How does the urinary system work?

The urinary system consists of the kidneys, bladder, the ureters and the urethra. The kidney filters the bloods to remove waste products and form urine. The urine flows from the kidneys, down through the ureters to the bladder. From there it passes through another tube called the urethral to the outside when urinating (peeing/weeing).

Why does my child need a urethral catheter?

You child’s consultant will explain the reasons why your child needs urinary catheter. Some of the possible reasons include:

• To allow urine to drain if your child has a blockage or narrowing in their urethral e.g. Posterior Urethral valve (PUV).
• To allow your child to empty their bladder if they are unwell and unable to use the toilet
• To allow your child to empty their bladder if there is nerve damage which is affecting their ability to urinate
• To drain your child’s bladder after some types of surgery e.g. spinal surgery, orthopaedic surgery or have epidural insitu
• To administer medication into your child bladder e.g. urodynamic with contrast
• To monito how much urine your child is making
• To provide information about your child urinary system.

How is urinary catheter inserted?

Sometimes a catheter is inserted whilst your child is having an operation (when they are sleeping).

However, urinary catheters are usually inserted whilst a child is awake. If they are old enough (usually over age of 5 years), Entonox can be used for any discomfort they may feel during the procedure or for anxieties. Entonox is a gas made of oxygen and nitrous oxide that is used for pain relief. Entonox works very quickly and it can help your child to relax, which help reduce your child anxiety about having catheter. You child consultant and urology CNS will assess whether Entonox is a suitable option for you child.

For little baby sucrose can be given. Oral sucrose is a mild analgesic which is effective in decreasing short-term pain and distress during minor procedures. Small amounts of sweet solutions (oral sucrose) are placed on the infant’s tongue to reduce procedural pain. Oral sucrose administration is clinically indicated for the reduction of procedural pain and distress in infants 0-18 months.

Sometimes it is also helpful for the child to have distraction from the hospital play specialist. In some circumstances, light sedation may be used. Your child consultant and urology CNS will discuss which option is most appropriate for your child. If child is awake during the procedure, you will be allowed to stay with them. Once the catheter is inserted it should not be hurting.

How is urinary catheter removed?

The catheter is held in place by a balloon filled with water. You consultant or the urology CNS will decide when the catheter should be removed. A syringe is attached to the balloon port at the end of the catheter. The water is removed using the syringe. Your child’s consultant, ward doctors (RMO) or nurse will then gently pull the catheter out. Sometimes a child may complain of some discomfort during catheter removal and when they first pass urine. This should settle and it helps if they drink plenty of water. If they continue to complain of discomfort or have any symptoms of urinary tract infection, you should seek medical advice.

You should not attempt to remove the catheter yourself.

Equipment:

The drain system consists of catheter (thin, plastic tube). Catheters come in different sizes and your child consultant or urology CNS will make sure right catheter size is used. Catheter can be drain in two ways, either into double nappy (for little small children) where the catheter passed through the first nappy and drains into the second nappy and this is to ensure the catheter site is kept clean or using urine bag to collect. You will also need some types and possible new collection bags. The hospital will supply you everything you need before you get discharged.

What are the risks of my child having urinary catheter?

Urinary tract infection (UTI)

All children who have a catheter in place will have a small amount of bacteria in their urine. Antibiotic treatment is only prescribed if your child becomes unwell with symptoms of urinary tract infection.

Symptoms of urinary tract infection include:

• Offensive smelling urine.
• Cloudy urine.
• Lethargy (tiredness).
• Nausea (feeling sick).
• Loss of appetite.
• High temperature

If you child has any of above symptoms it is important to speak with your consultant or the urology CNS as soon as possible. A sample of urine must be taken before antibiotic treatment is started. Encourage your child to drink lots of fluid can prevent urinary tract infection, by reducing the amount of bacteria in the urine. Good hygiene, including through hand washing before touching the catheter is also important. If you child is using a catheter drainage bag this should be change every five to seven days according to the manufacturers guidelines.

Urinary catheter is always inserted on temporary basis. It will be removed as soon as possible to void risk of infection.

• Bladder spasms:

Catheters may irritate the bladder and this may cause spasms. Your child may complain of cramping pains in their tummy or pain in their bottom. They may also complain of the need to pass urine. Medication can be given to help these spasms e.g. oxybutynin. Please inform your child’s consultant or nurse if you think your child is having bladder spasms. It is also important to check that the catheter is in the correct position. Spasms can occur when the catheter is too far into the bladder.

• If the catheter falls out:

If your child’s catheter falls out please seek medical advice soon as possible, as it may need replacing.

