SA Community Care helps to support immediate hospital avoidance and SA Ambulance Service avoidance with community management of indwelling catheter (urethral) or suprapubic urinary catheter replacement. Services are delivered to eligible patients in their own homes, including residential aged care facilities.

The information below has been developed to assist General Practitioners, Residential Aged Care Facilities and other community health professionals to refer patients into the SA Community Care program who are at risk of a hospital presentation.

An urinary catheter replacement fact sheet (PDF 182KB) is also available.

Eligibility criteria

This SA Health hospital avoidance program can be accessed for patients who require a routine/regular catheter change only when there is not access to clinicians who can undertake this task on site or in GP clinic. The Metropolitan Referral Unit (MRU) will arrange a registered nurse to replace the catheter and work with you to explore long term solutions for this device management.

Is any specialised equipment required?

The patient or the care provider/organisation should ensure that a suitable replacement long term catheter and drainage bag is available. The MRU will arrange a clinician to replace the catheter. In instances where there are no alternatives, a device will be provided for immediate hospital avoidance.

Recommendations for catheter stock and management

Hydrogel coated indwelling catheters are recommended for long term use as these provide numerous benefits including urethral cushioning, improved comfort for the patient and may reduce infection.

Urinary catheters are available for purchase from medical/surgical suppliers. BARD is the current SA Health supplier of urinary catheters and the BARD Biocath® is the standard issue catheter within SA Health facilities. These catheters should be changed every 6 to 8 weeks, and as per manufacturer’s instructions can be left up to 12 weeks, but no longer than this.

Is it necessary to purchase specific supra-pubic catheters (SPC)?

Urinary catheters, including standard hydrogel coated catheters are generally suitable for both general urethral and supra-pubic catheterisation. Most patients do not require specialised supra- pubic catheters; however, these are available from medical/surgical suppliers.

How often should urinary catheters be changed?

Long term catheters should be changed on an individual need’s basis and not strictly by the time insitu. As per manufacturer’s instructions most can be left up to 12 weeks, but no longer than this.

Catheter change decisions should be based on an assessment that includes:

  • manufacturers recommendations
  • degree of catheter encrustation
  • frequency of blockage.

The longest duration a catheter remains indwelling should be based on the manufacturer’s recommendations for catheter change.

Good practices in catheter care and management

Equipment

Leg bags should be changed weekly. If the bag becomes damaged, is difficult to empty or becomes uncomfortable to wear it should be changed sooner. If the bed bag has a drainage tap, it can be re- used for up to a week. Wash thoroughly and allow it to dry. If the bed bag does not have a tap, a new one may be required each night: discuss with supplier or a continence expert.

Catheter hygiene

Wash the skin around the urethra with a mild soap and warm water at least twice a day. The area should be dried thoroughly. Talcum powder or creams should not be used.

Contact a medical officer if any of the following symptoms are present:

  • prolonged pain
  • urine has not drained after 2 to 3 hours
  • blood in the urine and it does not clear after fluid intake is increased.
  • urine become cloudy, offensive in odour, in the presence of burning, and/or these symptoms do not improve after drinking extra fluids
  • urine keeps leaking around the catheter.

Leaking catheters

Catheters that continue to leak should have the balloon checked for patency. If the catheter continues to leak, a replacement catheter may be indicated. An alternative catheter type may be indicated, however inserting a larger gauge catheter is generally not indicated. Please contact the Metropolitan Referral Unit if the device is leaking and we will discuss a hospital avoidance option with you.

How to contact MRU for indwelling catheter (IDC)/SPC replacement?

You will need:

Complete the referral form including the following information:

  • size/gauge of existing catheter
  • date catheter was last changed – noting we recommend 8 to 12 weeks changes in line with product recommendations unless medical issues or problems with the device
  • confirm that suitable replacement device is available
  • any other relevant clinical information including presence of infection, anticoagulation therapy
  • date service is requested to occur
  • stock on site or in home on site and drainage bag.

Submitting your referral

Please send above information to the Metropolitan Referral Unit and await service confirmation. Service confirmations are sent between 8:00 am and 8:00 pm, 7 days a week including public holidays.

Contact the Metropolitan Referral Unit team on 1300 110 600 if you wish to discuss an individual’s needs and eligibility for this service.