![]() ![]() A clear plan of action should the TWOC be considered a failure (Yarde, 2015 Bardsley 2017).Ongoing assessment of bladder function, including any retention.The environment in which the TWOC is performed.A TWOC should always be planned in advance with consideration around: The primary aim of a TWOC is to establish the ability to effectively and successfully empty the bladder unaided (Robinson, 2005 Table 2). PURPOSE OF TWOC AND WHEN IT SHOULD BE CONSIDERED? Any healthcare professional participating in elements of catheter care, including insertion and removal, should be able to demonstrate safe effective practice in line with current clinical evidence. The most recent evidence-based guidelines reflect changes in practice and healthcare culture, and demonstrate that registered and non-registered staff are potentially responsible for insertion and removal of catheters (RCN, 2019). NHS Improvement also released national clinical documentation to support the safe and effective use of urinary catheters (NHS Improvement, 2019). They are aimed at any healthcare professional responsible for safe and effective catheterisation techniques and should be readily available and widely evidenced in everyday practice across the various health and social care environments. The RCN’s best practice guidelines relating to catheterisation were recently revised (RCN, 2019). In health care we are guided by best practice and clinical evidence. This article will explore the optimum timing for TWOC and current evidence advising on how to safely and effectively manage a TWOC. Questions are often raised regarding the optimum time to perform a trial without catheter (TWOC). Use of indwelling catheters should be planned around an individual’s needs and appropriate management and early removal must be addressed. Any situation where the bladder cannot effectively empty or drain should be carefully assessed and consideration taken as to how to manage the situation and relieve symptoms safely and effectively. While it is recognised that an indwelling catheter is a last resort, there are several valid reasons for their use (Geng et al, 2012 Royal College of Nursing, 2019 Table 1). The current cost of treating catheter-associated urinary tract infections (CaUTIs) is reported to be almost 2000 an episode (Yates, 2016), and the total cost of using Foley catheters within the NHS is estimate to be between 1.0 and 2.5 billion a year (Yates, 2016). ‘Indwelling catheters are potentially risky devices and have an adverse effect on the health and social wellbeing of individuals, as well as a financial implication for services.’ Indwelling catheters are potentially risky devices and have an adverse effect on the health and social wellbeing of individuals, as well as a financial implication for services. It is recognised that a significant number of these individuals will develop sepsis, and in some cases lead to fatalities - estimated to be around 2100 deaths a year directly caused by the use of indwelling catheters (Feneley et al, 2015). It has been estimated that at least 90,000 people living in community settings across England currently use urinary catheters long term (Gage et al, 2017), and almost one-quarter of all inpatients experience an indwelling catheter at some point during their hospital stay (Health Protection Scotland, 2012 Feneley et al, 2015).Įvidence over several years has indicated that the length of time a catheter is in place has a direct implication on the increased risk of developing an infection, with figures of 20% widely referenced (Chenoweth and Saint, 2013 Loveday et al, 2014). Indwelling urinary catheters are still one of the most commonly used clinically invasive devices across the UK (Loveday et al 2014 Feneley et al, 2015).
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