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The child’s perspective
The incidence of Foley catheter use in children is
far less than in adult practice, but the risks from
improper use are the same, if not more significant.
Excellent paediatric leg bags are now available,
so why do we still see children on hospital wards
with adult-sized, long-tube leg bags, or even worse,
night bags or urometers trailing behind them as
they walk down the ward? For those of us who work in the field, using
a paediatric product is obvious:
i
It promotes acceptance in the child – e.g. child-friendly images on
bags places them reassuringly in the same category as toys, rather
than scary hospital equipment
i
It reduces clinical risk — as the child recovers and becomes more
active, a long loop of inadequately secured tubing is highly likely to
get caught in a toy/buggy/cot side.
So, why are paediatric leg bags not universally used? I’m guessing
at least in part because of ignorance; general nurses simply don’t know
they are available. However, it is the responsibility of specialists in the
field to share their knowledge and awareness of products.
Although in recent years we have seen some children’s catheter
accessories coming onto the market, what is apparent to us at ERIC is
that there is very little investment in the field of paediatric continence;
it is the ‘poor relation’ that attracts little interest or support.With
regard to catheters themselves, the only concessions toward child users
are smaller charrière sizes and shorter lengths. Is that sufficient? If
manufacturers respond to Professor Fader’s criticism of their attention
to innovation and improvement, will they remember that children are
not just little adults?
Brenda Cheer,
ERIC nurse, The Children’s Bowel & Bladder Charity
old woman living in a nursing home
in Clacton, Essex, died after staff
failed to notice her catheter was
blocked. She was found to have
retained two litres of urine (http://bit.
ly/2C0RJHJ).
MORE IS NOT
NECESSARILY MERRIER
Not all catheters are necessary.
Approximately one-quarter of
patients admitted to hospital are
fitted with a catheter and in 30–50%
of cases, the clinical rationale is
unclear (Loeb et al, 2008). Often, as
a result of lack of knowledge and
poor assessments, catheterisation
is treated as a routine intervention,
undertaken as casually as inserting
a cannula or recording a patient’s
blood pressure.
The first question a nurse
needs to ask when considering a
catheter, particularly an indwelling
catheter, is: ‘Does my patient need
this?’Nurses need to investigate
whether a less invasive alternative
could be used, for example, would
conservative methods such as pelvic
floor exercises, bladder retraining, or
teaching a patient or carer to employ
intermittent self-catheterisation, be
more effective?
Of course, this is not easy —
properly assessing a patient’s
suitability for a catheter requires
the completion of a full assessment
including measurements of the
patient’s post-void residual urine
and a frequency/volume chart. But,
while nurses are all busy, there is
no excuse for failing to perform a
comprehensive assessment before
considering such an invasive
procedure as a catheterisation.
After all, it is thought that improved
catheter care can reduce the rate of
CAUTIs by 30% (Academic Health
Science Network [AHSN], 2016).
Determining whether a patient
requires a catheter is the first step in
improving care. There are protocols
designed for this very purpose,
for example, nurses can use the
HOUDINI
anagram to identify the
reasons why a catheter should be
used (Houghton, 2017):
i
H:
haematuria
i
O:
obstruction (urinary)
i
U:
urology surgery
i
D:
pressure ulcer (open sacral
or perineal wound in an
incontinent patient)
i
I:
input and output monitoring
being performed
i
N:
not for resuscitation; nursing
management for end-of-life care
i
I:
immobility.
If none of these factors are
involved, the nurse should consider
removing the catheter. If the nurse
decides that a catheter is necessary,
it should be removed as soon as
possible and not left
in situ
simply
because it is more convenient for the
healthcare staff.
PASSPORT TO IMPROVING CARE
Catheter passports are documents
that provide information for
patients on how they should
care for their catheter at home,
as well as including a section for
healthcare staff and carers to record
catheter changes and maintenance.
Catheter passports can improve
communication between primary
and secondary care services, where
often the rationale for a catheter
insertion has not been adequately
communicated. Catheter passports
can also promote self-care among
patients, improve communication
between patients and nurses and
help patients to adjust to living with
a catheter (Jaeger et al, 2017). One
study found that using a catheter
passport not only helped patients
to cope at home, but also assisted
nurses who wanted to increase their
CONTINENCE CARE MATTERS
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UROLOGY AND CONTINENCE CARE TODAY
2018,Vol 1, No 1