Continence Resources

Indwelling urinary catheters remain one of the most commonly used clinically invasive devices across the NHS and social care in the UK. The problems associated with the prolonged use of catheters are widely referenced. Healthcare-acquired infections (HCAIs) currently result in 5,000 preventable deaths a year, with 20% of all HCAIs associated with the urinary tract. Many staff have learned catheterisation techniques in their early careers, with no need for a formal review of skills and knowledge. This has perhaps contributed to some historical and now outdated tasks still being performed. The evidence for best practice when managing indwelling catheters is reflected in national and international guidelines, which have recently undergone a complete overhaul. This article explores common practices and best practice evidence to assist with safe and effective management of these essential but often risky devices.

The effect of drugs on mental and physical health are well documented. However, these consequences do not necessarily prevent people using them either recreationally or more regularly, with some becoming addicted to their drug or drugs of choice. It is estimated that in 2016/17, around one in 12 (8.5%) adults aged 16 to 59 in England and Wales had taken an illicit drug in the last year (NHS Digital, 2018). Ketamine has become increasingly popular, especially among younger users, as it is cheap and mistakenly seen as a ‘safe’, non-addictive drug. However, the reality is that even recreational use may have serious consequences. The effect on the urinary system can be devastating, with users experiencing anything from frequency and cystitis-like symptoms, to extreme debilitating pain from the inflamed and shrunken bladder, resulting in cystectomy and urinary diversion, and, if the kidneys are affected, renal failure and dialysis.

Indwelling urinary catheterisation is a common procedure especially within a community setting. However, healthcare professionals are sometimes unaware of what is current best evidenced-based practice. This article outlines the clinical indicators for insertion of a urinary catheter, rationale for catheter selection, including Charrière (Ch) or French gauge (Fg), length, balloon size and material of choice including any coating. Catheter insertion requirements are outlined and drainage and supporting/securing devices discussed. Complications of indwelling catheters, such as catheter-associated infections and encrustation are also discussed with recommendations for treating, and, finally, new innovations which may benefit in future care are identified — all with reference to current national guidance and best clinical evidence-based practice.

Nocturia is a common lower urinary tract symptom that mainly affects older people. Nocturia causes excess urination at night and, because of associated night-time rising, can also result in falls and fractures. Nocturia has a range of presentations, therefore it is vital that nurses understand how to assess the condition accurately to provide appropriate treatment. This article examines the effective assessment of nocturia, as well as detailing the various lifestyle treatment options that can be used, such as a targeted reduction of fluid intake, weight loss and altered medication profiles. Medication and surgical options should only be used following a trial of lifestyle interventions.

The National Catheter Education Programme is a Health Education England-funded initiative to improve the care of patients with catheters. Part of this initiative is the Secret Life of Catheters programme. This article highlights the need for improvement in catheter care and explains the development of this project, which aims to drive improvements across primary and secondary settings through the large-scale delivery of a multiprofessional educational programme in catheter care. The programme explores key dilemmas that district nurses, community nurses, healthcare assistants and doctors can encounter with catheters, and provides approaches to address them. By standardising the teaching of clinical concepts and practice strategies, it is hoped that variations in practice and pockets of misunderstanding can be eliminated.

There are a variety of reasons as to why a patient may require an indwelling catheter, however, these are seldom documented or communicated across healthcare services (Codd, 2013). Thus, short term catheters are at risk of becoming long-term catheters in the absence of clear documentation and forward planning. The risk of infection increases the longer a urinary catheter remains in situ. This article explores the guidance available to support appropriate urinary catheter use, catheter management, documentation, forward planning and patient education for effective catheter care. How this can be implemented to support appropriate removal of urinary catheters or ongoing care for long-term urinary catheter use for patients across the primary and secondary care services is also discussed.

Here, Sharon Holroyd, lead CNS, Calderdale Bladder and Bowel Service; chairperson, Yorkshire ACA, defines stress urinary incontinence and the treatment options available, and reviews the evidence to support pelvic floor exercises as an effective rehabilitation for patients with symptoms of stress urinary incontinence.

Urinary incontinence (UI) has been associated with chronic respiratory symptoms, which impact on patient quality of life (da Silva Paes et al, 2016). Chronic respiratory symptoms, such as coughing, wheezing, and dyspnoea, and patients with chronic chest conditions, such as asthma, bronchitis or chronic obstructive pulmonary disease (COPD), are associated with increased occurrence of UI. Women with respiratory symptoms have more severe symptoms and are more likely to have stress urinary leakage than those without. This paper provides an overview of asthma, and highlights the importance of community nurses not only addressing issues associated with respiratory diseases, such as ensuring that there is a personalised asthma action plan (PAAP) in place for those with asthma, but also assessing urinary incontinence to evaluate occurrence and decide upon measures that can be taken to prevent or lessen any leakage