VOL: 102, ISSUE: 09, PAGE NO: 49
Adele Brodie, RGN, is Coloplast nurse adviser, Continence Division, Coloplast LimitedUrinary sheaths can be used to manage a wide variety of continence problems. The groups of patients for whom they c...
Urinary sheaths can be used to manage a wide variety of continence problems. The groups of patients for whom they can be used include those with the following problems:
- Sphincter damage following prostatectomy, for example;
- Spinal cord injury;
- Neurological pathology such as Parkinson's disease, multiple sclerosis, spina bifida, brain tumour;
- Functional incontinence. People with this problem include those with poor mobility, dementia, impaired vision, or for whom getting to a toilet poses a safety issue. It should be noted, however, that these men must have adequate support, such as access to social care or to a family network, to ensure that the sheath's drainage system is used appropriately;
- Poor skin integrity - a urinary sheath will allow drainage of urine away from the skin surface.
Urinary sheaths are also useful for the terminally ill patient, as they are less invasive than indwelling catheters.
Before considering any device to manage urinary incontinence, a thorough continence assessment must be carried out to identify the underlying cause of the problem and possible treatment options.
An assessment should be carried out of the volume of any residual urine in the bladder following micturition so as to exclude problems with incomplete bladder emptying. Urine should also be tested for any signs of a urinary tract infection.
Once a sheath has been applied and is connected to a drainage bag, it is more difficult to assess frequency, urgency and individual volumes voided. Patients who are carrying out intermittent catheterisation for incomplete bladder emptying can use a sheath between procedures.
Before attempting to measure for, or apply, a urinary sheath, it is essential that the patient understands and gives consent (Department of Health, 2000). The patient must be given accurate and appropriate information about the product and how it is applied. The manufacturer's guidelines must be followed, and patients should be informed of these as, according to the Medicines and Healthcare products Regulatory Agency, the prescriber is responsible for the safe and correct use of the product.
Phillips (1992) identified that health care professionals need to be confident and familiar with a product in order to be able to explain its application to a patient or carer.
A step-by-step guide to the fitting of a one-piece urinary sheath is presented in Box 1.
Sometimes urinary sheaths fail owing to variations in the method of application, temperature, storage and anatomical changes (Foxley, 2005). It is necessary, therefore, to leave appropriate contact details for a patient in case he requires further advice.
It is important to evaluate the product with the patient and to be aware of alternatives or improved products.
The sheath sometimes falls off
- First check the size, as this can alter according to temperature changes, age, weight loss or gain, or position;
- Use a measuring guide that is specific to the make of urinary sheath that is being used;
- Measure the patient in the position he is normally when the urinary sheath falls off; for example in bed if it falls off during the night. This may mean that he needs a different size sheath at night; alternatively, a skin adhesive could be used under the sheath;
- Try a shorter length urinary sheath in the same size if a patient has a retraction of his penis when he is in certain positions;
- Check that the patient is not using creams, talcum powder or moisturisers that may affect the adhesive properties of the sheath;
- Check that the patient has not secured the drainage bag too tightly, as this will pull on the sheath.
- It may be useful to use a G-strap to add extra security;
- Check that there is a small gap between the end of the penis and the drainage port of the urinary sheath. If there is not enough room for the urine to drain, it will flow backwards and cause the sheath to fall off.
There is no urine draining from the sheath into the drainage bag
- Check if the sheath has become dislodged;
- Check that the tubing of the drainage bag is not occluded;
- Check that drainage is not being prevented by a vacuum that has developed in the end of the sheath. If this is the case, disconnect the drainage bag briefly, which will release the vacuum and allow the urine to drain;
- Check that the sheath is not too tight, as this may compress the urethra and obstruct the flow of urine;
- Check that the sheath is not twisted at its end, as this may obstruct urine drainage.
- Check the condition of a patient's skin before applying a sheath for the first time so that any allergic reactions to the material in the sheath can be identified;
- Do not use a sheath until any broken skin has healed, as this could cause further skin breakdown and infection;
- Use a skin barrier before applying a sheath; this would include wipes and sprays;
- Try an alternative sheath if a patient has an allergic reaction after its application, particularly if a latex sheath has been used;
- Check for any infection under the foreskin that may need to be treated before a sheath is applied;
- Check the size of the sheath and penis, as the sheath may be too tight;
- Change sheaths every 24 hours according to the manufacturer's guidelines. If possible, allow the skin to breathe for short periods in between sheath changes;
- Check how the patient/carer is removing the sheath. It must be removed with warm, soapy water every time; pulling it off will cause trauma.
Difficulty in removing the sheath
- Check the size of the sheath, as it may be too tight;
- If necessary, an adhesive remover can be used. There are various products available on prescription.
Urinary sheaths are still used too infrequently. If this situation is to change, more product information needs to be available, together with demonstrations showing the correct use of sheaths.
Although community and specialist nurses accept that it is their responsibility to initiate the use of urinary sheaths for patients, they remain apprehensive because of the large variety of sheaths available from which to choose.
Lack of education and training is the biggest barrier, but nurses are unsure from where they can access the knowledge and skills that are required. Company representatives are often in a position to provide this information. Companies should be recognising the need to supplement their product information with research supporting the design, and facilitating ongoing evaluation in order to respond to changing patient needs.