Urinary Catheters

  1. Does anyone know where I can find the standard of nursing practice for clamping catheter's for bladder training. Is there a standard or is this considered an infection control issue and not a standard of practice.
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  2. Poll: To clamp or not to clamp?

    • It is standard to clamp a catheter to bladder train.

      41.79% 28
    • It is not standard to clamp a catheter for bladder training

      16.42% 11
    • You can only clamp a catheter to obtain a urine speciman.

      10.45% 7
    • You can only clamp a catheter with an MD order with specific guidelines to release.

      31.34% 21
    67 Votes
  3. 15 Comments

  4. by   sunnygirl272
    Hmmm...dunno the standards...i know that i have clamped for specs before ...also remember having clamped for retraining...but cannot recall if there were orders for the retraining...
  5. by   lpnga
    Click here: Policy #: Extended Dwell Peripheral Catheters, Care & Maintenance (CL 30-07.04)

    check this out and see if this is what you need
  6. by   lpnga
    and policy #:
    Extended Dwell Peripheral Catheters, Care & Maintenance, CL 30-07.04

    manual:
    Clinical Policy Manual

    categories:
    Infusion and Blood Product Therapy

    section:
    none listed

    review responsibility:
    Practice Committee

    effective date:
    August, 1999

    last revised date:
    March, 2002

    team members performing:
    RN, LPN

    guidelines applicable to:
    All patient care Areas*
    Exceptions: NICU, PHV
    (*VMG includes satellite sites unless otherwise noted)

    specific education requirements:
    Completes the CVC course and demonstrates skills competency

    Physician Order requirements:
    Yes

    Extended Dwell Peripheral Catheters
    CARE AND MAINTENANCE

    I. Outcome Goal:

    To provide intermediate to long-term venous access in a safe, aseptic manner.

    II. Policy

    Extended Dwell Peripheral Catheters (EDPC) will be managed according to the guidelines as written.

    III. Procedures

    A. ACCESSING

    1. Equipment:
    a. 10 ml syringe with 5 ml normal saline for each lumen to be accessed.
    b. Use 2 ml nonbacteriostatic saline for infants under 1 year of age.
    c. Prepared medication syringe or IV set
    2. Process
    a. Wipe access port with alcohol pad. (If IV fluids are administered continuously, may remove access port)
    b. Aspirate blood return.
    c. Flush with normal saline.
    d. Connect IV set or medication syringe.
    e. Secure connections and tubing.

    NOTE: EDPC may be used for diagnostic exams by Radiology to manually inject contrast medium. The power injector may not be used to inject contrast medium. Following manual injection of contrast, flush with saline (at least 5-10 ml), followed by heparinized saline (at least 1 ml).

    B. CAPPING

    1. Change access cap with each dressing change, every 7 days and prn, or per standing orders.
    2. Equipment:
    a. Access cap (positive pressure)
    b. Flushing supplies
    3. Process:
    a. Crimp tubing.
    b. Disconnect infusion line, or medication syringe, or access cap.
    c. Apply new access cap - flush if necessary.

    C. FLUSHING

    1. Check blood return.
    2. Flush lines daily and after each use if lumen is 21 gauge or larger.
    3. Flush with normal saline. (Pediatrics 5ml, Adults 10 ml)
    4. Flush with 1.0 ml heparinized saline, (may omit heparin for Groshong)
    5. If lumen is less than 21 gauge (as documented in insertion note):
    * Preferably connect continuous fluids
    * If intermittent, flush at least every 6 hours
    6. For each lumen to be flushed:
    a. 10 ml Syringe with 5-10 ml normal saline.Use 2 ml preservative free saline for patients under one of age.
    b. Syringe with 1 ml heparinized saline 100 u/ml. For infants less than one year of age, heparinized solution is 10 u/ml and preservative free
    c. Alcohol pads

