1 Continence Care Management Formulary Document Description Document Type Formulary Service Application All Clinical Staff and Care Staff Lead Author Name Position within the Organisation Gill Davey Continence Services Manager , DGNFT Jag Sangha Pharmaceutical Adviser (v1.3 onwards), Dudley CCG Louise Storey Nurse Prescribing Lead, DGNFT Caroline Whitehouse Community Nurse, DGNFT Caroline Clarke Older Persons Specialist Pharmacist, Dudley CCG Presented for discussion, approval and ratification to Area Medicines Management Committee October 2012 Area Clinical Effectiveness Committee Approved November 2016 Review Date November 2019 Change History Version Date Comments 1 October 2012 Ratified at AMMC 1.1 February 2013 Hydro-Caine Lubricating Gel removed 1.2 February 2015 Qufora product information included, Bowel Aids, updated to include review date 1.3 Sept 2016 Contiform included, Ugo fix, bladder infusion kit, Prosys all silicone catheter 1.3 October 2016 Consultation on full document with Urology (including Hospital to Home urology Team, Geriatrician, Community Nursing Teams, Practice based Pharmacists, Pharmaceutical Public Health Team, Older Persons Specialist Pharmacist, Office of Public Health Infection Control Team. 2.0 November 2016 Approved November 2016 Link with Care Quality Commission Essential Standards of Quality and Safety Regulation 10, Outcome 16 - Assessing and monitoring the quality of service provision. Regulation 13, Outcome 9 - Management of medicines. Link with Trust Purpose and Values statements We will work to continuously improve services ‘ We will support, deliver and develop our staff’
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Continence Care Management Formulary
Document Description
Document Type Formulary
Service Application All Clinical Staff and Care Staff
Lead Author
Name Position within the Organisation
Gill Davey Continence Services Manager , DGNFT
Jag Sangha Pharmaceutical Adviser (v1.3 onwards), Dudley CCG
1.3 October 2016 Consultation on full document with Urology (including Hospital to Home urology Team, Geriatrician, Community Nursing Teams, Practice based Pharmacists, Pharmaceutical Public Health Team, Older Persons Specialist Pharmacist, Office of Public Health Infection Control Team.
2.0 November 2016
Approved November 2016
Link with Care Quality Commission Essential Standards of Quality and Safety
Regulation 10, Outcome 16 - Assessing and monitoring the quality of service provision. Regulation 13, Outcome 9 - Management of medicines.
Link with Trust Purpose and Values statements
We will work to continuously improve services ‘We will support, deliver and develop our staff’
Jane Ashmore-Hall Deputy Head of Procurement, DGFNT
Margaret Cooksey Clinical Skills Lead, DGFNT
Nadine Edinborough-Edwards Clinical Nurse Specialist – Infection Prevention Control, Office of Public Health, Dudley MBC
Raj Khunkun Community Nurse, DGFNT
Contacts
Continence Service Brierley Hill Health & Social Care Centre (01384 321516)
Infection Control Team Dudley Group via RHH Switchboard (01384 456111)
Infection Control Team Office of Public Health (01384 321854)
Clinical Nurse Specialists (Urology) Dudley Group via RHH Switchboard (01384 456111)
Contents
Products Page
Long term urinary catheter (3 – 12 weeks) 3 - 4
Short/Medium term catheters 5
Silver Coated Catheters 6
Intermittent Self Catheters (ISC) 7 - 9
Lubricating Local Anaesthetic Gel 10
Catheter Maintenance Solutions 11 - 12
Penile Sheaths 13 - 15
Catheter Bags (Leg) 16 - 17
Night Drainage Bags 18
Accessories 19 - 20
Catheter Valves 21
Additional Accessories – (Specialist) 22 - 23
Bowel Aids 24 - 25
References 26
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Long Term Urinary Catheter (3 - 12 weeks)
Silicone Elastomer- this is a latex catheter with silicone bonding to the outer and inner surface, making the surface smooth and reduces encrustation. This has the combined advantage of silicone and latex (ACA, 2007, RCN, 2012) All Silicone: - a latex free catheter. It has a large lumen and the walls of the catheter are thin, these help with minimizing encrustation. (ACA, 2007, RCN, 2012) Polymer-coated Latex - It is latex with a coating of polymer hydromer; the manufacturers state this is more compatible with body tissue (Robinson, 2001). The hydrogel will absorb a small amount of body fluid to keep it smooth, reduce friction between catheter and urethral surface and less encrustation. (ACA, 2007, RCN, 2012) What to choose?
