getliffe K (1993) Care of urinary catheters. Nursing Standard July 21-27 7(44):31-34 Getliffe K, Dolman M, (2003) Promoting Continence: A Clinical Resource. Bailliere Tindall, London. Getliffe K, Hughes S, Claire M, (2000).The dissolution of urinary catheter encrustation. Loveday HP, Wilson JA, Pratt RJ et al. 2013. Epic3: National Evidence-Based guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. Journal of Hospital Infection; 86S1: S1-S70.Lowthian P (1998) The dangers of long-term catheter drainage. British Journal of Nursing 7(7): 366-79 National Institute for Health and Care Excellence.2012. Guidance 139. Infection: Prevention and Control of Healthcare-associated Infections in Primary and Community Care. London: National Institute for Health and Care Excellence; Available at www.nice.org.ukParkin J, Scanlan J., Woolley M. et al (2002) Urinary catheter ‘deflation cuff’ formation: clinical audit and quantitative in vitro analysis.British Journal of Urology. 90:666-671. Pomfret I (1995) Bladder Irrigation. Journal of Community Nursing Dec 24-29 Ryan-Wooley B (1997). Aids for the Management of Incontinence. London: Kings Fund The European Association of Urology Nurses, 2012. Evidence Based Guidelines for Best Practice in Urology Healthcare. Catheterisation, Indwelling Catheters in Adults. Urethral and Suprapubic. Netherlands: The European Association of Urology Nurses.

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FORMULARYBladder and Bowel Management

CONTENTS

URINARY CATHETERS

LONG TERM

LONG TERM - HYDROGEL COATED LATEX

MEDIUM TERM

COLLECTION SYSTEMS

LEG BAGS

BELLY BAGS

NIGHT DRAINAGE BAGS

CATHETERISATION PACK

SUPPORT FOR DRAINAGE BAGS

LEG BAG HOLDERS/SUPPORT

NIGHT BAG HOLDERS

CATHETER VALVES

CATHETER MAINTAINANCE SOLUTIONS

LUBRICANTS FOR CATHETERISATION

SKIN BARRIER FILMS

PREP WIPES

SHEATHS

SHEATH BAGS

SHEATH BEST PRACTICE TIPS

URINE TESTING COLLECTION PACK

BEST PRACTICE IN URINARY CATHETERISATION

DECISION FLOW CHART ON DRAINING OF THE CATHETER

REFERENCES

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OBJECTIVE OF GUIDELINES

The goal is to simplify prescribing of continence prescription appliance products across East Sussex Bladder and Bowel Service. This will involve good quality, effective products. Choices have been balanced, gauging effectiveness and value for money.

The guideline of products has been selected balancing patient requirements, commonly used products and the premise that 80% of patients in the community will find the products selected quite satisfactory for their needs. This is a guideline, therefore patient and carer’s clinical needs should be accommodated if the suggested products are not satisfactory. Prescribers and other professionals need to be aware of alternative options for when the baseline formulary is found to not be appropriate.

The products have been chosen based on experience and collaboration between the Medicines Management Team, the Bladder and Bowel Service and Community Nurses.

FORMULARYBladder and Bowel Management

URINARY CATHETERS

LONG TERM CATHETERS ‘Assess the patient’s needs prior to catheterisation in terms of latex allergy, catheter length (men must be catheterised with standard length catheters only), size of sterile bag or catheter valve and comfort and dignity’ (Loveday et al, 2013)

‘Select the smallest gauge catheter that will allow urinary outflow’ (Loveday et al, 2013)

‘Intermittent catheterisation should be used in preference to an indwelling catheter if it is clinically appropriate and a practical option for the patient’ (NICE, 2012)

‘Decontaminate hands and wear a new pair of clean, non-sterile gloves before manipulating a patient’s catheter, and must decontaminate hands after removing gloves’ (NICE, 2012)

‘Clean the urethral meatus with sterile, normal saline prior to the insertion of the catheter’ (Loveday et al, 2013)

All catheters listed are licensed for both urethral and suprapubic use.• Prescribe 2 initially, but only 1 to be added to repeat prescription. • More than 12 in a year - consider changing to medium term catheter.