Activity restrictions:

Your child should not do any strenuous activity whilst they have a urinary catheter in. They can walk short distances but otherwise they should use a wheelchair. They should not sit in a straddle position.

• Blockage of the catheter:

Your child’s catheter should drain a small amount of urine continuously. If the catheter stops draining it may be blocked. You should always ensure that the catheter is not allowed to kink or twist. If your child uses a catheter drainage bag this should always be at a position that is below bladder level. Please encourage your child to drink plenty of fluids. If your child’s consultant/urology CNS thinks there is a high risk of the catheter blocking, you will be shown how to flush the catheter. This helps to keep the urine draining and reduces the risk of an infection developing. If the catheter needs to stay in for longer than three months it will need to be changed.

If you’re worried that your child’s catheter is blocked please seek medical advice as soon as possible.

Caring for your urinary catheter at home:

Before your child is discharges you will be supplied with enough equipment to last for a week. If the catheter needs to stay more than a week the urology CNS will arrange either equipment to be delivery via your GP or you will come to the hospital for further equipment.

Equipment needed for catheter care at home includes:

• Tape to secure the catheter
• Urine bags/double nappies
• Flip flow valve
• Alcohol pads
• Gauze
• Saline (sterilise salt water) if the catheter flush required (always call the hospital before doing that specially with babies if you haven’t been trained to do by urology CNS)
• Catheter stand
• 60msl syringe with catheter tip (if catheter flushing is required )

Important points to remember:

• Keep the catheter taped securely to your child’s leg so it does not get accidently pulled, kinked or twisted. The tape should be replaced if it becomes loose or dirty. Your child’s nurse will show you how to do this.
• Keep the catheter as straight as possible to prevent kinking and blockage of catheter.
• The catheter drainage bag should be kept below waist level (to encourage drainage) and off the floor (to prevent infection and catheter being accidently being pulled out). Leg bags, which can be secured to leg beneath trousers or skirt, can help.
• Always wash your hands with soap and water and dry them well before and after emptying or changing your child’s catheter bag.
• When emptying the catheter bag try to make sure that the drainage tap does not come into contact with the toilet or any other surface. Always clean the tap with an alcohol pad before and after emptying the catheter drainage bag.
• The drainage bag should only be disconnected from the catheter when absolutely necessary to reduce the risk of introducing infection. It should be changed every five to seven days unless it is damaged then it should be changed immediately.
• It is important to observe for constipation whilst your child has a catheter in. Constipation can prevent the catheter draining well. It can also increase the risk of urinary tract infection and can cause leakage of urine around the catheter. Encouraging your child to eat a healthy balanced diet that includes fruit, vegetables and fibre can help prevent constipation. Sometimes laxatives may be prescribed to help prevent constipation. If your child is toilet trained they can have their bowels open on the toilet. If your child is constipated they may need to push hard. This may cause the catheter to leak (bypass). If you have any concerns please contact your child’s urology nurse. Please ensure your child’s bottom and catheter is cleaned after a bowel movement.

To empty the catheter bag:

• The bag should be emptied before it is three quarters full or at least four times per day, so you can observe that the catheter is draining. If the bag overfills the catheter will not drain.
• You will need: alcohol pads and a clean jug and/or access to a toilet.
• Wash your hands with liquid hand soap and dry on kitchen towel.
• Stand or sit your child near the toilet.

Clean the tap at the bottom of the drainage bag with alcohol pad.

• Open the tap at the bottom of the bag.
• Drain the urine from the bag into a toilet or clean jug (avoid the tap touching the jug or toilet to reduce the risk of infection).
• When the bag is empty close the tap.
• Clean the tap with an alcohol pad.
• If using a jug dispose of the contents down the toilet then rinse the jug in hot soapy water and allow drying.

Changing the drainage bag:

• You should do this once every five to seven days, or if the bag becomes disconnected or is damaged.

You will need:

1. New drainage bag (either two litre drainage bag or leg bag).
2. Alcohol pads.
3. Clean towel.

• Wash your hands with liquid soap and water then dry them on a clean towel or disposable paper towels.
• Prepare a clean surface by cleaning the area with an alcohol pad.
• Open the packet containing the new drainage bag and put it on a surface cleaned with an alcohol pad.
• If applicable, remove tape securing catheter to your child’s body.
• Put a clean towel under the catheter.
• Gently bend the catheter over to stop urine leaking.
• Gently twist the tube of the old drainage bag and remove from the catheter.
• Clean the end of the catheter with an alcohol pad.
• Remove the protective cap from the new drainage bag. Do not touch the sterile connector of the new bag.
• Attach the new drainage bag to the catheter.
• Ensure the drainage tap of the bag is closed.
• Straighten the catheter and re-secure.
• Empty the old drainage bag into the toilet. Then double wrap it in newspaper or plastic bag and dispose of in household waste.
• Wash and dry your hands

Attaching a night bag onto a leg bag:

At night you should attach a large nigh bag onto your child leg bag.