Polymer coated or hydrogel as less likely to cuff on deflation. However if patient is allergic to latex then all silicone must be used (MDA, 2001 and Parkin, 2002, RCN, 2012)
Company/product Male code
Female code
Expected use
Teleflex Medical Sympacath
DH3101 (12-16)
DH2101 (12-16)
Urethral/supra pubic
3-12 weeks Hydrogel coated latex catheter
Pre filled syringe
Teleflex medical (formerly known as Rusch) Brilliant Aquaflate
DA3101 12 DA3101 14 DA3101 16 DA3101 18 Use the below sizes with specialist advise ONLY DA3101 20 DA3101 22 DA3101 24 (12-24)
DA2101 (12-18)
Urethral/supra pubic catheters
3-12 weeks
An all silicone catheter
Prefilled syringe
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Company/product Male code
Female code
Expected use
Coloplast Folysil (open ended)
AA74 12 AA74 14 AA74 16 AA74 18
AA75 12 AA75 14 AA75 16
Urethral and supra –pubic all silicone
L.IN.C medical All Silicone Catheter with integral balloon
For frequent changes consider these types of catheters. (RCN, 2012) These are not generally suitable in primary care unless the patient is a frequent blocker (e.g. high frequency of catheter change) which necessitates greater than 12 catheter changes per year. The rationale should be clearly documented within the relevant patient record (e.g. single assessment folder). Please ensure one additional catheter is available with the patient at all times should a need arise to change the catheter at short notice. The Hospital to Home nursing team operates from Urology Ward C6, DGH. Please note that this team only has input into the management of those patients under the care of a urology consultant. Details include:
Olivia Thornton
Tina Steventon
Monday to Friday 9am to5pm
Tel: 01384 456111 extension 2282/2692
Company/product Male code
Female code
Expected Use
Teleflex Medical (Rusch) Aquaflate
DP3101 12 DP3101 14 DP3101 16
DP2101 12 DP2101 14 DP2101 16
For urethral and supra pubic use
1 to 3 weeks
Comes with pre filled syringe for balloon inflation/deflation
These are suitable for patients prone to recurrent urinary tract infections, as silver coating provides an increase in antibacterial protection. Most of the research has been in short term use only, which is not deemed suitable for primary care. These catheters preserve the integrity of the urethral mucosa, preventing inflammation, loss of epithelium and formation of a biofilm. The silver ions inhibit formation and reduce the risk of infection. 4 weeks maximum in using these catheters EAU, (2012) RCN (2012) Seek advice before prescribing Silver Coasted Catheters. For DGH contact Clinical Nurse Specialist for urology.
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Intermittent Self Catheters (ISC)
This method is well established and an accepted form of management of neuropathic bladder dysfunction, atonic bladder and often other causes of incomplete emptying. This can be used for stricture management to prevent the stricture reoccurring. Clean (patient to maintain adequate hand hygiene) Intermittent self-catheterisation of the urinary tract helps prevent reflux and reduces the threat of encrustation and infection. (RCN, 2012) Clean Intermittent self-catheterisation is a safe procedure for all ages. Manual dexterity does need to be considered, however there are aids to assist and facilitate easier handling. Patients are encouraged to empty their bladder by inserting a urethral catheter and hand hygiene is important with this procedure and should be emphasised at each review. Patients are discouraged from touching the catheter tip to avoid urinary infection. The quantity of ISC to be prescribed is dependent upon the medical indication, bladder charts and continence assessment:
Generally clean intermittent self-catheterisation can be from once a day up to six times per day.