    D. DRESSING CHANGE

    1. Use sterile procedure.
    2. Remove post-op gauze dressings 24 hours after insertion and apply transparent dressing, unless drainage mandates reapplication of gauze dressing.
    3. Change transparent dressings (without gauze) every 7 days, PRN, or per protocol.
    4. Change gauze dressing every 48 hours and PRN.
    5. If line inserted by Pediatric surgeon, the dressing is changed only with an order from the surgeon.
    6. Equipment:
    Central line dressing kit
    7. Process:
    a. Wash hands.
    b. Put on mask and non-sterile gloves.
    c. Loosen tape, secure catheter hub, and remove dressing toward the insertion site.
    d. Re-wash hands and put on sterile gloves.
    e. Clean site with alcohol swabs X 1, followed by chlorhexadine gluconate (CHG) X 1 and allow to dry.
    f. Apply skin prep and allow to dry
    g. Apply transparent dressing.
    h. Anchor catheter/ T-connector and edge of dressing with tape.
    i. Label dressing with date, initials, and catheter type (PICC, Midclavicular, Midline).
    j. Apply tube dressing to secure catheter, if desired.

    E. BLOOD DRAWING
    1. Equipment
    a. Syringe for waste
    b. Syringes and containers for samples desired.
    c. Adapter blood transfer, female (attaches to syringe)
    d. Alcohol swabs
    e. Non-sterile exam gloves.
    f. Flusing Equipment
    2. Process
    a. Stop and clamp all infusions for at least one minute before drawing blood.
    b. Aspirate waste (may use red top tube for waste.)
    Adult/Peds: 3 ml
    Neonates: 1ml
    c. Aspirate desired sample
    d. Flush with normal saline (Peds 5ml/Adults 10 ml), follow with 1 ml heparinized saline. (may omit heparin for Groshong).

    F. REMOVAL
    1. With a physician's order, RNs may discontinue EDPC lines.
    2. Assess catheter site and pathway prior to removal.
    3. Equipment:
    a. 2 x 2 gauze
    b. tape
    c. tape measure
    4. Process:
    a. Remove tape and dressing.
    b. Remove line by grasping at exit site and pulling 1 to 2 inches, then grasp with opposite hand at exit site pulling 1 to 2 inches. Removal should be a continuous, steady, slow motion. Repeat until completely removed. If resistence is met, do not continue. Redress and notify EDPC team for removal. Warm moist heat may be applied to promote relaxation of venous spasm.
    c. Examine catheter length and tip to ascertain that catheter was removed intact.
    NOTE: Measure catheter and compare length with insertion notes and/or manufacturer patient booklet.
    d. Apply pressure at insertion site to achieve hemostasis.

    IV. Nursing Implications

    A. Use no smaller than a 10 ml syringe for routine flushing. After patency is confirmed, may use appropriate size syringe to administer medication.
    B. Administer all IV infusions with a pump.
    C. If sterile T-connector is placed at time of catheter insertion, it need not be changed unless it is damaged or contaminated.( In this event, it will be changed with every cap change.)
    D. Luer-lock connections are recommended for infusion lines. When this is not possible, all non-leur connections will be securely taped.
    E. A specific IV fluid infusion rate order is recommended. If an order is written for KVO rate, the following rates are recommended:

    1. Adults - 10 ml per hour
    2. Peds - 3ml per hour

    F. Avoid use of scissors or other sharp devices in catheter management
    G. If damaged, call the EDPC team.

    1. Damaged catheters are usually discontinued and replaced.
    2. With a physician order, the EDPC team will exchange, or replace the EDPC line.

    H. When a peripheral line is inserted or replaced, fresh IV fluid and tubing are required.

    V. Patient/Family Education
    The patient and family/significant other(s) are educated about the following:

    A. Preoperative/postoperative routines.
    B. Possible complications and their management.
    C. Signs and symptoms to report to the health care provider.
    D. Catheter care, including implications for physical activity.
    E. Flushing and medication administration (when indicated).


    VI. Documentation

    A. Document condition and appearance of catheter site every shift.
    B. Document heparin flushes on designated forms or Outpatient Assessment Form.
    C. Document dressing changes.
    D. When using TPA, document verification of occlusion, number of attempts required, result of installation, and patient response in the medical record.
    E. Document dosage of TPA on MAR or Outpatient Assessment Form.
    F. Line care, removal of line, and appearance of catheter site and pathway shall be documented in the medical record.


