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Date issued: April 2024

Review date: April 2026

Ref: B-502/AC/Urology/Planning for a Trial without catheter (TWOC) v3

PDF: Care of your catheter and planning for a Trial Without Catheter.pdf [pdf] 481KB

Why do I need a catheter?

There are many reasons why people need a indwelling urinary catheter. Your healthcare professional will explain to you:

• Why you need to have a catheter.

• How long you need to have the catheter for.

• What type of catheter is best for you.

Leaving Hospital  

On leaving hospital with an indwelling urinary catheter, please make sure that you, or your carer, have been provided with the following:

• Details of how to care for your catheter.

• You have been given your ‘Catheter Passport’.

• A ‘Hospital to Home’ bag which includes details of how to order further supplies.

You should have been told by the nursing team whether you are having a Trial without Catheter (TWOC) or a future catheter replacement, which should also be detailed on your hospital discharge letter.

Please refer to the contact details

Going home with a catheter               

Caring for your catheter

Hygiene

• Always wash your hands before and after touching your catheter or bag.

• You can have a shower, bath or strip wash as normal.  If you have a leg bag attached, do not disconnect it.

• Wash with unscented products. Do not use strong smelling soaps, shower gel, bubble bath, cream, or talcum powder around or on the catheter.

• Ensure the catheter is cleaned after you have been for a poo to prevent the risk of infection.

• If you experience any leakage of urine from around the catheter, please check that the tubing is not kinked or twisted.

• If your catheter should fall out, please contact us using the details in this leaflet.

Diet and Fluids

It is very important to drink when you have a catheter.

• Try to drink at least 1.5 to 2 litres (6-8 glasses) of fluid a day unless you have been advised otherwise by a healthcare professional. Water, lower fat milk and sugar free drinks, including tea and coffee all count towards your daily fluid intake. Drinking the recommended daily amount of fluid will help prevent infections and flush out any debris from your catheter.
• Keep a watchful eye on the amount or urine (wee) you pass and also note the colour of your urine (wee) which should be a clear, pale, yellow colour.
• Ensure that you are avoiding becoming constipated.
• Eat adequate fibre in your diet and aim for 5 portions of vegetables / fruit a day.    
• If you are prone to developing constipation, or you think you are constipated, please discuss this with your nursing or medical team as its important to get this resolved as soon as possible.

Volumes of cups / glasses                         

Mug – 250mls                                    Plastic cup – 185mls                        Small – 340mls, Medium – 450mls

Securing & Emptying

• It is very important that your indwelling urinary catheter is secured safely. It will need to be secured with a catheter fixation device or a strap. This will reduce the risk of the catheter causing damage to your bladder (where your urine is stored) and urethra (the tube connecting the bladder to the outside). It will also minimise the risk of the catheter being accidently pulled out.

• If you have a catheter fixation device, it will need to be replaced every 5-7 days, or earlier if it has become dirty.

Examples of Catheter Fixation Devices

• If you have a leg strap, rotate the position of the leg strap every 12 hours to minimise the risk of skin damage.

• The strap should be changed if it becomes dirty or a minimum of weekly.

• Your catheter bag can be emptied straight into a toilet, making sure that you wash your hands before and after you touch the catheter valve. Open the valve at the bottom of the bag and allow the urine to drain, then close again. Ensure it is safely secured.

• Your catheter bag will need to be changed every 5-7 days to minimise the risk of infection.

What is a Trial without Catheter (TWOC)?

A ‘Trial without Catheter’ or ‘TWOC’, involves removing the catheter from your bladder to see if you can pass urine (wee) without it. 

Where will I have my TWOC?

Where your TWOC is performed will depend on where you live and why your catheter was inserted. All patients living in Cornwall will be referred to the Community District Nursing Team who will contact you to organise the TWOC.

Plymouth patients discharged from Derriford Hospital will be seen at the Chestnut Unit, Urology Department at Derriford.

How do I prepare for the Trial without Catheter (TWOC)?

Please bring your ‘Catheter Passport’ along to the appointment with you.

If you have a catheter valve, it will be helpful if you can attend the clinic with a comfortably full bladder. Try not to open the valve for 1 hour before your appointment, however if you have any abdominal pain / discomfort, then open the valve.