This equates to one catheter per use (box of 30) and thus up to 6 x 30 ISC may be required each month
There are exceptional indications for use such as neurogenic and atonic bladder and for patients with spinal injuries. These patients could require emptying their bladder more frequently up to 8-12 per day (equivalent to between 8 and 12 boxes of ISC per month).
If there are any concerns or queries regarding inappropriate quantity of ISC use, please contact either Urology or the Continence Service for advice. Patients are required to choose the catheter that suits their needs and how they want to receive them i.e. via their community pharmacy or appliance contractor. Patients should be supported and educated to ensure they make an informed choice of catheter. Please refer to the continence service if a patient requires guidance.
Lofric Primo can be folded over for 24hrs without damaging the catheter
Teleflex Medical Flocath Quick
Male 851241 Sizes 8 – 2 10+12
Female 85122 Sizes 8 – 20 10+12
Single use only
Saline attached
30 in pack
Manfred Sauer
Male IQ
Intermittent catheters for males
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IQ 2004.12 -14 Male IQ+ 2104.12
Pack of 30
IQ requires water to activate lubricant
IQ+ has saline included in package good for gentlemen with prostrate problems
Rochester Hydrosil
63610-10ch 63612-12
71610-10ch 71612-12
Single use
Own sachet of sterile water
30 in box
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Lubricating Local Anaesthetic Gel
This is a single use sterile gel/lubricant for the urethral mucosa. It must be used for female and male urethral catheterisation. (RCN, 2012) Contraindications to the use of Lubricating Local Anaesthetic Gel:
Must not be used in patients with known hypersensitivity to the active ingredients (amide-type anaesthetics, chlorhexidine and alkyl hydrobenzoated) or any of the excipients.
Should not be used in patients who have damaged or bleeding mucous membranes because of the risk of systemic absorption of the ligocaine hydrochloride. Special warnings and precautions for use: should be used in caution in patients receiving antiarrhythmic drugs, hepatic insufficiency, epileptics and impaired cardiac conditions.
Company/product Volume Expected Use
Instillagel Lidocaine 2% Chlorhexidine 0.25%
6ml 11ml
Local anaesthesia, disinfection and instrument lubrication in urethral catheterisation and cystoscopy
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Catheter Maintenance Solutions
These solutions are NOT for routine use, but as part of an overall management plan. They assist in the patency of the catheter and the use of 50mls is as effective as 100mls in reducing encrustation. Two sequential uses of 50mls are more effective than a single instillation. (Getliffe, 2000) DEFINITION Manual bladder irrigation is used for clearing clot retention rather than clearing the catheter of encrustation. If the catheter is blocked with encrustation it will require changing. Catheter blockage is a very common complication in long term catheter users. Up to 50% of long term catheters are changed prematurely due to catheter blockages. (RCN, 2012; EAU2012) There are 3 main catheter solutions available:
1. Normal saline NOT TO BE ROUTINELY USED; only to clear blood clots, pus or debris In order to prevent premature catheter changes please could you ensure normal saline catheter maintenance solutions are available for all catheterised patients within their homes.
2. Solution G (see table below)
3. Solution R (see table below)
Company/product Code Expected Use
Braun Uro-Tainer Suby G 2 X 30mls Citric Acid Uro-Tainer Solution R 6.0% Citric Acid 2 X 30ml
9746609 9746625
A twin chamber system containing 30ml of citric acid (3.25%) solution
Reduces /resolve crystallisation
Recommended regime following assessment is from once weekly to twice daily depending on severity.