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ORDER code (size in bold) PIP code PRODUCT GAUGE/Ch size DRUG TARIFF price

08501205G 08501405G 08501610G 08501810G

282-8291 282-8309282-8317304-2900

Standard /Male length 41cm

12ch14ch16ch18ch

£5.50

085012051G 085014051G 085016101G

282-8390282-8408282-8416

Female length12ch14ch16ch

£5.50

L.IN.C MEDICAL CATHETER WITH ACCOMPANYING STERILE WATER AND SYRINGE. 100% SILICONE Please note some of these catheters have a 5ml balloon.

ORDER code PRODUCT GAUGE/Ch size DRUG TARIFF price

DA3101 Standard /Male length 41cm 12 - 16 £6.07

DA2101 Female length 12 -16 £6.07

TELEFLEX RUSCH BRILLIANT AQUAFLATE 100% SILICONE CATHETERIncludes empty syringe for deflation of previous catheter and a syringe pre filled with sterile water (add size to end of order code)

URINARY CATHETERS• Careful patient assessment is essential before deciding to catheterise because of the high risk of

infection and other complications associated with catheter use.

• Choice of product depends on: • your assessment and diagnosis • patient choice • local guidelines

• No one product suits all.

• To avoid problems such as bypassing, the smallest size that provides adequate drainage should be used.

• A 5 to 10 ml balloon should be used depending on the catheter chosen, this represents the amount of sterile water required to fully inflate the balloon. Under inflation can distort the angle of the catheter tip, causing bladder spasm.

• Select the correct length of catheter: female (shorter) length is suitable for ambulant females only and is not recommended for bed or chair-bound people.

• A standard length catheter is required for use with a ‘Belly bag’ for both male and female users.

LONG TERM CATHETERS (up to 12 weeks) • Packaged in single units.

• Prescribe 2 initially but only 1 to be added to repeats.

• If there are repeated catheter blockages which do not respond to treatments such as catheter maintenance solutions, then consider changing to medium term catheter.

• Pre-filled balloons are more expensive and have a short shelf-life. Reported problems include water loss and deflation.

100% Silicone• Thin-walled catheters provide a larger diameter drainage lumen compared to coated catheters

(Ryan-Wooley 1987)

• Basically compatible with urethral mucosa and have encrustation-resistance properties, but lack flexibility.

• Silicone balloons may allow slow diffusion of water into the bladder and may occasionally deflate in situ (Getliffe 1993)

• May not be best option for suprapubic use due to cuffing/adhesion on removal (Parkin et al., 2002)

Hydrogel coated latex • High compatibility with human tissue.

• Polymers absorb water to produce a slippery surface which reduces trauma on insertion.

• There is some evidence to suggest there are fewer episodes of urinary bypassing – therefore it may be retained for longer than silicone elastomer-coated catheters (Bull et al 1991, Cox 1987)

FORMULARYBladder and Bowel Management 6 7

LONG TERM CATHETERS - HYDROGEL COATED LATEX Suitable for urethral and supra pubic catheterisation


DH3101 Standard /Male length 41cm 12 - 16 £6.12

DH2101 Female length 12 -16 £6.12

TELEFLEX RUSCH SYMPACATH AQUAFLATE HYDROGEL COATED LATEX CATHETER - Includes empty syringe for deflation of previous catheter and a syringe pre-filled with sterile water (add size to end of order code)

ORDER code P RODUCT GAUGE/Ch size DRUG TARIFF price

D2264 Standard /Male length 41cm 12 - 16 £8.43

D2268 Female length 12 -16 £8.47

BARD BIOCATH HYDROGEL COATED LATEX CATHETERPre-filled with sterile water. (add size to end of order code)


AA8C12 Standard length only 12 £5.86




COLOPLAST FOLYSIL OPEN ENDED SILICONE CATHETERThis catheter can be used for urethral or suprapubic use and may offer an alternative for those patients experiencing problems with repeated by passing and blockage. There is no tip to the end of this catheter creating an additional drainage channel. Includes pre-filled syringe.

