Download Urinary Incontinence in Adults

Urinary Incontinence in Adults
Urinary Incontinence Care Pathway
Patients with urinary incontinence may seek help from General Practitioner, Continence Advisor,
Specialist Physiotherapist or Community Nurse (District Nurse, Practice Nurse or Health visitor).
Adult Female
Initial Assessment
Clinical history
Urinalysis
Symptomatic 3rd degree pelvic organ prolapse
Palpable bladder post void
Microscopic haematuria if aged 50 years and older (Two week referral)
Visible haematuria (Two week referral)
Recurrent or persisting UTI associated with haematuria if aged 40 years and older (Two week referral)
Suspected pelvic mass (Two week referral)
Refer to appropriate
service as per
Referral Pathway
Yes
No
Refer to secondary care
Bladder/continence Diary
Quality of life score
Physical examination
Measure post void residual urine if voiding dysfunction/recurrent UTI
Lifestyle Interventions
 Modify high/low fluid
intake
 Lose weight if BMI
above 30
Treatment




Consider
referral
Consider
catheterisation
Bowel Function
Score using Bristol Stool scale
Advise re constipation and diet
Symptoms
Stress Incontinence

Pelvic floor muscle
training - at least 3
months

Digitally assess pelvic
floor muscle
contraction



Mixed Stress and Urge

Treat according to most
dominant symptom
Urge Incontinence


Caffeine reduction
Bladder re-training – at
least 6 weeks
Consider
anticholinergic
medication see below
Treat post menopausal
vaginal atrophy
Prompted/timed
toileting


Consider Duloxetine –
only as an alternative
to surgical
intervention
Containment/appliances
Consider referral to specialist
service/ secondary care

Treatment Success
No
Yes


Continue/complete
treatment
Maintain/Review
The information contained in the Formulary is based on evidence available at the time of writing; it is issued for guidance
and advice only. For information on the cautions, contra-indications, side effects and doses of individual drugs, please
check the current SPC or BNF section for that drug. Prescribers remain responsible for their patients’ care and
prescriptions signed. Version 4 February 2012
1
Adult Male
Initial Assessment
Clinical History
Urinalysis
Digital Rectal Examination
Prostate-specific antigen
Symptom score Assessment (IPSS)
Estimate Flow rate
No
Refer to appropriate
service as per
Referral Pathway
Abnormality
Yes
Bladder/continence Diary
Quality of life score
Measure post void residual
urine/recurrent UTI
Lifestyle Interventions
 Modify high/low fluid
intake
 Lose weight if BMI
above 30
Consider referral to Secondary
Care (Urology)
and/or
Pharmacological interventions
Consider catheter
Treatment


Bowel Function
Score using Bristol Stool
scale
Advise re constipation and
diet
Storage Problems
Post Micturition
Symptoms
Urgency
Frequency
Urgency incontinence
Nocturia
Dribbling


Pelvic Floor Exercises
Bulbar urethral massage




Bladder retraining
Review caffeine intake
Consider anticholinergic
medication
Prompted/timed toileting
Voiding Difficulty
Weak or intermittent urinary stream,
Straining
Hesitancy
Terminal dribbling
Incomplete emptying
Treatment Success


Containment/applia
nces
Consider referral to
specialist service/
secondary care
No
Yes


Continue/complete
treatment
Maintain/Review
The information contained in the Formulary is based on evidence available at the time of writing; it is issued for guidance
and advice only. For information on the cautions, contra-indications, side effects and doses of individual drugs, please
check the current SPC or BNF section for that drug. Prescribers remain responsible for their patients’ care and
prescriptions signed. Version 4 February 2012
2
DRUG CHOICE
First Line Antimuscarinics
NICE-There is no evidence of a clinically important difference in efficacy between
antimuscarinic drugs. However, immediate release non-proprietary oxybutynin is the most cost
effective of the available options.
Drug
Oxubutynin
Hydrochloride plain
tabs
Licensed in urinary
frequency, urgency and
urge incontinence,
neurogenic bladder
instability and nocturnal
enuresis associated with
overactive bladder
Tolterodine tartrate
Licensed in urinary
frequency, urgency and
urge incontinence
Dose
Over 12 years of age5mg two to three times a
day-max 5mg four times
a day
Elderly-2.5 to 3mg twice
daily increasing to 5mg
twice daily
Adults over 18 years 2mg twice daily reducing
to 1mg twice daily if
required to reduce side
effects
Comments
 6-week trial to enable
assessment of the benefits
and side effects
 Titrate dose to combat
adverse effects
 Review treatment after 3-6
months to confirm continued
need