Instil for 5-10 minutes per chamber
Twin chamber system containing 30 mls of citric acid (6%)
Dissolves persistent crystallisation in the catheter or can be instilled 5-10 minutes prior to catheter removal to minimise trauma
Uro-Tainer NaCl 0.9% Normal saline
FB99849 (50ml)
NOT FOR ROUTINE USE
For removal of
Expected Use clots, debris & pus to prevent preventative catheter change
Bard CSG 50 Citric acid (3.25%) dissolves
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Optiflo G 50ml Single 3.23% Citric Acid Optiflo R 50 ml Single 6.0%
For removal of clots, debris & pus to prevent catheter change
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Penile Sheaths
Penile sheaths must be fitted by an appropriately trained health care professional and a referral to a specialist should be made for the patients if fitting difficulties. (NICE, 2015) The problems usually encountered relate to poor skin preparation, poor fitting and the inappropriate choice of product. This results in increased susceptibility to urinary tract infections, sores on the end of the penis and/or damage to the surrounding skin caused by some adhesives. Sheaths are to be kept in place for no longer than 24 hours. Assessment For success of a correctly fitted sheath, the following need to be adhered to:
1. Non retracted penis
2. Healthy, unbroken skin
3. No risk of sheath being pulled off
4. Reasonable mental awareness, eyesight, manual dexterity and adequate carer
availability
The next step is to ensure that the patient is measured correctly to get the size of sheath to maintain continence. Each company provides individual fitting guides which can vary in size and if a different sheath is used, ensure the correct fitting guide is utilised. It is inappropriate to guess the correct size. Size is taken from the base of the penis, not the glans. A small sheath may constrict the penis and too long a sheath may disconnect, kink and leak. Length is important; if too long this may roll off. Generally if a patients penis measures 3cm in length, it is unlikely that a sheath device will be suitable and an alternative method for management needs to be considered. Do not use talc or cream before application. Generally one box of 30 penile sheaths will last one month. The P-Sure sheath (Manfred Sauer) is the only company which has a wide range of sizes which can be used for adults and paediatrics. If unsure contact the Continence Service. Samples can be obtained from the Continence Service.
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Company/product Male code
Quantity Expected Use Advantages
Bard (previously Rochester) Clear advantage With Aloe Vera Style 1
1243 24mm 1283 28mm 1323 32mm 1363 36mm 1403 40mm
Box of 30
Pack of 30 Silicone self-adhesive 5 sizes Adult only Fitting guides and measuring devices included
For men with sensitive skin
Bard (previously Rochester) Pop on Clear advantage With Aloe Vera Style 2 Style 3 Wideband adhesive
Box of 30 Range of sheaths Latex free and self-adhesive 18mm -40mm (includes paediatric) Includes 1 free pubic hair protective cloth Fitting guides Anti-blow back system Adaptable for retracted penis and can used for drip urinal
Coloplast Ltd Optima Shorter length
21mm 22121 25mm 22125 30mm 22130 35mm 22135
Box of 30 Non latex ,self-adhesive with Anti-kink design Fitting literature And measuring guides For patients with a short penis Adult only
Standard Length 25mm 22025 30mm 22030 35mm 22035 40mm 22040
Box of 30
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Catheter Bags – (Leg)
Leg bags are for the collection of urine from an indwelling catheter or penile sheath. They may be worn in different positions (thigh, calf, and belly). The leg bags differ with outlet taps, connectors, length of outlet tube and inclusion of straps. Patients need to be assessed on dexterity for tap closure/opening before prescribing. Leg bags must be changed using an aseptic non touch technique. They can remain in situ for up to 7 days (follow manufacturers guidance). (RCN, 2012; EAU, 2012)
Company/product Tap Bag Size/Code Expected Use
Clinisupplies Prosys
Lever Slide Action
500ml short P500S-LT 500ml long P500L-LT 350ml short P350S 350ml long P350L 500ml short P500S 500ml long P500L 750ml short P750S 750ml long P750L
Box of 10
Needle free port
Gloves come with catheter Latex free
Uno medical/Careline
T Tap Lever
Short 350ml 45-01-SVC 500ml 45-05-SVC 750ml 45-09-SVC Long 350ml 45-02-LVC 500ml 45-06-LVC 750ml 45-10-LVC Short 500ml
