Your browser is no longer supported

For the best possible experience using our website we recommend you upgrade to a newer version or another browser.

Your browser appears to have cookies disabled. For the best experience of this website, please enable cookies in your browser

We'll assume we have your consent to use cookies, for example so you won't need to log in each time you visit our site.
Learn more

Prescribing catheters

  • Comment

VOL: 98, ISSUE: 09, PAGE NO: 50

Ray Addison, RN, FETC, Cert.H.Ed, BSc, is nurse consultant, bladder and bowel dysfunction, Mayday Healthcare NHS Trust, Croydon, honorary nurse consultant to The UK Continence Foundation and honorary senior lecturer, St George’s Medical School and Kingston University

Catheterisation is an invasive procedure, and indwelling catheters pose a greater risk to the patient than intermittent catheterisation. Compared to stoma products that are external to the body, Foley catheters are retained in the bladder, and such treatment may be long term. Nursing assessment is vital to challenge the need for and type of catheterisation before prescribing products. Intermittent bladder drainage is considered to be a better option by use of a valve or intermittent catheter when compared to long-term free drainage (Addison, 2001).

 

Catheterisation is an invasive procedure, and indwelling catheters pose a greater risk to the patient than intermittent catheterisation. Compared to stoma products that are external to the body, Foley catheters are retained in the bladder, and such treatment may be long term. Nursing assessment is vital to challenge the need for and type of catheterisation before prescribing products. Intermittent bladder drainage is considered to be a better option by use of a valve or intermittent catheter when compared to long-term free drainage (Addison, 2001).

 

 

It is also important to consider patient choice and comfort when selecting a catheter, as the patient has to cope with the long-term consequences of that decision.

 

 

Criteria for selecting a catheter
During 2000 I undertook a series of workshops around the UK in 10 centres which looked at competence in caring for patients undertaking intermittent self-catheterisation.

 

 

The 184 delegates who attended were asked to select the six most important criteria in selecting a catheter. The results can be seen in Table 1 in order of popularity.

 

 

Focus groups
Delegates were also asked to discuss in small focus groups their professional, legal and ethical roles in choosing a type and brand of catheter for a patient to use. Some examples were given in each category to guide the exercise (Table 2). The complexities of nursing and caring emerged from this exercise, highlighting the many dilemmas faced by nurses in such a simple activity as choosing a catheter for a patient.

 

 

Feedback from focus groups
The focus groups expanded the discussion of the professional role in choosing a catheter to include a discussion of the need for guidelines related to catheterisation. The use of local policies and procedures and national guideline, such as those published by the Medical Devices Agency, were viewed as important.

 

 

Benchmarking gives nurse prescribers the opportunity to consider whether patients with catheters have equal access to continence services, including user groups and follow-up. Nurses must ensure that patients are aware of the benefits, disadvantages and alternatives to catheterisation, and this should be documented.

 

 

Anyone selecting a catheter for a patient must be able to demonstrate competence and have an up-to-date knowledge base as required by PREP.

 

 

The focus groups explored a number of legal aspects related to catheter selection:

 

 

- Employment law - your employer must have a policy and procedures to support catheterisation by nurses;

 

 

- Product liability law - products must be prescribed and used in line with the manufacturers instructions;

 

 

- Data protection Act - maintaining confidentiality, including patients’ personal details, not releasing these to third parties without patient consent;

 

 

- CE mark - ensuring that all catheters, bags, catheter valves carry this mark;

 

 

- Consent - legal consent must be obtained, ensuring the patients is mentally able, gives informed consent and is not coerced;

 

 

- Duty of care as a nurse;

 

 

- Documentation - remembering to meet professional, legal and benchmarking standards in record-keeping;

 

 

- Care provided must meet health and safety directives.

 

 

Ethical aspects were expanded to include:

 

 

- Adhering to reasonable patient wishes - there is a growing trend to allow patients to choose their own intermittent catheter. Nurse prescribers need to consider whether patients should be allowed to choose their own Foley catheter or brand and size of pad;

 

 

- Freedom of choice is supported by information that allows patients to make informed decisions;

 

 

- Nurses need to consider the vulnerability of certain patient groups, such as people with a learning disability or communication problems;

 

 

- Inducements and rewards must be acknowledged - for example, stating if the catheter care leaflet was sponsored by a company;

 

 

- No release of data to companies related to product evaluations without consent of the patient.

 

 

Conclusion
The power to prescribe places even more responsibility on nurses to demonstrate competence in catheter care and prescribing.

  • Comment

Have your say

You must sign in to make a comment

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions. Links may be included in your comments but HTML is not permitted.