Appendix 1: Information to be considered when teaching adult patients intermittent self-catheterisation or dilation

NHS Ayrshire & Arran guidelines
NHS Ayrshire and Arran

Introduction

When embarking on teaching Intermittent Self Catheterisation (ISC) whether at home or in hospital it is extremely important that nurses fully understand the complex needs of ISC.

The programme will include patient selection, discussion and observations as detailed below.

Patient selection Well motivated, good cognitive skills, manual dexterity and physical ability
Patient discussion Knowledge regarding anatomy and reasons for ISC and type of bladder dysfunction
General discussion Personal hygiene, storage and disposal of catheters and quality of life issues
Health issues ISC problem solving, diet, sexual activity and exercise
Observations Discuss and observe the variety of techniques.
Discuss patient compliance.
Nurses attitude towards the technique of ISC.

Action

Instruct the patient to carry out the following:-

Preparation for females Preparation for males
Explain procedure to patient ensuring they void spontaneously prior to procedure if appropriate. Explain procedure to patient ensuring they void spontaneously prior to procedure if appropriate.
Inform patient to wash hands and genital area (unscented wipes may be used if hand washing facilities are not available) Inform patient to wash hands and genital area (unscented wipes may be used if hand washing facilities are not available).
Instruct the patient to prepare the catheter.
See Appendix 2		 Instruct the patient to prepare the catheter.
See Appendix 2
The procedure may be easier for the patient to sit on a chair or the side of a firm bed where a mirror can be placed in a position that offers a clear view of the urethra. Some patients may find it easier to find the urethra by touch. The procedure may be carried out either standing, sitting on a chair or on the edge of a firm bed. They should ensure the foreskin is retracted back to visualise the meatus.
Wash hands as before. Wash hands as before.
Instruct the patient to position herself and remove the catheter from the sterile package. Instruct the patient to position himself and remove the catheter from the sterile package.
Instruct the patient to hold the catheter in the dominant hand and pass smoothly through the urethra into the bladder until urine starts to flow and drain into appropriate draining receptacle. Instruct the patient to hold the catheter in the dominant hand holding the penis upwards towards the stomach (this extends the urethra making it easier to insert the catheter).  The catheter will then pass smoothly through the urethra until resistance is felt at the external sphincter. The patient should then be instructed to cough which will relax the sphincter and allow the catheter to be pass into the bladder smoothly until urine starts to flow and drain into appropriate draining receptacle.
When urine stops flowing slowly remove the catheter pausing if more urine starts to flow, this ensures that urine remaining at the base of the bladder is drained and the bladder is fully emptied. When urine stops flowing slowly remove the catheter pausing if more urine starts to flow, this ensures that urine remaining at the base of the bladder is drained and the bladder is fully emptied (ensure the penis is positioned upwards towards the stomach for easy removal).
Slowly remove the catheter placing a finger over the funnel end before removing it from the urethra as this traps urine in the catheter, preventing urine spilling onto clothing or onto the floor. Slowly remove the catheter placing a finger over the funnel end before removing it from the urethra as this traps urine in the catheter, preventing urine spilling onto clothing or onto the floor.

In Hospital Dispose of catheter etc into clinical waste bag.

In Community Put the catheter etc into  disposal bag and dispose of into domestic waste

In Hospital Dispose of catheter etc as per Clinical Waste Policy

In Community Put the catheter etc into disposal bag and dispose of into domestic waste.

Instruct patient to wash and dry hands after the procedure and readjust the clothing

Instruct patient to wash and dry hands after the procedure and readjust the clothing

Written information should be given to the patient to reinforce instructions. Nurse should ensure ISC care plan is completed. See Appendix 2

Written information should be given to the patient to reinforce instructions. Nurse should ensure ISC care plan is completed. See Appendix 2

Intermittent Self Dilatation when carried out by the patient should always be a clean technique rather than an aseptic technique.

Action

Instruct the patient to carry out the following:-

Preparation for females Preparation for males
Explain procedure to patient ensuring they void spontaneously prior to procedure. Explain procedure to patient ensuring they void spontaneously prior to procedure.
Inform patient to wash hands and genital area (unscented wipes may be used if hand washing facilities are not available). Inform patient to wash hands and genital area (unscented wipes may be used if hand washing facilities are not available).
Instruct the patient to prepare the catheter
See Appendix 2.		 Instruct the patient to prepare the catheter
See Appendix 2
The procedure may be easier for the patient to sit on a chair or the side of a firm bed where a mirror can be placed in a position that offers a clear view of the urethra. Some patients may find it easier to find the urethra by touch. The procedure may be carried out either standing, sitting on a chair or on the edge of a firm bed. They should ensure the foreskin is retracted back to visualise the meatus.
Wash hands as before. Wash hands as before.
Instruct the patient to position herself and remove the catheter from the sterile package. Instruct the patient to position herself and remove the catheter from the sterile package.
Instruct the patient to hold the catheter in the dominant hand and pass smoothly through the urethra into the bladder until urine starts to flow and drain into appropriate draining receptacle. Prior to removing the catheter the patient should be instructed to rotate the catheter anticlockwise twice to ensure dilatation of the urethra. Instruct the patient to hold the catheter in the dominant hand holding the penis upwards towards the stomach (this extends the urethra making it easier to insert the catheter).  The catheter will then pass smoothly through the urethra until resistance is felt at the external sphincter. The patient should then be instructed to cough which will relax the sphincter and allow the catheter to be pass into the bladder smoothly until urine starts to flow and drain into appropriate draining receptacle. Prior to removing the catheter the patient should be instructed to rotate the catheter anticlockwise twice to ensure dilatation of the urethra. Patients with meatal strictures should be instructed to insert the catheter only 5cm into the urethra as further insertion into the bladder is not required due to the position of the stricture.
When urine stops flowing slowly remove the catheter pausing if more urine starts to flow, this ensures that urine remaining at the base of the bladder is drained and the bladder is fully emptied. For urethral strictures when urine stops flowing slowly remove the catheter pausing if more urine starts to flow, this ensures that urine remaining at the base of the bladder is drained and the bladder is fully emptied (ensure the penis is positioned upwards towards the stomach for easy removal)
Slowly remove the catheter placing a finger over the funnel end before removing it from the urethra as this traps urine in the catheter, preventing urine spilling onto clothing or onto the floor. Slowly remove the catheter placing a finger over the funnel end before removing it from the urethra as this traps urine in the catheter, preventing urine spilling onto clothing or onto the floor.

In Hospital Dispose of catheter etc into clinical waste bag.

In Community Put the catheter etc into  disposal bag and dispose of into domestic waste.

In Hospital Dispose of catheter etc as per Clinical Waste Policy.

In Community Put the catheter etc into  disposal bag and dispose of into domestic waste.
Instruct patient to wash and dry hands after the procedure and readjust the clothing. Instruct patient to wash and dry hands after the procedure and readjust the clothing.
Written information should be given to the patient to reinforce instructions. Nurse should ensure ISC care plan is completed. See Appendix 2. Written information should be given to the patient to reinforce instructions. Nurse should ensure ISC care plan is completed. See Appendix 2.