ORDER code PIP code PRODUCT GAUGE/Ch size DRUG TARIFF price

08451205G 284-8661 Standard length with 5ml balloon 12 £10.95



L.IN.C MEDICAL SUPRAFLO OPEN TIP CATHETER


DG3101 Standard /Male length 41cm 12 - 16 £7.07

DG2101 Female length 12 -16 £7.07

TELEFLEX RUSCH BRILLIANT SILFLATE 100% SILICONE CATHETERIncludes empty syringe for deflation of previous catheter and a syringe pre-filled with 10% aqueous glycerine solution. This catheter is exactly the same as the RUSCH BRILLIANT AQUAFLATE, except for the solution used to inflate the balloon. All silicone catheters have a tendency to leach water from the balloon, causing the balloon to deflate. If the balloon is not fully inflated the tip of the catheter can angle downwards, hitting the Trigone causing spasm and bypassing. The 10% glycerine added to the sterile water, prevents leaching from the balloon so that it remains fully inflated for the 12 weeks it may stay in the bladder. (add size to end of order code)

ORDER code PIP code PRODUCT GAUGE/Ch size

DRUG TARIFF price

PCF12F10 386-0624 Prosys All Silicone Foley Catheter Long Term Use, Female 2 Way 10ml 12 £5.64

PCF12M10 386-0616 Prosys All Silicone Foley Catheter Long Term Use, Male 2 Way 10ml 12 £5.64

PCF14F10 386-0558 Prosys All Silicone Foley Catheter Long Term Use, Female 2 Way 10ml 14 £5.64

PCF14M10 386-0582 Prosys All Silicone Foley CatheterLong Term Use, Male 2 Way 10ml 14 £5.64

PCF16F10 386-0608 Prosys All Silicone Foley CatheterLong Term Use, Female 2 Way 10ml 16 £5.64


PCF18F10 386-0590 Prosys All Silicone Foley CatheterLong Term Use, Female 2 Way 10ml 18 £5.64


CLINISUPPLIES PROSYS FOLEY LONG TERM CATHETER WITH A 10ML INTEGRAL BALLOON 100% SILICONE10ml pre-filled syringe of water. For urethral and suprapubic use. Large eyes at the tip of catheter to promote better drainage and help those patients that tend to block.


ORDER code PIP code Product Bag vol.

Tube length

Tap design

Inner pack

DRUG TARIFF price

1C/500/ST/L 400-8546 Ugo 1C 500ml Short Tube Lever Tap Box of 10 £23.77

2C/500/LT/L 400-8603 Ugo 2C 500ml Long Tube Lever Tap Box of 10 £23.77

3C/500/ST/T 400-8611 Ugo 3C 500ml Short Tube T tap Box of 10 £23.77

4C/500/LT/T 400-8629 Ugo 4C 500ml Long Tube T tap Box of 10 £23.77

5C/350/DI/L 400-8637 Ugo 5C 350ml Direct Inlet Lever Tap Box of 10 £23.77



8C/750/LT/L 400-8660 Ugo 8C 750ml Long Tube Lever Tap Box of 10 £23.77

OPTIMUM MEDICAL UGO LEG BAGS (Community)

Fabric backing – 1 pair of Ugo Fix Leg Bag Straps in every box.• Designed to be used with either an indwelling urethral or suprapubic catheter.• Short, easy-to-remember names for quick and easy re-ordering.• Purpose measured soft silicone outlet tubing for kink free link drainage ensuring patients can

move around in bed without blocking or damaging the tubing.

ORDER code PIP code PRODUCT Size Box

Qty.DRUG

TARIFF price

P350S 299-6817 Prosys Leg Bag Short Tube (10cm) with non latex gloves and velcro straps. Slide Tap 350ml 10 £25.40

P350L 299-6767 Prosys Leg Bag Long Tube (30cm) with non-latex gloves and velcro straps. Slide Tap 350ml 10 £25.40


P500S-LT 351-1474 Prosys Leg Bag Short Tube (10cm) with non latex gloves and velcro straps. Lever Tap 500ml 10 £25.40


P500L-LT 351-1466 Prosys Leg Bag Long Tube (30cm) with non-latex gloves and velcro straps. Lever Tap 500ml 10 £25.40

CLINISUPPLIES PROSYS LEG DRAINAGE BAGS

COLLECTION SYSTEMS LEG BAGS ‘Do not add antiseptic or antimicrobial solutions to urinary drainage bags’ (Addison et al, 2012)

‘Never wash urine bags and re-connect them in any care setting’ (Addison et al, 2012)

‘Urine samples must be obtained from a sampling port using aseptic technique’ (NICE, 2012)

• The bags may be worn in different positions on the leg. The intended position i.e. thigh or calf will determine the length of the inlet tube.