You will need:

1. Night drainage bag
2. Alcohol pads

• Wash your hands with liquid soap and water and dry them with kitchen towel
• Prepare a clean surface by cleaning the area with alcohol pad
• Open the packet contacting the night bag and put on surface cleaned with an alcohol pad
• Clean the tap of the leg with alcohol pad
• Remove the protective cap from the night bag without touching the sterile connector
• Attach the night bag to the leg bag tap
• Open the le bag tap to allow urine to drain from the leg bag into the night bag
• Ensure the tap is close on nigh bag
• Place the night bag on stand to help drainage
• Wash and dry and hands

Removing a night bag:

• In the morning you should remove the night bag.

1. You will need:
2. Alcohol pads

• Wash your hands with liquid soap and dry them with kitchen towel
• Close the leg bag tap.
• Disconnect the night bag tube from the leg bag.
• Clean the leg bag tap with an alcohol pad.
• Empty the night bag into the toilet. Double wrap in newspaper or plastic bag and dispose of it in household waste.
• Wash and dry hands

Cleaning around the catheter site

• Please clean around your child’s catheter site twice daily with a cloth and mild (non-fragranced) soap and water.
• Before your child showers or uses the bath empty the drainage bag, but leave it connected.

Do not use talc or creams (unless advised by your consultant or urology nurse) around the catheter entry site.

Flushing the catheter:

If your child’s urology nurse or doctor think the catheter may become blocked you will be shown how to flush your child’s catheter before discharge. You should flush the catheter if it is not draining or if it appears to be blocked. You should only flush regularly if you have been trained to do so by your child’s doctor or nurse.

You will need:

1. 60ml syringe with catheter tip.
2. Alcohol pads.
3. Saline (sterile salt water)
4. Gallipot
5. Clean towel.

• Wash your hands with liquid soap and dry on kitchen towel.
• Prepare a clean surface by cleaning the area with an alcohol pad
• Remove the gallipot from the package.
• Open the saline packet and empty it into the gallipot.
• Remove the syringe from the packet. Put the packet to one side.
• Use the syringe to draw up the saline. Your child’s nurse will advise you how much to use. It is usually between 10 and 20mls.
• Place the syringe back in the packet to keep it sterile (free from germs). Do not touch the tip of the syringe or let it touch anything else.
• Put a clean towel under the catheter.
• Remove the catheter drainage bag and clean the catheter with an alcohol pad.
• Connect the syringe to the end of the catheter.
• Gently push on the plunger of the syringe. This will insert the saline into the bladder.
• Continue until all the fluid is inserted then remove the syringe.
• Clean the end of the catheter with an alcohol pad and re-attached the drainage bag.
• If the saline won’t go in do not force it. Instead gently try to withdraw fluid from the catheter by pulling the plunger of the syringe with one hand. If there is any resistance stop.

If you can’t remove any fluid or urine from the catheter and the catheter is not draining into the bag contact your consultant or urology nurse as soon as possible.

Discharge information:

You should seek medical advice if:

• The catheter falls out.
• The catheter becomes blocked and you are unable to unblock the catheter with flushing. If the catheter is blocked no urine or very little urine is draining from the catheter even though your child is drinking and you have emptied their catheter bag.
• Urine leaking around catheter.
• Your child has symptoms of urine infection.
• Your child complains of stomach ache or their bladder feels full or painful.
• Your child has signs of an infection around the site including redness, swelling or discharge.

Please do not remove your child’s catheter under any circumstances.

Further appointment information:

Your child will be continue to have regular follow up with their urology consultant. If there are any problem in the meantime you may contact the urology CNS or our Paediatric Site Practitioners.

For further information please contact

We hope that you find this information helpful. If you have any questions or problems either before or after your child catheter insertion, please do not hesitate to contact, Clinical Nurse Specialist, Paediatric Urology on 020 7580 4400, 10838 (09:00 – 17:00 Monday to Friday) or email at: [email protected]

For Out of hours: Contact our Paediatric Site Practitioner via the switchboard on: 02075804400 ex 10843

Disclaimer Whilst this leaflet aims to provide you with useful information, it must be noted that it should only act as a guidance. Should you have any further concerns about this procedure, it is advisable that you discuss them with your Consultant.