5 to 7 days duration of use
A ridged connector and needle free port
Overnight connector
Non return valve prevent back flow
1 pair of elastic and Velcro straps included per box of 10 bags
350ml short tube 10100 A 500ml short tube 10103C 500ml long tube 10104E 750ml short tube 10106 1000ml long tube 10120W
Pack of 10 Latex free 100% Needle free port Straps included 180 degree lever tap Overnight connector
Manfred Sauer Bendi bag
Swing 700ml direct inlet 70-33-045 12cm inlet 70-33-125 1300ml direct 12cm 70-47-045 20cm 70-47-205
Pack of 10 Useful for people in wheelchairs/chair bound Velcro straps included Overnight connector included
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Night Drainage Bags
These are connected to the leg bag (day bag) and used in conjunction with a stand which may be obtained by contacting the company. The position of the bag should be below the bladder level to enhance gravity induced drainage, but no more than 30cm below as can have negative effect and cause suction effect to the bladder mucosa and will cause blockage of the catheter. (RCN, 2012) Please ensure a catheter stand is used; this prevents damage to the bladder neck.
Company/product
Drainable/ Non Drainable Tap
Code
Expected Use
Night Drainage Bags Unomedical Ltd Careline Easi MT
Non Drainable 2L
47-60-LBH 10 in pack
Single use
Twist off drainage outlet
Non return valve
Simpla S 2 Clinisupplies
Non Drainable 2L
320902 Single use only
Prosys Clinisupplies
Non Drainable 2L
PSU2 Single use only
Prosys Clinisupplies
Drainable 2L
P2000 Slide outlet Tap
Sterile
Prosys Clinisupplies
Drainable 2L
P2000-LT Lever outlet Tap
Sterile
Great Bear GB4
Drainable 2L
10400W Sterile night bag with tap, non-return valve, sample port and anti-kink tubing
For use when leg bag not indicated
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ACCESSORIES
This is equipment to be used with the urinary catheter ensuring the catheter is anchored to the leg and thigh of the patient. There is a range available to meet individual need e.g. – large and oedematous legs or thin frail legs.
Company/ product
Size Code Expected Use Guidance on correct use
Flexicare Medical Atraps
One Size 00-0032
Coloplast G Strap Thigh
Adult Abdominal 80cm
383001 383003
Pack of 5 Washable and Reusable Order one pack only Replace when strap becomes unserviceable Elasticated retainer strap helps steady the catheter and assists in keeping bladder neck up. Around thigh
2 to 3 packs per year is adequate
Hollister Thigh
58.5cm 9343 Deluxe leg straps 2 in a pack Measure the leg Wrap around thigh Good for large thighs
2 to 3 packs per year is adequate
Manfred Sauer P Grip
Leg 38mm x 600mm Waist 38mm x 900mm
CS.01 CS.02
Assists with clean ISC, an aid to raise the penis so the catheter can be directed down the urethra
Single use should be sufficient
Unomedical Care Sleeve
Small (30-45cm) Medium (45-65cm) Large (55-80cm)
46-LS-01 46-LS-03 46-LS-
2 to 3 packs per year is adequate
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Extra Large (65-90cm)
05 46-LS-07
Ugo fix Gentle clip for catheters
One size fits all
3004 Pip-394-9054 5 in the box
Gentle clip that fixes at bifurcation On for 7 days Can be used in the shower
Follow instructions to ensure it fits correctly
CathIT advance pack
n/a n/a Catheterisation pack- first layer is the removal kit and the second layer is the insertion
Facilitates aseptic non touch technique to reduce the risk of urinary tract infections associated with catheters
Pelvic toner Female use Helps to engage and strengthen the pelvic floor muscle Only one needs to be prescribed
Must see a specialist physiotherapist (Continence Service) Pelvic floor muscle needs to assessed first before use
Contiform Female use Vaginal pessary lasts 45-60 days Correct fitting is essential Moulded elastomer resembles a hollow tampon which makes insertion easy
Must see a specialist physiotherapist from the continence service to check pelvic floor muscle before use
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Catheter Valves
Patients (or carer) can use these with long term catheters who have sufficient manual dexterity to be able to turn the valve to empty the bladder when required. This then will reduce the need for a day bag. The patient also needs cognitive awareness and adequate bladder capacity to use this system. This can be used on urethral and supra pubic catheters. (RCN, 2012; EAU, 2012)
Avoids the need for day bags and does not restrict what the person wears.