6-week trial to enable
assessment of the benefits
and side effects
Titrate dose to combat
adverse effects
Review treatment after 3-6
months to confirm continued
need

Second Line Antimuscarinics
Drug
Dose
Comments
Detrunorm tablet
(propiverine
hydrochloride) 15 mg
Overactive bladder, adult
over 18 years, 15 mg 1–2
times daily, increased if
necessary to max. 15 mg 3
times daily
Neurogenic bladder
instability, adult over 18
years, 15 mg 3 times daily

Use with caution in hepatic and
renal impairment.
Trospium Chloride
Adults and child over 12
years of age:
20 mgs twice daily.

6-week trial to enable assessment
of the benefits and side effects
Titrate dose to combat adverse
effects

Review treatment after 3-6 months to
confirm continued need
Contraindications-antimuscarinic drugs-should be avoided in patients with myasthenia
gravis, significant bladder outflow obstruction or urinary retention, severe ulcerative colitis, toxic
megacolon, and in gastro-intestinal obstruction or intestinal atony.
The information contained in the Formulary is based on evidence available at the time of writing; it is issued for guidance
and advice only. For information on the cautions, contra-indications, side effects and doses of individual drugs, please
check the current SPC or BNF section for that drug. Prescribers remain responsible for their patients’ care and
prescriptions signed. Version 4 February 2012
3
Side-effects- antimuscarinic drugs include dry mouth, gastro-intestinal disturbances
including constipation, flatulence, taste disturbances, blurred vision, dry eyes, drowsiness,
dizziness, fatigue, difficulty in micturition (less commonly urinary retention), palpitation, and skin
reactions (including dry skin, rash, and photosensitivity); also headache, diarrhoea,
angioedema, arrhythmias, and tachycardia. Central nervous system stimulation, such as
restlessness, disorientation, hallucination, and convulsion may occur; children are at higher risk
of these effects. Antimuscarinic drugs can reduce sweating, leading to heat sensations and
fainting in hot environments or in patients with fever, and very rarely may precipitate angleclosure glaucoma.
Additional contraindications for individual products
Oxybutinin-should also be
Tolterodine-should be
avoided in breastfeeding
avoided in patients with a
prolonged QT interval and
with other drugs that
prolongs QT interval
Slow release preparations-May be appropriate for patients that have tried standard
release products and have either experienced side effects or have compliance
problems. The need for continuing antimuscarinic drug therapy should be reviewed
every 4-6 weeks until the symptoms stabilise and then every 6-12 months.
Drug
Dose
Comments
Fesoterodine tablets
(4 mgs and 8 mgs)
4mgs once daily, increased if
necessary to 8 mgs once daily.
Solifenacin (5 mgs
and 10 mgs)
Darifenacin
5 mgs once daily, and increased if
necessary to 10mgs once daily.
7.5mgs once a day
Trospium chloride XL
(60 mgs)
Oxybutynin
transdermal
preparation
3.9 mgs/24 hours
36 mgs patch
Adult over 18 years, 60 mgs once
daily.
Adult over 18 years of age. Use one
patch twice weekly to clean, dry
unbroken skin on the abdomen, hip or
buttock. Remove after every 3-4 days
and site replacement patch on a
different area (avoid using same area
for 7 days.
Detrunorm XL
(Propiverine) 30 mgs
Adult over 18 years, urinary
frequency, urgency, and incontinence,
30 mg XL once daily
use with caution in hepatic
and renal impairment and with
concomitant cytochrome p450
inducing drugs.
max. 7.5 mg daily in moderate
hepatic impairment; avoid in
severe hepatic impairment
Hepatic impairment avoid in
moderate to severe
impairment
Renal impairment
manfacturer advises caution in
mild or moderate impairment;
max. daily dose 30 mg if
eGFR less than 30
mL/minute/1.73 m2
Duloxetine (Yentreve™)
The information contained in the Formulary is based on evidence available at the time of writing; it is issued for guidance
and advice only. For information on the cautions, contra-indications, side effects and doses of individual drugs, please
check the current SPC or BNF section for that drug. Prescribers remain responsible for their patients’ care and
prescriptions signed. Version 4 February 2012
4
Drug
Duloxetine
hydrochloride
Dose
Adults over 18 years of
age-40mg twice daily
Licensed for moderate to
severe stress urinary
incontinence in women as
an alternative to surgery.
(Not recommended as
first line treatment)
(initially 20mg twice a
day can minimize side
effects)
Comments
 use in addition to pelvic floor
muscle exercises and alone
 assess for benefit and
tolerability after 2-4 weeks