• The bags should remain connected for approximately 5-7 days. More frequent change is normally unnecessary and breaks the closed system, thereby increasing risk of infection. Non-sterile bags are not to be used with indwelling catheters but are available for use with penile incontinence sheaths.

• No more then 1 box of 10 should be issued alternate months - 6x10 per year.

MEDIUM TERM CATHETERS (use up to 4 weeks only)

Suitable for urethral and suprapubic use.

• PTFE-coated latex (Polytetraflouroethylene)

• PTFE (commonly known as Teflon) is permanently bonded to latex.

• PTFE is inert providing a smooth outer surface, reducing incidence of irritation and rejection. However there may be a greater susceptibility to encrustation (Getliffe and Doman 2003).


DP3101 Standard /Male length 41cm 12 - 16 £2.16

DP2101 Female length 12 -16 £2.16

TELEFLEX RUSCH AQUAFLATE PTFE COATED LATEX FOLEY CATHETERIncludes empty syringe for deflation of previous catheter and a syringe pre-filled with sterile water (add size to end of order code)

ORDER code PRODUCT GAUGE/Ch size

DRUG TARIFF price

D1265LV Standard /Male length 41cm 12 - 16 £2.66

D1265AL Standard length – pre-filled balloon 12 -16 £3.03

DO169LV Female length 12 -16 £3.96

BARD PTFE COATED LATEX CATHETERIncludes empty syringe for deflation of previous catheter and a syringe pre-filled with sterile water Only one of these catheters comes with a pre-filled balloon (add size to end of order code)

Lever tap Ugo Leg Bags with a lever tap are ideal for those with impaired dexterity.

T tap

continued on next page


ORDER code PIP code PROD. Tap design Clinical use Inner

packDRUG TARIFF

price

9/NS/SU/DO 400-8488 Ugo 9Non Drainable

(tear corner to drain) – Non sterile

Single use link drainage only

Bag of 10 £2.04

10/NS/SU/DO 400-8496 Ugo 10Single Use T Tap

(can only drain once) – Non sterile

Single use link drainage only

Bag of 10 £3.04

11/S/SU/DO 400-8504 Ugo 11* Single Use T Tap (can only drain once)

Attaching di-rectly to cathe-ter or single use

link drainage

Box of 10 £4.86

12/S/D/L 400-8512 Ugo 12

Lever Tap (continuous

drainage) – Sterile pouch

packaged

Attaching directly to

catheter for up to 7 days with

needle free sample port

Box of 10 £11.96

13/S/D/T 400-8520 Ugo 13

T Tap (continuous

drainage) – Sterile pouch

packaged

Attaching directly to

catheter for up to 7 days with

needle free sample port

Box of 10 £11.96

OPTIMUM MEDICAL UGO 2L DRAINAGE BAGSUgo 9 and Ugo 10 to be used with Ugo Leg Bags (non sterile).Ugo 12 and Ugo 13 to be attached directly to a catheter (sterile).• Short, easy-to-remember names for quick and easy re-ordering• Ugo 9 and Ugo 10 provided in tamper-resistant, protective, resealable bags

* For patients using a Ugo Catheter Valve overnight.

Comprehensive patient and carer user guide is supplied with all Ugo Urology products, including detailed information about how to use and care for them. To request a copy you can email [email protected].

NIGHT DRAINAGE BAGS ‘A link system should be used to facilitate overnight drainage, to keep the original system in tact’ (NICE, 2012)

• These bags are suitable for night time use for the collection of urine from indwelling catheters or incontinence sheaths.

• They are generally used in conjunction with a bag hanger (not available on FP10) some companies will supply free of charge.

• The position of the bag should be below bladder level to enhance drainage but not more than 30cm below as the negative pressure created may cause a suction effect to the bladder mucosa, which may block the catheter (Lothian 1998).

