Childs Indwelling catheter Download the PDF leaflet Caring for your child’s indwelling catheter. A guide for parents and carers Introduction This booklet is designed for parents/carers of a child going home with an indwelling catheter. Please use the booklet in conjunction with the instructions given to you by your child’s doctor or nurse. If you have questions or concerns that have not been addressed in this booklet please contact your child’s doctor or the nurse who initially taught you how to care for your child’s catheter. They will be pleased to answer your questions. There are so many different reasons why children require this form of catheterisation. Your doctor or nurse will explain to you the reason your child required an indwelling catheter. During the first few days with a catheter, your child may complain of discomfort or feel like they want to wee. This is perfectly normal and should resolve within a few days. If the discomfort continues you must contact your child’s nurse or doctor. What is a catheter? A catheter is a hollow flexible tube which helps drain urine/wee from your child’s bladder. To prevent it falling out, a small balloon at the catheter tip is inflated inside the bladder. The catheter usually enters the bladder through the urethra (the tube which leads from the bladder to the outside. However, some catheters enter the bladder through the tummy and this is called supra pubic catheterisation. This type of catheterisation will initially be carried out whilst your child is under anaesthetic. How is the urine collected from the catheter? Your child’s catheter will be attached either to a urine bag which can be worn next to your child’s leg, or a catheter valve which is small tap which fits to the end of the catheter and can be opened to empty the bladder. What is a urine catheter bag? There are two types of drainage bags: A leg bag and a night/bedside drainage bag. A leg bag can be worn under your child’s normal clothing during the day and a night/bed bag can be connected to a leg bag for overnight use. This is required when your child produces more urine than the leg bag could hold during the night. How to care for a leg bag? Your child’s leg bag can be secured to your child’s thigh or calf with a pair of soft, comfortable straps or a bag holder. When the bag is nearly full or becomes uncomfortable to wear you will need to empty it from the tap at the bottom of the bag. Guidelines for emptying the leg bagStep 1: Wash your hands thoroughly before touching the catheter or bag. Step 2 : Clean the tap at the bottom of the bag with an alcohol wipe, then open the tap and allow the urine to drain either into the toilet or a jug which you keep for this purpose. Step 3 : Close the tap and wipe it with a tissue to ensure that it is dry, before securing it back to your child’s leg. Step 4 : Wash your hands thoroughly once again, if you have used a jug to collect urine, wash it in hot soapy water and dry it thoroughly. What is a catheter valve? This is a small tap that fits onto the end of the catheter. This acts like a clamp and must be opened at regular intervals throughout the day, in order to drain your child’s bladder. You can either drain urine straight in to the toilet or into a jug which you keep for this purpose, following the above guidelines for emptying the leg bag. With a catheter valve you do not need a leg bag during the day. However this type of bladder management is not suitable for every child and your child’s doctor or nurse will be able to tell you if it is appropriate for your child. Almost all the children who use a catheter valve during the day will connect the valve to an overnight urine drainage bag. The valve needs to be changed every five to seven days. Guidelines on how to change your leg bag or catheter valve Step 1 : Wash your hands thoroughly. Step 2 : Clean around the catheter junction where it is connected to the leg bag/catheter valve with an alcohol wipe. Step 3: Disconnect the leg bag/catheter valve from the catheter. Step 4: Remove the protective cap from the new leg bag/catheter valve and insert it into the catheter. Step 5: Check urine flows freely. What is an overnight urine collection bag? This is a much larger bag which connects by along tube to the end of the leg bag or catheter valve and will not require emptying overnight. Guidelines on how to attach your night/bed bag Step 1: Wash your hands thoroughly Step 2: Clean the tap at the bottom of the leg bag/valve with an alcohol wipe and empty as previously described. Step 3: Remove the protective cap from the night/bed bag and insert into the end of the leg bag or catheter valve. Step 4: Open the tap on the leg bag or catheter valve and check that the urine flows freely into the night bag. Check that the night/bed urine drainage bag is lower than your child’s bladder, in order to allow urine to drain freely, and support the bag with a stand or hanger. In the morning disconnect the night.bed bag, empty the urine from the bag into the toilet and rinse the bag thoroughly then leave to dry. The same urine bag may be used five to seven days at home. How should I dispose of the drainage bags? Empty the bag out and wash it. Bags should be then wrapped in newspaper or a plastic bag and placed in the dustbin. Commonly asked questions and answers. Can my child have a bath?Yes-try to give your child a bath or shower every day. Wash around the catheter twice a day with warm soapy water. Do not use strong perfumed soaps, talc or creams on or around the catheter. How much should I give my child to drink?Try to encourage your child to drink about six to eight glasses a day. Cranberry juice may help prevent urine infections. If you would like more details about this ask your nurse or doctor. How much should I give my child to eat?Try to give your child plenty of fresh fruit, vegetables and cereals to provide sufficient fibre to avoid constipation. A full bowel can press on the catheter and stop urine flowing freely increasing the risk of infection. Can we still travel abroad? Yes. Always take enough supplies to last the whole of your holiday and a spare catheter, even if a catheter change isn’t due. Ask your family doctor (GP) to write a letter for you explaining that you are taking catheters and supplies with you. This may save time and confusion with custom officials. Always carry some supplies in your hand luggage just in case your luggage gets lost! And remember to check the small print on your travel insurance to make sure that it includes your child’s medical condition. What if it stops draining? a) Check if the catheter tubing is twisted or kinked.b) Check the catheter drainage bag is lower than the bladder.c) Are the bag and valve connected properly?d)Check your child’s clothing is not to tight and cutting off the flow of urine.e) has your child been drinking enough?f) is your child constipated? After two hours if your child still has not passed urine contact your nurse or doctor. Catheter maintenance/irrigationSometimes when your child’s catheter has stooped raining it may be necessary to flush the catheter with sterile saline. You will be given full instructions on how to do this by your child’s nurse. My child leaks from around the catheter.Check all of the above. Sometimes the balloon of the catheter rests on the sensitive part of the bladder. This can cause leakage and discomfort. Contact your nurse or doctor as your child may require medication to help this. Can my child develop a urinary tract infection? Yes, especially if they have experienced them before. It is important for you to recognise if your child has an infection:• Temperature • Be generally unwell• Have cloudy urine• Have strong smelling urine or blood in the urine• Sometimes children will also complain of backache Contact your GP or nurse if you suspect your child has an infection. Will my child need to have a catheter change? Yes usually every three months, but your nurse or doctor will inform you exactly when the catheter needs to be changed. Often parents/carers can be taught how to change the catheter. What happens if the catheter falls out? Contact your GP or nurse immediately. This is very important if your child has a supra pubic catheter as the tract (opening) where the catheter goes in can close in 20 minutes. Supplies Your child’s supply of catheters and preferred drainage systems are available on prescription and can be obtained from your GP or through a free of charge delivery system. Your nurse will discuss this with you. Getting your child’s first supplies can take up to two weeks. You will be given supplies to take home to see you through this period. Writen by Christine Rhodes, Paediatric Urology Department © January 2011. All rights reserved. Nottingham University Hospitals NHS Trust. Compiled by members of the More information about children and kidney problems atwww.emeesykidney.nhs.uk The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.