Valves should be replaced weekly (1 x 5 per month) An assessment is needed for bladder function and the Continence Service can be contacted for further assistance and guidance on prescribing. Contraindications to their use:
Reduced bladder capacity.
Not to use on patients who have under gone a radical prostatectomy and bladder reconstruction.
No bladder sensation.
Cognitive impaired.
Insufficient manual dexterity to operate the valve.
Company/product Pack Size code Expected Use
Unomedical Ltd Careline
5 Lever 90821 15-20 Tap 90805 15-20
L.IN.C Care flow catheter valve
5 CFI
Manfred Sauer Smart flow valve
5 CVS
Will connect to any catheter
Twist connector
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Additional Accessories - Specialist
For more information please contact the continence service. Retracted penis pouch is an alternative when the patient has a small penile length and a sheath cannot be attached. Flow directors can assist patients aim their flow into the toilet more fluently. Male and female are available. A meatal penile sheath can be applied to the small area of the glans around the meatus which differs from a standard penile sheath which is applied over the whole penis. The hydrocolloid petals adhere to the glans of the penis. The butterfly application helps seal around glans. This type of sheath can be valuable for patients who have spinal injuries or neurogenic bladders. Please seek advice from the Continence service if this type of sheath may be required.
Company/product Male code
Female code
Practical Use Clinical Scenario
Hollister Retracted penis pouch
9811 9873
Single use only; one needed per 24 hours
Beambridge Male Flow directors Jug urinal
6-35mm
Washable and re-usable; Male use; Only one needs to be prescribed for any individual
Good for gentlemen with Parkinson’s or Bed bound. They direct the flow of urine into a toilet/bottle/ Receptacle.
Beambridge Female flow director Pod there are two types Extension tube Saddle urinal Bridge urinal
6-60T (Tap) 6-60 (No tap) 6.39
6-60T (Tap) 6-60 (No tap) 6.39 6.26 6.29 6-18 6-18T
Washable and re-usable; Female use; Use sitting on edge of bed/chair or standing; Can use a connector to attach to a bag; only one needs to be prescribed per individual; Can use connector to attach a night bag.
Hip replacement - these devices assist ladies in managing to direct the flow of urine into the toilet if they feel they are unable to bend.
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Clinimed Bio derm – Meatal Sheath
Pack of 5; Hydrocolloid skin friendly; Fits on to the glans of the penis; Has drainable plug which will fit most leg /night bags; Alternative to sheaths; On for 2 to 3 days and therefore 1 to 2 packs per month only.
Spinal injury; Young men with multiple sclerosis
Bullen Health Care Uri drain system
Use for retracted penis Must be measured use guide Hip/ waist required
For gentlemen who lead active lives and found sheaths had dislodged off due to daily functioning
L.I.N.C bladder infusion kit Designed to reduce the risk of urine infections
Pack of 10 To deliver catheter maintenance without breaking the closed system
Keeps the closed system intact. All that is required is to clamp off and instil the catheter maintenance solution.