• Night bags should be directly connected to the leg bag to maintain a closed system.

DRAINABLE NIGHT BAGS • Not recommended for use in residential or nursing homes. • These bags are not intended for single use and may be reused for up to 7 days. • Good hygiene control should be used to avoid infection risks (refer to manufacturers guidance)

Best practice suggests rinsing through using tap water only, and replace dust cap.

ORDER code PRODUCT Pack

sizeDRUG TARIFF

price

B1000 1000ml (short outlet tube) 10 £106.20

B1000P 1000ml (short outlet tube) with sample port. 10 £106.20

B1000CT 1000ml with extra long (60cm) outlet tube easier emptying for someone in a wheelchair. 10 £106.20

PBBCO1 Belly Bag PSU2 connector - product available direct from CliniSupplies Tel: 0800 085 4957 10 Free

TELEFLEX RUSCH BELLY BAG

BELLY BAGS • Positioned on the abdomen. • Urine drains into the bag by means of residual bladder pressure. • 1 litre capacity. • Does not require a night drainage bag. • For additional drainage (more than 1 litre over night) a PSU2 connector

can be used to attach a ProSys single use night bag. • Can be left in place for 28 days. • No more than 2 belly bags should be issued alternate months.

CLINISUPPLIES PROSYS 2 LITRE DRAINAGE BAGS



P10LS 299-6841 Prosys Leg Straps - 10 £25.40

ORDER code PIP code PRODUCT Size Box Qty. DRUG

TARIFF price

PSU2 327-6672 Prosys Single Use Drainable Bag 2ltr 10 £3.04

P2000 313-7940 Prosys Sterile Drainable Bag 2ltr 10 £12.10

P2000-LT 351-1458 Prosys Sterile Drainable Bag + Lever Tap 2ltr 10 £12.10

P2 304-0516 Prosys Non-Drainable Bag 2ltr 10 £2.05


ORDER code PIP code Description Inner

packDRUG TARIFF

price

3004 394-9054 Ugo Fix Gentle (catheter clip) Box of 5 £12.50

OPTIMUM MEDICAL UGO FIX GENTLE (CATHETER CLIP)

• Gentle re-adhesive pad with silicone technology• Easy to apply, remove and reposition• No skin preparation required before application and suitable

for re-application over the same area of skin• No sticky residue• Revolving clip for natural movement


packDRUG TARIFF

price

3001 393-3371 Ugo Fix Catheter Strap Extra short – up to 35cm Box of 5 £12.50

3002 393-3389 Ugo Fix Catheter Strap Short – up to 45cm Box of 5 £12.50

3003 393-3397 Ugo Fix Catheter Strap Medium – up to 80cm Box of 5 £13.80

3009 393-3405 Ugo Fix Catheter Strap Long – up to 130cm Box of 5 £16.80

3010 393-3413 Ugo Fix Catheter Strap Extra Long – up to 180cm Box of 5 £18.80

OPTIMUM MEDICAL UGO FIX CATHETER STRAP

• Fully adjustable and can be cut to fit• Silicone technology for extra firm grip to skin• Reusable and washable (provided with laundry bag to maintain optimum performance for longer)

Where the Ugo Fix Catheter Strap can be securedPrior to fitting it is important that you measure around the leg or abdomen and use the correct length.

SUPPORT FOR DRAINAGE BAGS

LEG BAG HOLDERS / SUPPORT‘Movement induced trauma can lead to urinary tract infection and tissue necrosis.’ (EAUN, 2012)‘Best practice suggests catheters are secured to avoid trauma.’ (NICE, 2012)

• It is extremely important that the leg bag is well supported so that there is no pulling on the catheter that could cause urethral trauma.

• Leg bag holders or sleeves provide much better support than leg straps, which may be provided with the leg bag.

• Leg bag holders are manufactured from soft, latex free fabric and encase the leg bag to hold it against the patient’s leg.

• May be worn on the thigh or calf – NB please measure to ensure correct fit.

• These products are washable and 1 pack should last 6 months.

• No more than 2 packets should be issued every year.

• Should not be on repeat screens.