nausea, vomiting, dyspepsia, constipation,
diarrhoea, abdominal pain, weight changes,
decreased appetite, flatulence, dry mouth;
palpitation, hot flush; insomnia, abnormal
dreams, paraesthesia, drowsiness, anxiety,
headache, dizziness, fatigue, weakness,
tremor, nervousness, anorexia; sexual
dysfunction; visual disturbances; sweating,
pruritus; less commonly gastritis, halitosis,
hepatitis, bruxism, dysphagia, tachycardia,
hypertension, postural hypotension, syncope,
raised cholesterol, vertigo, taste disturbance,
cold extremities, impaired temperature
regulation, impaired attention, movement
disorders, muscle twitching, musculoskeletal
pain, thirst, stomatitis, hypothyroidism, urinary
disorders, and photosensitivity; rarely mania;
very rarely angle-closure glaucoma; also
reported supraventricular arrhythmia, chest
pain, hallucinations, suicidal behaviour
Contraindications-Duloxetine should be avoided in patient with hepatic impairment,
renal impairment (<30ml/minute), pregnancy and breastfeeding. Caution with other
drugs that cause bleeding e.g. NSAIDS and other SSRI related antidepressants.
Selective β3 agonist
Dose
Mirabegron-License-urinary
frequency, urgency and urge incontinence
associated with overactive bladder
syndrome
Over 18
years-50mg
daily
Mirabegron is recommended as an option for treating
the symptoms of overactive bladder only for people in
whom antimuscarinic drugs are contraindicated or
clinically ineffective, or have unacceptable side effects.
NICE TA 290
Continence Products
Introduction
These guidelines have been developed by the Continence Service and the Medicines
Management Team to provide information about urological/continence products and
medicines that are used regularly and recommended based on best practice.
All products are listed in their generic groups.
All products (not medication) listed are included in the National Nurses Prescribing
Formulary.
Products have been selected according to their efficiency, efficacy and availability.
Current costs for each item can be obtained through the Drug Tariff.
Products not listed in these guidelines, but available for patient use, can still be
recommended or prescribed if the practitioners professional knowledge and expertise deems
the treatment appropriate.
Contents
Page No
The information contained in the Formulary is based on evidence available at the time of writing; it is issued for guidance
and advice only. For information on the cautions, contra-indications, side effects and doses of individual drugs, please
check the current SPC or BNF section for that drug. Prescribers remain responsible for their patients’ care and
prescriptions signed. Version 4 February 2012
5
Indwelling Urinary catheters
Urinary catheter draining systems
Fixation/support/stands
Lubricants/Anaesthetic gel
Catheter maintenance solutions
Sheaths
Urinals/Appliances
Bowel care
Urethral/ Supra pubic
Intermittent
Leg bags
Night bags
Valves
Anal plug
Anal Irrigation
Skin Care
Barrier Cream
The information contained in the Formulary is based on evidence available at the time of writing; it is issued for guidance
and advice only. For information on the cautions, contra-indications, side effects and doses of individual drugs, please
check the current SPC or BNF section for that drug. Prescribers remain responsible for their patients’ care and
prescriptions signed. Version 4 February 2012
6
This information covers Adults only – for paediatric products please consult the Continence Service directly.
Indwelling Urinary Catheters – NEVER use female length catheters for a male patient. All of these products are licensed for
both urethral and supra-pubic use.
Type
Manufacturer &
Product
Size
Pack Size
Order Code
Supra-pubic use – MUST BE size 14ch or above and
standard length for routine use.
Long term
Pre-filled Hydrogel
coated Foley
