Cystostomy care 

Authors: Brikez Y.I., Poplavets E.V.

Editor: Rednenko V.V.

Level of care:

  • Hospital and outpatient health care organisations

DESCRIPTION OF THE CLINICAL SITUATION (VARIANT):

  • Patient A., a 67-year-old man, was admitted for inpatient treatment to the surgical department of the central district hospital with a diagnosis of ‘Adenoma of the prostate gland’. A month ago, the patient underwent percutaneous suprapubic epicystostomy with insertion of a Foley catheter.
  • Perform catheter replacement, epicystostomy care and educate the patient on self-care of the catheter at home

Training options:

  • Individual.

Training requirements for trainees

  • Knowledge of algorithms ‘Care of urological catheter placed for long term’, ‘Bladder catheterisation using urological Foley catheter’
  • Conducting a briefing on working with the simulator

Indications for cystostomy:

  • acute urinary retention when urethral catheter placement is not possible due to urethral lumen obstruction (acute prostatitis, prostate adenoma, etc.).
  • urethral stricture
  • formation of a false passage during urethral catheterisation
  • inability to catheterise through the urethra
  • traumatic urethral rupture
  • periurethral abscess
  • lack of conscious control by the patient over the process of urination: neurogenic bladder as a result of spinal cord injuries, acute disorders of blood supply to the brain, multiple sclerosis, neuropathy, etc.

POSSIBLE COMPLICATIONS:

  • catheter blockage
  • catheter dislocation with overgrowth of the stoma opening
  • inflammation of the skin around the catheter
  • Haematuria after cystostomy placement
  • psychological discomfort
  • bladder infection
  • excessive granulation of the skin around the catheter

EQUIPMENT FOR PERFORMING THE PRACTICAL SKILL:

  • phantom with a Foley catheter inserted in the epicystostomy
  • manipulation table
  • disinfection table
  • packaged gauze wipes (t-shaped)
  • packaged sterile gauze balls
  • tweezers (2 pcs.) and scissors in individual packaging
  • urine collector
  • sterile Janet syringe
  • sterile 20 ml injection syringe.
  • 3% hydrogen peroxide in a bottle
  • medical gauze
  • absorbent nappy
  • sterile saline solution in a 100 ml bottle. (cap not sealed)
  • sterile solution of furacilin 1:5000 - 100-200 ml
  • water thermometer
  • adhesive plaster
  • sterile Foley catheter in packaging (inner packaging made of cellophane, outer packaging made of paper)
  • tray (container with water for heating furacilin)
  • sterile tray
  • skin protection paste
  • PPE: smock‘ cap’ medical gloves in package (sterile)‘ oilcloth apron’ mask' goggles
  • water-based skin antiseptic (chlorhexidine solution)
  • Emergency disinfection chemical for disinfection of external surfaces of medical devices
  • working solution of chemical disinfectant in containers:
    •  «Disinfection of dressing materials, PPE»
    •  «Disinfection of syringes and other medical devices»
    •  container ‘Packaging’
  • medical records.

 THE ORDER IN WHICH THE SKILL IS PERFORMED:

 Preparatory phase:

  • Check the completeness, integrity and expiry dates of the MIs required for the procedure
    • Identify the patient
      • Say hello to the patient, introduce yourself.
      • Identify the patient
    • Get informed consent
      • Inform the patient about the upcoming manipulation
      • Obtain verbal consent to perform the manipulation
    • Prepare the patient for the procedure
      • Place a medical oilcloth on the couch (bed) and put an absorbent nappy on top of it
      • Help the patient into a comfortable supine position
      • Ask the patient (help the patient) to unclothe the epicystostomy area
    • Prepare the workplace
      • Check that the necessary equipment is available
      • If necessary, tidy up the workplace
    • Prepare (heat) the furacilin solution for use:
      • Monitor the temperature of the water in the container for heating the furacilin solution: 
        • Take a thermometer and put it in a container of water to warm it up (say: ‘The water temperature should be 40-45°C’).
        • remove the thermometer from the container and place it on the handling table
      • Place the bottle of furacilin in a container to be heated (say: ‘Furacilin heated to a temperature of 30-35°C’)
    • Wear protective equipment
      • Wear a waterproof apron, a mask.
      • Perform hygienic hand antisepsis
      • Put on non-sterile gloves
    • Prepare the MI to perform the procedure
      • Open the package containing the gauze balls 
      • Open the packaging of the Janet syringe
      • Open the packaging with a spatula
      • Open the packaging of the tweezers
      • Open the package with a sterile injection syringe
      • Open the package with a sterile wipe (t-shaped)
      • Cut two 10 cm long strips of plaster using scissors and place them on the manipulation table

 Main Stage:

  • ask the patient to lie on his/her back 
  • cover the area below the cystostomy with a nappy
  • remove (unbuckle) the securing straps of the urine collector on the patient's thigh
  • Remove the old dressing (if any) with tweezers:
  • Remove the fixation elements of the bandage (plaster) with scissors or tweezers
  • Pour 3% peroxide from a bottle (if necessary) on the dried areas.
  • Remove the t-shaped bandage with tweezers
  • Place used dressing material and forceps in the waste material tray
  • Examine the skin around the stoma, identifying signs of inflammation (hyperaemia, swelling, maceration of the skin, purulent discharge), ask about any complaints of the patient.
  • treat the skin around the stoma with an antiseptic
    • get new tweezers
    • Take a new pair of tweezers, take a gauze ball from the individual package and moisten it with skin antiseptic (aqueous chlorhexidine solution).
    • gently treat the skin around the catheter with an antiseptic gauze balloon. 
    • place the gauze ball in the waste tray
  • Disconnect the urethra connector from the catheter (using the urine diversion port).
  • lower the free edge of the catheter into the sterile tray
  • remove the urine collector 
  • assess the patient's diuresis (volume, clarity, colour of urine in the urine collector)

 Remove the Foley catheter from the stoma to replace it:

  • remove the 20.0 ml injecting syringe without needle from the opened package 
  • connect the syringe to the balloon inflation valve
  • Remove the sodium chloride solution from the cylinder by pulling the syringe plunger towards you until there is no air in the syringe.
  • disconnect the syringe from the balloon inflation valve
  • Rotate the catheter in the stoma 360 degrees to remove the catheter from the stoma 
  • Place the catheter in the container ‘Disinfection of syringes and other medical devices’.
  • if the urinal bag is 1/3 full, empty it by directing the flush valve to the toilet and opening the valve.
  • treat the drain valve with an antiseptic balloon 
  • take off your gloves

      

Insert a Foley catheter into the epicystostomy:

  • hygienic hand sanitisation
  • prepare the catheter insertion equipment:
  • Open and unfold the outer package of sterile gloves on the manipulation table without touching the inner package.
  • Open the outer packaging of the Foley catheter from the balloon inflation passage without touching the inner packaging.
  • draw 100 - 150 ml of sterile heated furacilin solution into a Janet syringe
  • Place the Janet syringe inside the sterile syringe package
  • open a vial of sterile sodium chloride solution
  • (place the cap (stopper) of the vial with its outer surface on the manipulation table)
  • draw 20 ml of sterile saline solution from the bottle into an injection syringe without a needle
  • hygienic hand sanitisation 
  • put on sterile gloves
  • Hold the inner catheter packaging with your left hand, remove part of the inner catheter packaging with your right hand, releasing the proximal end of the catheter (balloon inflation side).
  • Place the proximal end of the catheter between the fourth and fifth fingers of the right hand, lift the catheter out of the packaging
  • Intercept the catheter from above with the first and second fingers of the right hand 6-7 cm from the distal end.
  • remove the inner catheter packaging with your left hand 
  • take a vial of sodium chloride in the left hand, pour a few drops of solution into the tray, pour saline solution over the distal end of the catheter along the drained edge of the vial over the tray without touching the catheter with the vial.
  • warn the patient when catheter insertion begins 
  • Insert the catheter into the stoma to a depth of 6-7 cm
  • lower the free end of the catheter into the tray

Fill the catheter balloon:

  • remove the syringe with 20 ml of 9 mg/ml sodium chloride solution from the package, attach the syringe to the balloon inflation valve and inject the required amount of saline into the catheter balloon (the maximum volume of fluid to be injected for balloon inflation is indicated on the balloon inflation valve of the catheter balloon or see the Foley catheter instructions for use).
  • ask the patient how he or she is feeling
  • disconnect the syringe
  • Place the syringe in the waste material tray
  • Check the correct fixation of the catheter by gently pulling the catheter towards you as far as it will go (the catheter should not come out of the stoma).
  • gently push the catheter 0.5-1.0 cm into the bladder (the catheter should be kept moving).

Flush the Foley catheter:

  • take a prefilled Janet syringe from the package
  • Attach a Janet syringe to the urine diversion port.
  • slowly inject furacilin solution into the bladder cavity
  • disconnect the Janet syringe, place the syringe in the waste tray
  • lower the distal end of the catheter into the tray
  • wait for complete passive bladder emptying by gravity into the tray (through the urinary tract).
  • connect the urethraceptor to the urine output port of the Foley catheter.
  • fasten the securing straps of the urethraceptor on the patient's thigh

Treat the skin around the stoma:

  • treat your hands with gloves
  • take a sterile gauze balloon with tweezers.
  • moisten with chlorhexidine and gently, without pressure, treat the skin around the stoma
  • place the gauze ball in the waste material tray
  • Take a disposable spatula and apply a thin layer of protective paste (ointment) to the skin around the cystostomy (leave the protective paste to dry for 1-2 minutes).
  • place the spatula in the waste material tray 
  • Place a sterile gauze cloth around the cystostomy on the skin, in the form of so-called ‘trousers’ (a cloth measuring 12 cm × 6 cm and cut in the middle on one side by about ½ the length) or a patented sticker dressing.
  • fix the gauze cloth to the skin with strips of adhesive tape
  • Gently secure the Foley catheter with a patch to the patient's thigh. ensure that the catheter tube is not stretched and is positioned below the level of the stoma.

Teach the patient how to care for the cystostomy at home:

  • The stoma catheter is changed every 4 weeks
  • Emptying the urethrail as soon as it is more than 1/3 full.
  • the urinal is changed once every 3-4 days

Final Stage:

  • take off your gloves
  • place in the container ‘Disinfection of dressings’ PPE’
  • hygienic hand sanitisation
  • Organise medical records
Last modified: Wednesday, 7 May 2025, 10:19 AM