Using the Ugo Fix Catheter Strap

on upper leg


on abdomen

Using the Ugo Fix Catheter Strap on the leg bag tubing


at the catheter bifurcation

CATHETERISATION PACK • Two layer system (layer1: catheter removal kit. Layer 2: catheter insertion kit)

• Facilitates aseptic non touch technique to reduce risk of catheter associated urinary tract infections (CAUTI)

ORDER code PRODUCT Pack size DRUG TARIFF price

908410 Catheter procedure pack-gloves S/M 1 £1.98

908420 Catheter procedure pack-gloves M/L 1 £1.98

RICHARDSON HEALTHCARE CATH-ITCatheter Application/Removal Pack (Catheter or gel not included)



packDRUG TARIFF

price

3005 394-0178 Ugo Fix Sleeve Small – 24cm-39cm Box of 4 £7.28

3006 394-0160 Ugo Fix Sleeve Medium – 36cm-55cm Box of 4 £7.28

3007 393-3397 Ugo Fix Sleeve Large – 40cm-70cm Box of 4 £7.28

3008 394-0145 Ugo Fix Sleeve Extra Large – 65cm-90cm Box of 4 £7.28

OPTIMUM MEDICAL UGO FIX SLEEVE (LEG BAG HOLDER) ‘Maintaining a sterile, continuously closed urinary drainage system is central to the prevention of catheter-associated infection. The risk of infection reduced from 97% with an open system to 8-15% when a sterile closed system was employed as standard practice.’ (NICE, 2012)

• No need to disconnect leg bag from catheter when changing sleeve• External seam to protect skin and increase comfort• Colour coded for easy re-ordering• Reusable and washable (provided with a laundry bag to maintain optimum performance for longer)


packDRUG TARIFF

price

3011 400-8538 Ugo Fix Leg Bag Straps 10 pairs – one 75cm and one 45cm £13.10

UGO FIX LEG BAG STRAPS

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Place the strap around either the upper leg orabdomen in the desired position with the twosilicone lines facing down on the skin.Ensure the strap is not too tight and theUgo Fix strip is positioned where easily accessible.

Pull the Ugo Fix Sleeve over your foot and position on your thigh or calf. Ensure the coloured strip is at the top and on the outside of the sleeve, and that the sleeve is facing forwards.

Slide your leg bag into the front pouch through the opening at the top. Do not disconnect your leg bag from your catheter to fit your Ugo Fix Sleeve.

Push the drainage tap from your leg bag through the hole at the bottom of the sleeve. Adjust your Ugo Fix Sleeve to ensure optimum drainage and comfort.

You can now empty your leg bag without removing it from the Ugo Fix Sleeve.Lift the Ugo Fix strip and (a) wrap it over and under the tubing and then (b) through the eyelet.

Ensure the Ugo Fix strip is in the desired position and has a firm hold of the tubing, then secure in place on the strap using the Velcro tab.

Finally ensure the catheter is not pulling whenstood up and that you are able to move around comfortably with it in place.

Before securing the tubing/catheter

Securing the tubing/catheter

NIGHT BAG HOLDERS‘Urinary drainage bags should be positioned below the level of the bladder, and should not be in contact with the floor’ (NICE, 2012)

• Not available on Drug Tariff.

• May be obtained by contacting following companies.

Manufacturer- will provide holder free of charge Tel. number

Optimum Medical Ugo Stand with Dignity – Available with or without dignity cover 0113 263 3849

Clinisupplies ProSys – Bed bag stand (flat pack) 0800 085 4957

How to use the Ugo Fix Catheter Strap How to position your Ugo Fix Sleeve

Call 0113 263 3849

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Bladder Infusion Kit

The Bladder Infusion Kit is a device that enables the instillation of a catheter maintenance solution without the need to disconnect the patients leg/night bag therefore eliminating the need to break the closed catheter link system. The device enables the catheter maintenance solution to be instilled into the catheter and bladder via the needle free port of the catheter bag Ideally, if a catheter maintainence solution is required then best practice is to administer the instillation weekly at bag change. Order code MCI/701

CATHETER MAINTAINENCE SOLUTIONSThese should be considered for short term use to treat indwelling catheters blocked by encrustation or on removal of the catheter to dissolve crystal formation. They should not be considered as an option for routine catheter maintenance. Getliffe et al (2000) suggest that two sequential instillations of a small volume are more effective than a single administration.