catheter
Comments
Bard Biocath Aquamatic
- 10ml balloon
Female
Can be insitu for up to 12 weeks depending upon
individual patient need and assessment.
Has pre-filled balloon – sterile water.
12ch
14ch
1
1
D226812
D226814
12ch
14ch
16ch
18ch
1
1
1
1
D226412
D226414
D226416
D226418
Contains Latex
Standard (Male)
The information contained in the Formulary is based on evidence available at the time of writing; it is issued for guidance and advice only. For information on the cautions, contra-indications, side effects and
doses of individual drugs, please check the current SPC or BNF section for that drug. Prescribers remain responsible for their patients’ care and prescriptions signed. Version 4 February 2012
7
Hydrogel coated
Foley Catheter
Bard Biocath – 10ml
balloon
Female
Standard (Male)
100% silicone
12ch
14ch
1
1
D226912
D226914
12ch
14ch
16ch
18ch
1
1
1
1
D226512
D226514
D226516
D226518
Female
LINC medical
Open tip, integral 5-10ml
balloon (check individual
packaging)
Standard (Male)
Female
Contains Latex
Not pre-filled.
Coloplast
Folysil – 10ml balloon
Standard (Male)
All silicone Foley
Catheter
Can be insitu for up to 12 weeks depending upon
individual patient need and assessment.
Latex Free
12ch
14ch
16ch
18ch
1
1
1
1
AA7112
AA7114
AA7116
AA7118
12ch
14ch
1
1
AA7512
AA7514
Can be insitu for up to 12 weeks depending upon
individual patient need and assessment
All silicone catheters have a larger lumen
Can be insitu for up to 12 weeks depending upon
individual patient need and assessment
Integral balloon.
12ch
14ch
16ch
18ch
1
1
1
1
0845 12 05
0845 14 05
0845 16 10
0845 18 10
12ch
14ch
1
1
0847 12 05
0847 14 05
Effective in reducing problems experienced with
catheter removal in supra-pubic catheterization.
Open tip useful for improved drainage.
All silicone catheters have a larger lumen
Latex Free
The information contained in the Formulary is based on evidence available at the time of writing; it is issued for guidance and advice only. For information on the cautions, contra-indications, side effects and
doses of individual drugs, please check the current SPC or BNF section for that drug. Prescribers remain responsible for their patients’ care and prescriptions signed. Version 4 February 2012
8
Medium Term
Silver Foley catheter
Useful for patients with problems of repeated urinary
infections to attempt to reduce incidence. Will not
treat infection.
Bard Bardex, 10ml
balloon
Female
12ch
14ch
1
1
D236912S
D236914S
Standard (Male)
12ch
14ch
16ch
18ch
1
1
1
1
D236512S
D236514S
D236516S
D236518S
Can remain in situ for 4 weeks only.
Intermittent Urinary Catheters - should always be considered as first line for all patients who have been assessed to need
bladder drainage and are able/willing to undertake the procedure
Type
Nelaton
Manufacturer &
Product
Astra
Lofric Primo
Size
Male
10ch
12ch
14ch
16ch
18ch
30
30
30
30
30
960 10 00
960 12 00
960 14 00
960 16 00
960 18 00
8ch
10ch
12ch
14ch
30
30
30
30
968 08 00
968 10 00
968 12 00
968 14 00
8ch
10ch
30
30
416 08 25
416 10 25
Female
Lofric Sense
Pack Size
Order Code
Comments
.
Ready to use catheters. Water sachet in packaging.
Single use.
Foldable
Use depends on individual patient – 1-6 per day
PVC Free ready to use catheter, saline solution in
packaging
The information contained in the Formulary is based on evidence available at the time of writing; it is issued for guidance and advice only. For information on the cautions, contra-indications, side effects and
doses of individual drugs, please check the current SPC or BNF section for that drug. Prescribers remain responsible for their patients’ care and prescriptions signed. Version 4 February 2012
9
12ch
14ch
30
30
416 12 25
416 14 25
For Female ISC only 10cm tube
Discrete packaging, single use.
Hydrophilic coated
Coloplast
Speedicath
Ready to use catheters.
Single use
Male
10ch