    VII. Cross References:

    A. Clinical Policy Manual

    1. Section 30-06, "Medication Administration"
    2. Section 30-07, "Infusion and Blood Product Therapy"
    3. CL 30-07.07 "Catheter Clearance with TPA"
    4. CL 30-07.03 "Peripherally Inserted Central Catheters, Insertion"

    B. Chemotherapy Administration Course Manual (available from The Learning Center.

    C. Pediatric Chemotherapy Administration Course Manual (available from The Learning Center).

    D. Patient Education Materials
    1. MC#1985, Multidisciplinary Patient/Family Education Record
    2. MC#1986 Pediatric Multidisciplinary Patient/Family Education Record
    3. Manufacturer's patient information booklet, completed with information specific to patient's own catheter size and placement.

    VIII. References:

    Access Device Guidelines, 1996, Pittsburgh: Oncology Nursing Society
    Frey, A. (1995). Pediatric Peripherally Inserted Central Catheter Program Report A Summary of 4,536 Day. Journal of Intravenous Nursing , 18 (5), 246-249.

    Fabian,B. (1995). Peripherally Inserted Central Catheter Exchange.
    Journal of Intravenous Nursing , 18, (2), 92-96.

    Ryder, M. (1995). Peripheral Access Options. Vascular Access Options In the Oncology Patient 1055-3207. Surgical Oncology Clinics of North America, 395-400.

    Wall, J. (1995). Peripherally Inserted Central Catheters Resistance to Removal: A Rare Complication. Journal of Intravenous Nursing , 18 (5), 251-254.

    Marx, M. (1995). The Management of Difficult Peripherally Inserted Central Venous Catheter Line Removal. Journal of Intravenous Nursing , 18 (5), 246-249.

    Terry, J., Baranowski, L., Lonsway, R., Hedrick, C. (1995). Intravenous Therapy Clinical Principles and Practice. W.B. Saunders Company.

    Alexander, M. (1998). Revised Intravenous Nursing Standards. Journal of Intravenous Nursing , 21 (1S), 1S-95S.

    Lacy, J. and Brown, J. (1994). Peripherally Inserted Central Catheters Insertion, Care, Use, and Maintenance, 1-45.

    Bard Access Systems (1995), Groshong Peripherally Inserted Venous Catheter (P.I.C.C.) Nursing Procedure Manual.
    X. Endorsements

    Practice Committee - July 2001
    Pharmacy & Therapeutics - April 2000

    APPROVED:

    /s/ MARILYN DUBREE, Director, Patient Care Services Date 9-10-01
    /s/ GORDON BERNARD, MD, Chair, Pharmacy and Therapeutics Committee Date 9-22-01


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    PICC (PERIPHERALLY INSERTED CENTRAL CATHETERS)
    CARE AND MAINTENANCE SKILLS CHECK-OFF
    Accessing

    Wipe access port with alcohol pad. (If IV fluids are continuous, may remove access port)
    Aspirate blood return.
    Flush with normal saline.
    Connect IV line or medication syringe.
    Secure line and connections.

    Capping

    Crimp tubing .
    Disconnect infusion line, or medication syringe, or access cap.
    Apply new access cap - flush if necessary.

    Flushing

    May check blood return.
    Flush with normal saline.
    Flush with 1.0 ml heparinized saline, clamping on last 0,2 ml (may omit heparin and clamping for Groshong.)

    Dressing Change

    Wash hands.
    Put on mask and remove old dressing.
    Loosen tape, secure catheter hub and remove dressing pulling distal to proximal.
    Re-wash hands, put on sterile gloves.
    Clean site with alcohol swabs X 1.
    Clean site with chlorhexadine gluconate (CHG) X 1 and allow to dry.
    Apply skin prep and allow to dry.
    Apply transparent dressing.
    Anchor catheter/T-connector with tape chevron and edge of dressing with tape.
    Label with date, initials and PICC.
    Consider tub dressing to secure catheter.