• Monitoring urine pH will help identify the need for, and the type of solution required.

• Citric acid should only be used for those patients who have a consistently high pH of 7.4 and above (Pomfret 1995).

• It is good practice to cut open catheters on removal, from those patients where blocking is problematic to see if the lumen is blocked by sediment deposit.

• If a catheter maintainence solution is indicated more than weekly please use a bladder infusion kit to reduce the number of times the system is opened and reduces the cost of replacing the leg bag. Information for product below.

ORDER code PIP code PRODUCT Pack

sizeDRUG TARIFF

price

9746609 400-2937Citric acid 3.23% Suby G - 2 x 30mls (prevent or dissolve urinary salts & encrustation)

10 £45.10 / £4.51 each

9746625 305-6660

Citric acid 6% Solution R - 2 x 30mls (should not be used for more than 2 weeks and only when 3.23% solution has failed)

10 £45.10 / £4.51 each

B BRAUN URO-TAINER TWIN.The solution is divided into a twin delivery system allowing for two sequential administrations.

CATHETER VALVES ‘In patients for whom it is appropriate, a catheter valve can be used as an alternative to a drainage bag’ (NICE, 2012)

• May be helpful in retaining bladder tone. (Fader et al 1997)

• Allows drainage of urine from a catheterised bladder without the need for a permanently attached drainage bag.

• The catheter valve must be released regularly to prevent over distension of the bladder. Should only be considered for those patients or carers who have sufficient manual dexterity to operate the valve.

• Contraindications: reduced bladder capacity, no bladder sensation, cognitive impairment, poor manual dexterity and renal impairment.

• Catheter valves should be changed every 5-7 days.

• No more than 1 packet (5) should be prescribed every month

PR code PIP code Description Inner pack

DRUG TARIFF price

3000 388-2388 Ugo Catheter Valve Box of 5 £10.80

OPTIMUM MEDICAL UGO CATHETER VALVE• Safety lever feature to prevent accidental opening

• Universal stepped connector for secure fitting to all catheter materials

• Lever handle designed to ensure easy single handed operation

Please refer to page 11 (Ugo 11 sterile singe use 2L drainage bag) for overnight drainage.

ORDER code PIP code PRODUCT Pack size DRUG TARIFF price

40-006 251-684 Instillagel 6ml (female) 10 £14.05

40-011 251-538 Instillagel 11ml (male) 10 £15.76

CLINIMED (lubricant with anaesthetic)

LUBRICANT FOR CATHETERISATION‘Use lubricant from a sterile single use container to minimise urethral discomfort, trauma and the risk of infection’ (Loveday et al, 2013)

• Disposable syringes of sterile lubricant and/or local anaesthetic for instillation, can reduce injury to the urothenium and subsequent risk of possible urethral damage. It can also facilitate pain free instrumentation and help reduce the risk of associated infection.

• One to be used at each catheter change - prescribe same quantity as catheters. Recommended for use in both male and female patients (not usually necessary for suprapubic catheterisation).

• Must not be used in patients with known hypersensitivity to the active ingredients or in patients with significant damage or bleeding urethral mucosa.


SHEATHS • Can offer a valuable alternative method of urinary incontinence management in men.

• It is important to accurately assess for type and size of sheath along with the appropriate drainage system.

• It is recommended that sheaths are changed on a daily basis to relieve pressure and allow for skin hygiene.

• Generally 1 pack of 30 should be sufficient per month.

ORDER code Size Pack size DRUG TARIFF price

2243 24mm 30 £50.44

2283 28mm 30 £50.44

2323 32mm 30 £50.44

2363 36mm 30 £50.44

ROCHESTER CLEAR ADVANTAGE SHEATH WITH ALOE

ORDER code PIP Code PRODUCT Pack size DRUG TARIFF

price

3028 357-8366 Sorbaderm 92g tube (should last 3 months) single £7.19

3020 354-8765 Sorbaderm 28ml spray bottle single £5.99

SORBADERM® SKIN BARRIER FILM/CREAM

SKIN BARRIER FILMSNOTE: the prophylactic use of a skin barrier film is not necessary for the majority of patients with urinary incontinence.