If you have been prescribed tamsulosin, you must have been taking it for a minimum of 3 days before having the TWOC,

For spinal injury patients who are at risk of autonomic dysreflexia (AD), please bring your emergency medication that you would use if experiencing AD to the appointment with you and alert the nursing staff when you attend.

How long will I need to stay at the clinic/hospital?

You may be at the appointment for approximately 4-6 hours, or at least until you have passed urine satisfactorily. It will be necessary for you to have a bladder scan so that we can monitor your progress. This may need to be done intermittently after you have passed urine, it is painless and will only take a few minutes. If you feel uncomfortable or cannot pass urine, please tell the nurses immediately so that they can bladder scan you earlier.

Once your indwelling urinary catheter has been removed, you will be encouraged to drink water to fill your bladder. If you prefer you can bring your own drinks.

Please ensure that you are not constipated as this may cause problems with you being able to pass urine properly. If you think you are, please tell the nurses on arrival to the appointment. 

As the appointment may extend over lunchtime, you may wish to bring a snack with you. If time permits, you could visit the hospital café. If you are at a community clinic, you can ask if you can leave and return later in the day. If you are a diabetic, please remember to bring any lunchtime medication with you.

You may wish to bring a book or something to read.

We also advise you to bring a change of underwear or a pad, in case of incontinence.

Helpful hints for emptying your bladder

Females

Your bladder empties best when you are sitting, feet flat on the floor, elbows leaning on your thighs, and you are relaxed. Try to avoid hovering.  When you have finished weeing, count to 10, lean forward slightly and wee again. Alternatively, stand up, move around a bit, and sit back down again. This is called ‘double voiding’ and it will help to make sure that you empty your bladder completely.

Males

Your bladder empties best when you are standing, feet slightly apart, and you are relaxed. When you have finished weeing, count to 10, lean forward slightly or apply gentle pressure to your lower abdomen.

What happens afterwards?

If you can pass urine and you are comfortable, we will let you go home. If you cannot pass urine you may need to have a new indwelling urinary catheter inserted (re-catheterised). 

If appropriate, the nursing staff may introduce you to intermittent self-catheterisation (ISC). If this is necessary, the nurse will fully explain and provide you with everything you need for to perform intermittent self-catheterisation (ISC).

It is normal to experience a slight stinging sensation for a day or two after removal of your catheter. You may resume normal daily activities and sexual activity as soon as you feel comfortable to do so. You should continue to drink plenty of fluids (about 2 – 3 litres) over the next few days to flush any debris out of your bladder and to help prevent any urinary tract infections (UTI).

Concerns?

If you have a concern whilst you have the catheter still in place, please follow the advice below:

• If you have not been contacted regarding removal of your catheter within 2 weeks of your hospital discharge

• If you are experiencing either of the following:

  • Your catheter is not draining urine.

  • You have developed abdominal pain or discomfort.

Please refer to the ‘contact information’ section.

Contact Information

If you have not received your indwelling urinary catheter supplies contact:

• Great Bear, Nightingale Home Delivery, Tel: 0800 304 7434

 

If you have a problem with your indwelling catheter contact:

• The relevant District nursing hub. Monday to Friday, between 8:30am to 4:30pm

Livewell Southwest

• Plymouth DN Hub, 01752 898283
• Ivybridge DN Hub, 01752 898283
• Kingsbridge DN Hub, 01752 438211
• Tavistock DN Hub, 07811 017744

Out of hours: Friday from 4:30pm to Monday until 8:30am, including Bank Holidays: Please contact 111

• Chestnut Unit, Urology, Tel: 01752 430081

 

If you have not received details of your appointment date for removal of catheter within 12 working days of discharge from hospital, please contact:

• Chestnut Unit, Urology, Tel no: 01752 430081, Friday to Monday, 8am to 4pm.

 

Patients living in Cornwall:

If you have a catheter related issue, please contact your GP surgery within working hours, who will give you the District Nurse contact details.  Alternatively contact 111 for advice.

 

If you have had your catheter removed and have concerns regarding:

• A raised temperature and / or you feel unwell.

• Your urine is cloudy and smells offensive.

• You cannot pass urine.

Please contact your GP during working hours or 111 out of hours.