    Blood Drawing

    Stop/"hold" infusions to all lumens for one minute.
    Aspirate waste of 1-2 ml.
    Aspirate desired sample.
    Flush with at least 2-5 ml normal saline, follow with 1 ml heparinized saline, clamping on last 0.2 ml (may omit heparin and clamping for Groshong.

    Removal

    Remove tape and dressing.
    Remove PICC by grasping at exit site and pulling 4 to 5 inches, then releasing catheter. Repeat until completely removed. If resistance is met, do not continue. Redress and notify IV team for removal. Warm moist heat may be used to overcome venous spasm.
    Examine catheter length and tip to assure catheter was removed intact.
    NOTE: Measure catheter and compare length with insertion notes and/or manufacturer patient booklet.
    Apply pressure until bleeding stops.


    --------------------------------------------------------------------------------


    I have successfully:

    Accessed PICCs
    Capped PICCs
    Flushed PICCs
    Changed the dressing of PICCs
    Drawn blood
    Removed PICCs
    Staff Nurse Signature:
    Have nurse sign here


    The above staff nurse has demonstrated proper technique in:

    Accessing PICCs
    Capping PICCs
    Flushing PICCs
    Changing the dressing of PICCs
    Drawing blood
    Removed PICCs


    i could not get the link..so check this out....is this what you need
  7. by   lpnga
    if this isn't it then go to keyword search and type in what you need and hopefully you will get what you need...good luck
  8. by   RNonsense
    Ummm...I don't think it was CVC's don was talking about...

    anyway, if an indwelling foley has been in for an extended period of time...our surgeons will order the foley out, and also order to clamp and release....
  9. by   RNonsense
    ...did the 747 go over my head???
  10. by   boggle
    hmmmm....not so sure RNonsense.

    lpnga, great info, wrong catheter site . but I'm keeping your info for reference for IV caths, thanks.

    I'm also looking for evidence based guidelines for the old clamp the foley for bladder training routine. There is a difference of opinion on the subject between the rehab docs and medical docs here too.

    I'll keep you posted ( no pun intended).
  11. by   boggle
    one more thing...

    DONRN, how about asking the moderators to move this to the General Nursing Discussion forum if you don't get the responses you need here? I think your thread would get more views there.
  12. by   lpnga
    your welcome...what should I have typed?...good luck finding what you need...
  13. by   kids
    Originally posted by lpnga
    your welcome...what should I have typed?...good luck finding what you need...
    Urinary catheter.

    Both the rehab Docs and the urologists in my area abandoned clamping foleys for bladder retraining a long time ago...the reason given was that it is not really effective and is more apt to cause a UTI
  14. by   disher
    Originally posted by kids-r-fun
    Urinary catheter.

    Both the rehab Docs and the urologists in my area abandoned clamping foleys for bladder retraining a long time ago...the reason given was that it is not really effective and is more apt to cause a UTI
    Ditto .... physiatrists and urologists in my area would agree clamping foleys for bladder training went out of practice decades ago.
    Bladder retraining success really depends on bladder function. Before considering bladder training the patient would benefit from urodynamics testing and a cysto, if following testing the urologist thinks retraining is feasible. Remove the indwelling catheter, measure patient's voided volume, check post void residual by intermittent catheterization, if patient has not voided 4-hours after removing indwelling, do an intermittent catheterizations q4-6hr prn
    The goal in bladder training is for patient to void volumes of 300-400mls every 4hours and have post void residuals of <100mls.
  15. by   gwenith
    Hi disher - good response but we tend to use a bladder scanner to test for residual volumes.

    Re clamping IDC's

    I have been clamping catheters for years to stop the "catheter related urgency" problem that often comes up you KNOW the one -
    "Iwant to do a wee"
    "You have a catheter"
    "I wnat to do a wee"
    "You have a CATHeter it drains it for you"
    "Iwant to do a wee"
    and so on.

    I clamp but only to fill the bladder to 50 - 100 mls (about 1/2 - 1 hour) This is no more than would happen if the catheter airlocked and didn't drain for a short while. It reinflates the bladder away from the catheter tip and stops the urgency. I usually only have to do this once, occasionally twice but after that the urgency settles and even agitated confused patients settle.

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