• Sorbaderm products (durable barrier cream and film) are reserved for selected patients who experience skin problems. The use of Sorbaderm® is to: Protect skin from body fluids including wound exudate.

• Sorbaderm® Cream should be applied very sparingly (size of a 10 pence coin) after every third episode of incontinence as a preventative on intact skin (N.B. Cream is not no-sting).

• Over application leads to the skin feeling waxy. If waxy skin occurs then do not apply further cream since there is already sufficient present.

• Sorbaderm® Film product is indicated for both intact but primarily for broken irritated skin since it is waterproof.

• Sorbaderm® can be used up to the expiry date on the product once opened therefore no need to discard after 28 days. A 92g tube should be sufficient for 3 months treatment.


TF22530 326-2721

Style 2: Shorter length, suitable for retracted penis

25mm 30 £45.62

TF22930 326-2789 29mm 30 £45.62

TF23630 326-2805 36mm 30 £45.62

TF24130 326-2813 41mm 30 £45.62

ROCHESTER FREEDOM TRANSFIX 100% clear silicone sheath


22025

Standard length

25mm 30 £47.92

22030 30mm 30 £47.92

22035 35mm 30 £47.92

22040 40mm 30 £47.92

22121

Shorter length

21mm 30 £47.92

22125 259mm 30 £47.92

22130 30mm 30 £47.92

22135 35mm 30 £47.92

CONVEEN OPTIMA latex free self adhesive sheath

PREP WIPES For use with penile sheaths. The wipes provide a barrier which protects the skin and also aids adhesion, extending the life of the sheath.


10381B 387-1027 GB Soft Skin Medical Barrier Wipe 30 £23.32


10380A 384-5955 Adhesive Remover (50ml can) 1 £9.19

GREAT BEAR SOFT SKIN MEDICAL BARRIER WIPE

GREAT BEAR ADHESIVE REMOVER


URINE TESTING COLLECTION PACK Newcastle Urine Collection Pack (single use). Each pack contains 2 urine collection pads, a 5 ml syringe and a specimen container. Available from NHS Supply Chain catalogue/Oracle code 310019. Also available to purchase from Redland Health Care tel: 0800 854052. Price on request approximately 68p each

SHEATH BAGS BEST PRACTICE IN URINARY CATHETERISATION • Review need for catheter at each change and remove as soon as possible• Refer to catheter guidelines/trouble shooting guide on intranet• Intermittent Self Catheterisation should be adopted in preference to an indwelling catheter• Check for latex allergy• Males must be catheterised with STANDARD (40cm) length• Use smallest gauge possible that will allow urinary flow• Use aseptic technique (do not ‘double glove’)• Hand hygiene, wear apron and gloves when touching catheter• Maintain closed system. Drainage bags licensed for 5-7 days• Consider use of catheter valve if appropriate• Consider use of fixation device• Refer to Bladder and Bowel Advisory Service for advice and support

if necessary at the below address:

BLADDER & BOWEL ADVISORY SERVICE Bexhill Hospital Holliers Hill Bexhill on Sea East Sussex TN40 2DZ 01424 735688

These guidelines have been endorsed by the Meds Management team and put together by Sue Jenner and Tracey Perkins.


21574 Simpla non sterile leg bag - anti kink - 500ml, 25cm tube 10 £28.67

21578 Simpla non sterile leg bag - anti kink 10 £16.63

COLOPLAST SIMPLA PROFILE LEG BAG

SHEATH BEST PRACTICE TIPS• ALWAYS MEASURE BEFORE FITTING A SHEATH

• Ensure that your patient washes with a silicone soap, not moisturising soap and they dry thoroughly.

• Always refer to the manufacturers guidelines.

Please watch this video about the Conveen Optima for further information:https://www.youtube.com/watch?v=SqR0_VX9QsI

DON’T FORGET TO USE A CATHETER PASSPORT!


DECISION FLOW CHART ON DRAINING OF THE CATHETER

(Adapted from; European Association of Urology Nurses, 2012. Evidence Based Guidelines for Best Practice in Urology Healthcare. Catheterisation, Indwelling Catheters in Adults. Urethral and Suprapubic.)

nhs trust - eastsussexformulary.co.uk

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