12ch
14ch
16ch
18ch
30
30
30
30
30
28410
28412
28414
28416
28418
8ch
10ch
12ch
14ch
30
30
30
30
28508
28510
28512
28514
8ch
10ch
12ch
14ch
30
30
30
30
28578
28580
28582
28584
Ready to use catheters.
Female
Compact
Single use
Compact is for female use only.
Discreet.
Single use.
Use depends on individual patient – 1-6 per day
Hollister
Vapro
Ready to use catheter with protective tip
Single use
Male
10ch
12ch
14ch
30
30
30
72104
72124
72144
Female
10ch
12ch
14ch
30
30
30
72102
72122
72142
The information contained in the Formulary is based on evidence available at the time of writing; it is issued for guidance and advice only. For information on the cautions, contra-indications, side effects and
doses of individual drugs, please check the current SPC or BNF section for that drug. Prescribers remain responsible for their patients’ care and prescriptions signed. Version 4 February 2012
10
B Braun
Actreen lite
Ready to use catheter
Single use
With drainage bag
Male
10ch
12ch
14ch
16ch
18ch
30
30
30
30
30
228210E
228212E
228214E
228216E
228218E
Female
8ch
10ch
12ch
14ch
30
30
30
30
22838E
228310E
228312E
228314E
Ready to use catheter with drainage bag attached
B Braun
Actreen Glys Set
Male
Female
Astra Tech
Single use
10ch
12ch
14ch
16ch
18ch
30
30
30
30
30
226210E
226212E
226214E
226216E
226218E
8ch
10ch
12ch
14ch
30
30
30
30
22638E
226310E
226212E
226214E
Ready to use catheter with water sachet and
drainage bag attached.
The information contained in the Formulary is based on evidence available at the time of writing; it is issued for guidance and advice only. For information on the cautions, contra-indications, side effects and
doses of individual drugs, please check the current SPC or BNF section for that drug. Prescribers remain responsible for their patients’ care and prescriptions signed. Version 4 February 2012
11
LoFric Hydro-kit II
Male
Female
Single use
10ch
12ch
14ch
16ch
20
20
20
20
983 10 00
983 12 00
983 14 00
983 16 00
Catheter length 40cm
8ch
10ch
12ch
14ch
20
20
20
20
985 08 00
985 10 00
985 12 00
985 14 00
Catheter length 20cm
Urinary Catheters Draining Systems-Leg bags - All patients with an indwelling urethral catheter, who are ambulant and require
a drainage system, should use an appropriate leg drainage bag.
Type
Manufacturer &
Product
Uno medical
Care Line
Size
Pack Size
Order
Code
Comments
500ml short tube
500ml long tube
750ml short tube
750ml long tube
10
10
10
10
46-05SVC
46-06LVC
46-09SVC
46-10LVC
Leg bags can stay insitu for 5-7 days.
It is best practice to leave them insitu for the
maximum duration if possible to reduce risk
of infection, however if disconnected for any
reason, i.e. to instill catheter solution a new
bag MUST be used as they are a SINGLE
USE PRODUCT.
STERILE
‘Click close’ tap
Anti-kink tubing
Needle free sample
port
Coloplast - Simpla
Profile
350 ml, 6cm tube
350ml, 25cm tube
500ml, 6cm tube
500ml, 25cm tube
750ml, 6cm tube
750ml, 35cm tube
10
10
10
10
10
10
21563
21564
21573
21574
21593
21594
Leg bags can stay insitu for 5-7 days.
It is best practice to leave them insitu for the
maximum duration if possible to reduce risk
of infection, however if disconnected for any
reason, i.e. to instill catheter solution a new
bag MUST be used as they are a SINGLE
USE PRODUCT.
NON-STERILE(for
use with Sheaths
Coloplast - Simpla
Profile
500ml, 50cm tube
10
21584
Adjustable tubing for individual patient need
STERILE
With Lever Tap
Needle free sample
port
The information contained in the Formulary is based on evidence available at the time of writing; it is issued for guidance and advice only. For information on the cautions, contra-indications, side effects and
doses of individual drugs, please check the current SPC or BNF section for that drug. Prescribers remain responsible for their patients’ care and prescriptions signed. Version 4 February 2012
