Urology continence nurse specialist Frances Roberts explains the information and education required to allow patients to effectively conduct intermittent self catheterisation.
Good communication and education are essential for effective intermittent self catheterisation (ISC). The patient should set the pace of learning and adequate time should be given for this. Practical instructions should use language the patient can understand (Royal College of Nursing, 2008), and written instructions, DVDs and educational booklets should also be used.
Patients will usually need more than one teaching session before they feel able to perform ISC unsupervised. While the number of follow-up appointments required will depend on individual needs, all patients must be followed-up after two weeks and then at 6-12 month intervals to ensure safe practice is maintained.
It is vital to keep a fluid balance chart for at least two weeks after ISC is started to ensure a safe management plan is implemented (Association for Continence Advice, 2007).
Frequency of catheterisation depends on individual needs and the following should be taken into account:
- It is desirable that the voided urinary volume plus the residual urine volume is less than 500ml;
- It is advisable not to exceed a residual volume of 250ml as this can lead to recurring infections;
- If the patient is wet between procedures, more frequent catheterisation may be necessary;
- Catheterisation should not be performed more than every two hours during the day and sleep should be undisturbed if possible.
As well as learning the procedure patients will need to know about:
- Catheter storage and obtaining supplies;
- Catheter disposal - wrap and place in domestic waste bin or sanitary bin (Department of Health, 2006);
- Fluid intake, sexual activity and exercise;
- Travel advice - patients need a letter explaining why they are carrying catheters abroad (ACA, 2007).
Frances Roberts, DNCert, DPSN, RGN, is urology continence nurse specialist, University Hospitals Birmingham Foundation Trust
Association for Continence Advice (2007) Notes on Good Practice: Intermittent Catheterisation.
Department of Health (2006) Health Technical Memorandum 07-01: Safe Management of Healthcare Waste. London: DH.
Royal College of Nursing (2008) Catheter Care: RCN Guidance for Nurses. London: RCN.
The importance of patient information and education