Catheter care overview

Micro-organisms can enter the bladder during the insertion of the catheter or as a result of a catheter being in situ. The chance of infection increases each day that the catheter remains in situ. The two routes for micro-organisms to enter the bladder are:

• periurethral – between the outside of the catheter and the urethral wall;
  
• intraluminal – inside the catheter.

Once inside the bladder, micro-organisms may, in susceptible children, travel up the ureters to the kidney, causing kidney infection such as pyelonephritis.

Prevention of infection

• Good hygiene must be maintained and the urethral meatus (the entry to the urethra) should be washed daily with soap and water, strong perfumed soaps should be avoided. The use of antiseptic solutions to clean the meatus is not recommended. Washing should always occur from the front to the back in girls and in a circular motion for boys. A shallow bath is recommended for patients with suprapubic catheters.
  
• Cleaning of the catheter itself should be done from the urethral meatus down the catheter for a couple of centimetres.
  
• During daily washing the children’s nurse should observe for signs of infection such as redness, swelling or any discharge.
  
• Urine drainage systems can also be a source of infection and they must always be suspended on a suitable stand, off the floor.
  
• Drainage bags should be emptied regularly (4-hourly) to allow urine to flow and prevent reflux of the urine back towards the child.
  
• When emptying the drainage bag, the tap should be cleaned inside and out with an alcohol swab and allowed to dry, to kill any micro-organisms that may be present and could then enter the drainage bag. Children’s nurses must wear apron and gloves during this procedure.
  
• Ensuring an adequate or increased fluid intake and balanced diet will reduce the child’s susceptibility to an infection.

General care principles

• Following insertion of a urethral catheter, the catheter should be securely held in place by taping the catheter to the abdomen or thigh. Regular checks should be made to ensure the catheter is not causing trauma to the urethral meatus.
  
• To ensure a good flow of urine, the drainage bag should be placed below the level of the child.
  
• The drainage system must remain kink-free at all times, do not allow the tube to get caught in the bed rails.
  
• The child’s intake and output must be accurately recorded.
  
• When emptying the drainage bag, children’s nurses should be aware of any signs of infection such as:
  
  
  
  • cloudy or foul-smelling urine;
    
  • the presence of protein/blood/leucocytes/nitrates on 
urinalysis.
  
  
• Regular observations of vital signs should be recorded. An increase in temperature may indicate an infection.
  
• Children and young people should also be regularly assessed for pain. Abdominal pain may indicate a urinary tract infection. Discomfort or pain at the urethral meatus may indicate trauma or infection. Children and young people may also experience bladder spasms as a result of the catheter irritating the bladder; these can be managed with the prescription of an anti-spasmodic medication.

Removal of a catheter

• Ensure the child or young person and family are suitably prepared for the removal of the catheter.
  
• Consider if analgesia is required prior to the procedure.
  
• Universal precautions must be adhered to.
  
• Remove the tape or strapping from the child’s leg or abdomen using adhesive remover if necessary.
  
• Using an empty syringe, withdraw the water to deflate the balloon to the volume stated on the catheter. If the catheter has been in situ for a long time, some of the water may have leaked out.
  
• When the child is ready, hold the catheter near the entry site and gently using one steady motion, withdraw the catheter.
  
• Inspect the catheter to ensure it is intact and there are no signs of infection. Dispose of the catheter in line with Trust policy.
  
• Reassure the child or young person and advise that they may experience some discomfort in the next 24 hours. A warm bath can relieve this. Observe the child’s urine output to ensure there is no retention or dysuria.
  
• Document the procedure and subsequent passing of urine in the patient’s medical records.
  
• For suprapubic catheters, the retaining stitch is cut, the catheter withdrawn and pressure applied to the entry site for one minute to promote closure of the hole.