12
only)
Specialist
Coloplast – Simpla Plus
Knee Bag
1500ml, 25cm tube
10
21577
A sterile bag for those with limited
movements or using a wheelchair.
A urine storage bag that's worn at the waist
Can be used with both supra pubic and
urethral catheters.
Latex free
Teleflex - Belly Bag
Abdominal Urine Bag
1000ml.
2
B1000
Abdominal Urine Bag
with sample port
1000ml
2
B1000P
Abdominal Urine Bag
with extended drain tube
1000ml
2
B1000CT
2
P0337
Replacement Belt
Urinary Catheters Draining Systems-Night Bags
Type
Non drainable
Drainable
Manufacturer &
Product
Uno medical – Easy MT
Size
Pack Size
Order Code
Comments
2000ml
10
47-60-LBH
ProSys
Coloplast – Simpla
Profile Night Bag
2000ml
10
PSU2
Non sterile, single use, no return valve with twist off
outlet
Non sterile, single use drainable bag with tap outlet
2000ml,
120cm
tube
10
21578
Sterile bag with anti-kink tubing, click close lever tap
and needle free sample port
NOT FOR ROUTINE USE – suitable for bed bound
patients only
The information contained in the Formulary is based on evidence available at the time of writing; it is issued for guidance and advice only. For information on the cautions, contra-indications, side effects and
doses of individual drugs, please check the current SPC or BNF section for that drug. Prescribers remain responsible for their patients’ care and prescriptions signed. Version 4 February 2012
13
Urinary Catheters Draining Systems-Valves Catheter drainage valves should always be considered as first line choice when
commencing indwelling urinary catheterisation for patients who have been assessed as suitable (See Urinary Protocol CP074)
Type
Manufacturer &
Product
Size
Pack Size
Order Code
Comments
Coloplast - Simpla
-
5
380851
Sterile - For use with indwelling catheters.
5-7 days
Bard - Flip-flo
-
5
BFF5
Lever tap
5-7 days
Catheter valve
Fixation /Supports/Stands- all patients with an indwelling urinary catheter MUST have a support system to reduce risk of trauma
Type
Catheter retaining
strap
Manufacturer &
Product
Coloplast
G strap
Size
Pack
Size
Order
Code
Comments
Short (40cm)
Adult (50cm)
Abdominal (90cm)
5
5
5
383002
383001
383003
These can be cut to size.
Bard
Comfasure Retainer
Strap
Adult
Small
Abdominal
5
5
5
AD3403
SM3404
AB3405
Bard
Statlock - Foley
Foam Anchor pad for silicone
catheters
Foam Anchor pad for latex
catheters
Tricot Anchor pad for silicone
catheters
25
FOL0100
25
FOL0101
25
FOL0102
Re-usable
Strap free catheter stabilization
device.
Adhesive pad applied to the user’s
thigh or abdomen.
Sterile and latex free
Alcohol soluble adhesive
The information contained in the Formulary is based on evidence available at the time of writing; it is issued for guidance and advice only. For information on the cautions, contra-indications, side effects and
doses of individual drugs, please check the current SPC or BNF section for that drug. Prescribers remain responsible for their patients’ care and prescriptions signed. Version 4 February 2012
14
Tricot Anchor pad for latex
catheters
25
FOL0103
Leg bag straps
Holister
Deluxe straps
Ex Small (35cm)
Small (38cm)
Medium (49cm)
Large (56cm)
2
2
2
2
9663
9660
9661
9662
Useful for improved support and
comfort for use with leg bags.
Sleeves
Coloplast
Aquasleeve
Small (24-33cm)
Standard (34-39cm)
Medium (40-46cm)
Large (47-64cm)
Extra Large (65cm plus)
4
4
4
4
4
783678
783680
783686
783694
783708
Comfortable alternative to leg straps
Washable and re-usable
Bard
Urisleeve
Small (24-39cm)
Medium (36-55cm)
Large (40-70cm)
4
4
4
150111
150121
150131
Floor stand for bed/night
bags.
Not a prescription item, but
can be obtained from all
companies on request.
-
-
Stands
Support for 2 litre night bags.
Best practice to reduced risk of
infection.
Lubricants/Anaesthetic Gel
Type
Manufacturer &
Product
Size
Pack Size
Order Code
Comments
Anaesthetic gel
