CC05 Undertake a trial without catheter


This standard covers undertaking a trial without catheter (TWOC) following agreed local protocols, procedures and guidelines.  It involves establishing an individual’s suitability for trial without catheter and providing them with relevant information.  It also involves carrying out the trial without catheter and identifying appropriate treatments based on the results.

Users of this standard will need to ensure that practice reflects up to date information and policies.

Version No 1

Knowledge and Understanding

You will need to know and understand:

  1. The current European and National legislation, national guidelines, organisational policies and protocols in accordance with clinical/corporate governance which affect your work practice in relation to carrying out a trial without catheter
  2. The importance of working within your sphere of competence and when to seek advice if faced with situations outside of your sphere of competence.
  3. The importance of documentation, the data protection act, care of records and disclosure of information with consent from the individual and your employer and the legal and professional consequences of poor practice
  4. The anatomy and physiology of the male and female lower urinary tract in relation to lower urinary tract function and continence status including:
    1. urine production and what influences this
    2. normal micturition
    3. the nervous system including autonomic dysreflexia
    4. the bowel and its links to voiding problems
    5. the endocrine system
    6. sexual function and links to catheter usage
    7. the prostate gland, urethral sphincters and the urethra
    8. applied anatomy and physiology to voiding dysfunction and how a catheter could be used to relieve this
    9. the anatomy and physiology of a cystostomy (some individuals for trial without catheter may have a suprapubic catheter)
    10. anatomy and physiology links of how common catheter related complications occur
  5. How to advise individuals in the use of catheters in relation to their anatomy, its function and sensation
  6. The reasons why trial without catheter is necessary
  7. How to establish the individual’s health needs and suitability for trial without catheter
  8. The different types of trial without catheter and the rationale behind chosen methods
  9. When to not proceed or abandon a trial without catheter for an individual and what actions to take
  10. The effects of a trial without catheter on the individual’s comfort and dignity and ways of handling this
  11. How to terminate the usage of a urinary catheter in an effective and safe manner
  12. The adverse effects and potential complications during a trial without catheter and appropriate actions
  13. The different risks and health issues that will influence how and where a trial without catheter is performed
  14. The reasons why intermittent bladder drainage is the better option if the trial without catheter is unsuccessful
  15. How to perform a trial of voiding for an individual with a suprapubic catheter
  16. How to educate individuals using catheters in relation to lifestyle advice, maintaining catheter function, reducing infection, what to do in the event of problems with equipment and how to deal with common complications
  17. The different materials and equipment used for trial without catheter and to assess voiding
  18. The types of catheters, urinary drainage bags, link systems, catheter valves, support methods, including garments, straps and stands that can be used with appropriate selection to meet individuals specific needs
  19. The types of sterile dressings, indications for use, aseptic care and when to change them in relation to a cystostomy site
  20. The indications, mode of action, side-effects, cautions, contra indications and potential interactions of medication, antibiotics, anaesthetic agents and associated solutions used for individuals undergoing trial without catheter
  21. How to obtain valid consent and how to confirm that sufficient information has been provided on which to base this judgement
  22. The importance of respecting individuals’ privacy, dignity, wishes and beliefs and how to do so
  23. Those who may accompany the individual (e.g. carers, chaperones) and be present during the process and how to work with them
  24. The importance and methods of offering effective verbal and non-verbal support and reassurance to individuals when you perform a trial without catheter
  25. The ethical issues surrounding trial without catheter as applied to individuals
  26. The causes of urinary tract invasion from bacteria and how to minimise this in all care settings
  27. The importance of applying standard precautions for infection control and the potential serious life threatening consequences of poor practice
  28. How to meet standards of environmental cleanliness in the area where catheterisation is to take place to minimise the infection risk
  29. When to undertake urinalysis, obtain a catheter specimen of urine (CSU) or screen for multi resistant bacteria

Performance Criteria

You must be able to do the following:

  1. apply standard precautions for infection prevention and control and take other appropriate health and safety measures
  2. establish the individual’s health needs and suitability for trial without catheter
  3. undertake a risk assessment and use the outcomes to determine a suitable method for trial without catheter
  4. use equipment and materials correctly in accordance with guidelines and protocols
  5. provide the individual with the appropriate charts to measure input and output
  6. measure residual urine and take the appropriate action
  7. recognise any adverse effects and potential complications during the trial without catheter
  8. identify appropriate treatments for the individual based on the results of the trial without catheter
  9. provide the individual and relevant others with the appropriate health related information and advice
  10. provide appropriate care for individuals and relevant others where the trial without catheter is not effective
  11. produce records and reports that are clear, comprehensive, and accurate, and maintain the security and confidentiality of information

Additional Information

This National Occupational Standard was developed by Skills for Health in partnership with the Royal College of Nursing in December 2007.

This standard links with the following dimension within the NHS Knowledge and Skills Framework (October 2004):

Dimension: HWB6 Assessment and treatment planning
CC05 Undertake a trial without catheter
Final version approved June 2010 © copyright Skills For Health
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