Continence Resources

21 April 2020

Indwelling urinary catheters are still one of the most commonly used invasive devices in health care, with recognised significant risk factors, including catheter-associated urinary tract infection (CaUTI) and sepsis. Timely and successful removal of the catheter often falls to the responsibility of community nurses. There has been much debate about the optimum timing and circumstances for a successful trial without catheter (TWOC). This article looks at best practice guidelines and relevant clinical evidence to support healthcare professionals in making choices around TWOC procedures.

Topics:  Post-TWOC
11 February 2020
The development of an integrated children’s bladder and bowel service is a key recommendation from a number of national documents and helps ensure affected children are seen at the right time and place and by the right person. This facilitates potential cost savings in the long term, with resultant reductions in A&E attendance and secondary care referrals. The key reference document is the Children’s Continence Commissioning Guide, which sets out a clear service framework. By working with several services across the UK, a generic service model has been developed which supports appropriate interventions at both tier 1 and tier 2, including the development of care pathways to help reduce unwarranted variation and inequalities in the provision of care. The key to success with this model is also the empowerment of families to help them self-manage the child’s problem, which also fits within the NHS Long Term Plan (NHS England, 2019).
Topics:  Self-management
29 October 2019

Indwelling urinary catheters remain one of the most commonly used clinically invasive devices across the NHS and social care in the UK. The problems associated with the prolonged use of catheters are widely referenced. Healthcare-acquired infections (HCAIs) currently result in 5,000 preventable deaths a year, with 20% of all HCAIs associated with the urinary tract. Many staff have learned catheterisation techniques in their early careers, with no need for a formal review of skills and knowledge. This has perhaps contributed to some historical and now outdated tasks still being performed. The evidence for best practice when managing indwelling catheters is reflected in national and international guidelines, which have recently undergone a complete overhaul. This article explores common practices and best practice evidence to assist with safe and effective management of these essential but often risky devices.

Topics:  Catheter choice
29 October 2019

The effect of drugs on mental and physical health are well documented. However, these consequences do not necessarily prevent people using them either recreationally or more regularly, with some becoming addicted to their drug or drugs of choice. It is estimated that in 2016/17, around one in 12 (8.5%) adults aged 16 to 59 in England and Wales had taken an illicit drug in the last year (NHS Digital, 2018). Ketamine has become increasingly popular, especially among younger users, as it is cheap and mistakenly seen as a ‘safe’, non-addictive drug. However, the reality is that even recreational use may have serious consequences. The effect on the urinary system can be devastating, with users experiencing anything from frequency and cystitis-like symptoms, to extreme debilitating pain from the inflamed and shrunken bladder, resulting in cystectomy and urinary diversion, and, if the kidneys are affected, renal failure and dialysis.

Topics:  Pain control
16 August 2019

Indwelling urinary catheterisation is a common procedure especially within a community setting. However, healthcare professionals are sometimes unaware of what is current best evidenced-based practice. This article outlines the clinical indicators for insertion of a urinary catheter, rationale for catheter selection, including Charrière (Ch) or French gauge (Fg), length, balloon size and material of choice including any coating. Catheter insertion requirements are outlined and drainage and supporting/securing devices discussed. Complications of indwelling catheters, such as catheter-associated infections and encrustation are also discussed with recommendations for treating, and, finally, new innovations which may benefit in future care are identified — all with reference to current national guidance and best clinical evidence-based practice.

16 April 2019

Nocturia is a common lower urinary tract symptom that mainly affects older people. Nocturia causes excess urination at night and, because of associated night-time rising, can also result in falls and fractures. Nocturia has a range of presentations, therefore it is vital that nurses understand how to assess the condition accurately to provide appropriate treatment. This article examines the effective assessment of nocturia, as well as detailing the various lifestyle treatment options that can be used, such as a targeted reduction of fluid intake, weight loss and altered medication profiles. Medication and surgical options should only be used following a trial of lifestyle interventions.