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Bowel Aids
These are for assisting in bowel function. The anal plugs are useful if continence pads are not suitable. They are good for neurogenic conditions (e.g. spinal injury, multiple sclerosis, advanced dementia etc.) with impaired sensation. Adequate bowel movement must be instigated to avoid bowel inactivity which may lead to obstructive symptoms. Peristeem is known as Tran’s anal irrigation or rectal irrigation for select patients whereby laxatives no longer work. It is a method of emptying the lower bowel and helps in preventing faecal incontinence, constipation or a lazy bowel. The user sits on the toilet whilst warm water is instilled into the rectum via a catheter which is secured by balloon. On deflation the water is emptied from the bowel with contents. Please seek advice from the Continence Service, who teach and demonstrate the use of these bowel aids.
Company/product Size Code Practical Use Clinical Scenario
Coloplast Anal plugs
2 Sizes
1450 -small 1451 -large
Porous soft absorbent foam Change every 12 hrs -mucus leakage small /moderate loss only
For faecal smearing
Spina bifida
Multiple Sclerosis
Neurogenic
Coloplast Peristeem Anal irrigation
Rectal irrigation Allows to empty the lower bowel assists in preventing constipation, faecal incontinence the water goes up into sigmoid colon and assists with causing a peristalsis thus a normal bowel action
Spinal injuries
Multiple Sclerosis
Parkinson’s Disease
Hollister Faecal collector
Box of 10
9822 – 500ml 9821 – 1000ml
Can be left up to 24hrs Bed bound
Cannot sit on this will cause skin problems careful assessment required
Qufora IrriSedo Irrigation System Mini Set
1 hand pump and 15 cones 30 cones
53601-015 53601-030
Warm water is slowly inserted via a cone into the rectum which assists in emptying the rectum
Multiple Sclerosis
Early dementia if family/carer assist
Parkinson’s Disease
Any dysfunction of the bowel that
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Balloon system: base set (medium) base set (small) accessory set (medium) accessory set (small) catheter set (medium) catheter set (small) Bed system: 12mm 21mm 30mm Toilet system: Starter set Monthly set
1 control with Velcro strap, 1 water bag, 2 rectal catheters 1 water bag, 15 rectal catheters 10 rectal balloon catheters 1 water bag, 1 pump, 5 rectal catheters, 5 collection bags 1 pump, 1 water bag, cones and waste bags
2 medium catheters 2 small catheters 15 medium catheters 15 small catheters 10 medium balloon catheters 10 small balloon catheters 12mm catheter 21mm catheter 30mm catheter 5 cones, 5 waste bags, 1 toilet bag 15 cones, 15 waste bags
normal laxatives have not helped
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References
Association for Continence Advice, (2007) Notes on Good Practice. European Association of Urologist, (2015) EAU pocket guidelines;[email protected] European Association of Urologists (2012) Catheterisation indwelling catheters in adults urethral and suprapubic;[email protected] Getliffe.K (2000) Dissolution of Urinary Catheter Encrustation. British Journal of Urology (85): 60 – 65. Medical Device Agency. (2001) Safety notice SN 2001 (02) Problems removing urinary catheters; London. National Institute for Clinical Excellence ,(2013) Management of Urinary incontinence; clinical guideline CG171: nice.org.uk/guideline/cg171. National Institute for Clinical Excellence (NICE, 2015) Lower urinary tract symptoms in men: management; clinical guideline 97,nice.org.uk/guideline/cg97. Parkin. J (2002) Urinary Catheter “deflation cuff” formation: clinical audit and quantities in vitro analysis. British Journal of Urology International; 90(7):666-671. Rebmann T et al. (2010)AJIC: doi 10.10116/j.ajic.2010.08.003. RCN guidance for Nurses, 2012 Catheter care RCN 17th May; London. Robinson (2001) Urethral Catheter selection. Nursing Standard, 15 (25)7/3/2001, 39 – 42.