Instillagel
11mls
10
40-011
Male use
For urethral use when inserting a catheter
Caution in patients with cardiac problems or
sensitivity to any of the ingredients
Instillagel
6mls
10
40-006
Female/supra pubic use
The information contained in the Formulary is based on evidence available at the time of writing; it is issued for guidance and advice only. For information on the cautions, contra-indications, side effects and
doses of individual drugs, please check the current SPC or BNF section for that drug. Prescribers remain responsible for their patients’ care and prescriptions signed. Version 4 February 2012
15
Cathejell with Lidocaine
8.5ml
25
CJL08525
Caution in patients with cardiac problems or
sensitivity to any of the ingredients
Female use
Cathejell with Lidocaine
12.5ml
25
CLJ12525
Caution in patients with cardiac problems or
sensitivity to any of the ingredients
Male use
Lubricant only
Cathejell Mono
8.5ml
25
CJM08525
Cathejell Mono
12.5ml
25
CJM12525
Caution in patients with cardiac problems or
sensitivity to any of the ingredients
Water soluble lubricant can be used in patients where
use of lidocaine is contra-indicated
Catheter Maintenance Solutions- Best practice guidelines and current research suggests to be used only as part of individual
patient assessment. (See Catheter Protocol CP074)
Type
Normal saline
Manufacturer &
Product
B Braun
Sodium Chloride
Bard
Optiflo S
Size
Pack Size
Order Code
50ml
FB99849
50ml
CSS50
Comments
Not effective against encrustation.
Used to flush out debris/mucus – purely mechanical
action only.
Use under gravity instillation
Use with gentle agitation technique
3.23% citric acid solution
Solution G
B Braun
Suby G
Bard
Optiflo G
2x30ml
9746609
Used under gravity instillation. Maximum dose, twice
daily
Twin pack for double instillation.
50ml
CSG50
Use with gentle agitation technique.
Need two per installation for two sequential
procedure.
The information contained in the Formulary is based on evidence available at the time of writing; it is issued for guidance and advice only. For information on the cautions, contra-indications, side effects and
doses of individual drugs, please check the current SPC or BNF section for that drug. Prescribers remain responsible for their patients’ care and prescriptions signed. Version 4 February 2012
16
Solution R
6% citric acid solution
B Braun
Solution R
2x30ml
Bard
Optiflo R
50ml
9746625
Used under gravity instillation. Maximum dose, twice
daily
Twin pack for double instillation
CSR50
Use with gentle agitation technique
Need two per installation for two sequential
procedure.
Sheaths – all patients MUST be measured with the correct measuring guide prior to prescription and use.
Type
Silicone Self
Adhesive sheath
Silicone Self
Adhesive Sheath
Manufacturer &
Product
Coloplast
Optima
Rochester Medical
Clear Advantage with
Aloe
Size
Pack Size
Order Code
Comments
Standard
25mm
30mm
35mm
40mm
30
30
30
30
22025
22030
22035
22040
Anti-kink design 80mm length
Short
21mm
25mm
30mm
35mm
30
30
30
30
22121
22125
22130
22135
Anti-kink design 50 mm lengths – useful for penile
retraction.
Standard
24mm
28mm
32mm
36mm
40mm
30
30
30
30
30
1243
1283
1323
1363
1403
The information contained in the Formulary is based on evidence available at the time of writing; it is issued for guidance and advice only. For information on the cautions, contra-indications, side effects and
doses of individual drugs, please check the current SPC or BNF section for that drug. Prescribers remain responsible for their patients’ care and prescriptions signed. Version 4 February 2012
17
Short
28mm
32mm
36mm
40mm
Wide
Band
24mm
28mm
32mm
36mm
40mm
Useful for those with retraction.
30
30
30
30
2283
2323
2363
2403
Wider adhesive band for extra security
30
30
30
30
30
3243
3283
3323
3363
3403
Urinals/appliances – for more specialist products please contact the Continence Service for assessment/advice.
Type
Male urinals
Female urinals
Manufacturer &
Product
Beambridge
Male drainage jug
Manfred Sauer
Uribag
Beambridge
Bridge urinal
Size
Pack
Size
Order
Code
Comments
-
1
6-50T
With tap to attach to drainage bag
Washable with soap and water – re-usable.
-
1
URIbag
Discreet pocket sized.
Washable with soap and water – reusable.
-
Manfred Sauer
Uribag
Male funnels
Beambridge
Large – 220mmx48mm
1
6-18T
With tap to attach to drainage bag
Washable with soap and water – reusable
1
URIbagF
Discreet pocket sized
Washable with soap and water – reusable
1
6-35
Can be used as a urine director over the toilet
The information contained in the Formulary is based on evidence available at the time of writing; it is issued for guidance and advice only. For information on the cautions, contra-indications, side effects and
doses of individual drugs, please check the current SPC or BNF section for that drug. Prescribers remain responsible for their patients’ care and prescriptions signed. Version 4 February 2012
18
Urinal drainage bags
– non sterile
Bowel Care
Type
Anal plug
Anal irrigation
Funnel
Adult short -150mmx40mm
Mini – 100mmx28mm
1
1
6-37
6-35m
or with a drainage bag.
Washable with soap and water – reusable
Beambridge
2 litre
10
6-55
Can be used with male and female appliance
that have an open end, i.e. funnel, or tap
connection.
Used for 5-7 days.
Manufacturer &
Product
Coloplast
Size
Pack Size
Order
Code
Comments
Small 35mm
20
1450
Used to manage faecal incontinence
Large 45mm
20
1451
-
System
29121
1 control unit, 2 rectal catheters, 1 water bag, 1 set
of straps, and 1 toilet bag.
Accessory unit
29122
15 rectal catheters, 1 water bag
Rectal catheter
29123
10 rectal catheters
Strap
29124
1 set of straps
Tube
29125
2 tubes with blue connectors
Coloplast
Peristeen
It is advised that this product is used with specialist
support only. It can aid management of faecal
incontinence, constipation or bowel management
programs.
Skin care – incontinence
The information contained in the Formulary is based on evidence available at the time of writing; it is issued for guidance and advice only. For information on the cautions, contra-indications, side effects and
doses of individual drugs, please check the current SPC or BNF section for that drug. Prescribers remain responsible for their patients’ care and prescriptions signed. Version 4 February 2012
19
Type
Manufacturer &
Product
Water based
3M
Cavilon Durable barrier
cream
Size
Pack Size
Order
Code
92 g
1 tube
3392E
2g sachet
20 per box
3392S
Comments
A barrier cream for use against irritation from bodily
fluids.
Prevents skin damage associated with
incontinence
Water based products DO NOT ‘clog’ continence
products, thus optimize their use and improve
effectiveness.
References
1. Scottish Intercollegiate Guidelines Network. Management or urinary incontinence in primary care. (Guideline 79) Accessed from
http://www.sign.ac.uk/pdf/sign79.pdf on 19.01.09
2. The National Institute for Health and Clinical Excellence. Urinary Incontinence-The management of urinary incontinence in women. (Clinical Guideline 40)
Accessed from http://www.nice.org.uk/Guidance/CG40/NiceGuidance/pdf/English on 19.01.09
3. The British National Formulary March 2008 No 56. BMJ and RPS Publishing Accessed from http://www.bnf.org/bnf/bnf/current/104945.htm on 19.1.09
4. ACA
5. RCN
6. LUTS guidelines – consultation document
The information contained in the Formulary is based on evidence available at the time of writing; it is issued for guidance and advice only. For information on the cautions, contra-indications, side effects and
doses of individual drugs, please check the current SPC or BNF section for that drug. Prescribers remain responsible for their patients’ care and prescriptions signed. Version 4 February 2012
20