Indwelling Urinary Catheter Care and Removal
Intended to prevent infection and other complications by keeping an indwelling or Foley catheter insertion site clean, routine catheter care typically is performed after the patient’s morning bath and immediately after perineal care. (Bedtime catheter care may have to be performed before perineal care.)
Because some studies suggest that catheter care increases the risk of infection and other complications rather than lowers it, many health care facilities don’t recommend daily catheter care.1 Because of this, individual facility policy dictates whether or not a patient receives such care. Regardless of the catheter care policy, the equipment and the patient’s genitalia require inspection twice daily.
An indwelling urinary catheter should be removed when bladder decompression is no longer necessary, when the patient can resume voiding, or when the catheter is obstructed.2 Depending on the length of the catheterization, the doctor may order bladder retraining before catheter removal. To prevent catheter-associated urinary tract infections, the catheter should be removed as soon as it’s no longer needed.
Equipment
Gloves ▪ eight sterile 4″ × 4″ gauze pads ▪ basin ▪ washcloth ▪ soap and water ▪ leg bag ▪ drainage bag ▪ adhesive tape or leg band ▪ waste receptacle ▪ Optional: safety pin, rubber band, gooseneck lamp or flashlight, adhesive remover, antibiotic ointment, specimen container.
Commercially prepared catheter care kits containing all necessary supplies are available.
For Catheter Removal
Absorbent cotton ▪ gloves ▪ alcohol pad ▪ 10-mL syringe with luer lock ▪ bedpan.
Implementation
Catheter Care
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.7
Assemble the equipment and supplies at the bedside.
Explain the procedure and its purpose to the patient.
Provide the patient with the necessary equipment for self-cleaning, if possible.
Provide privacy.
Make sure the lighting is adequate so that you can see the perineum and catheter tubing clearly. Place a gooseneck lamp at the bedside, if needed.
Inspect the catheter for any problems, and check the urine drainage for mucus, blood clots, sediment, and turbidity. Then pinch the catheter between two fingers to determine if the lumen contains any material. If you notice any of these conditions (or if your facility’s policy requires it), using sterile technique,3,4 obtain a urine specimen from the specimen collection port. Collect at least 3 mL of urine, but don’t fill the specimen cup more than halfway. Notify the doctor about your findings.
Inspect the outside of the catheter where it enters the urinary meatus for encrusted material and suppurative drainage. Also inspect the tissue around the meatus for irritation or swelling.
Remove the adhesive tape or leg band securing the catheter to the patient’s thigh or abdomen. Inspect the area for signs of adhesive burns—redness, tenderness, or blisters.
Clean the outside of the catheter and the tissue around the meatus using soap and water. To avoid contaminating the urinary tract, always clean by wiping away from—never toward—the urinary meatus. Use a dry gauze pad to remove encrusted material.
Nursing Alert
Don’t pull on the catheter while you’re cleaning it. Pulling can injure the urethra and the bladder wall. It can also expose a section of the catheter that was inside the urethra, so that when you release the catheter, the newly contaminated section will reenter the urethra, introducing potentially infectious organisms.
Remove and discard your gloves and perform hand hygiene. Reapply the leg band, and reattach the catheter to the leg band. If a leg band isn’t available, use a piece of adhesive tape to tape the catheter to the patient’s leg or abdomen; retape the catheter on the opposite side of where it was before to prevent skin hypersensitivity or irritation.
Nursing Alert
Provide enough slack before securing the catheter to prevent tension on the tubing, which could injure the urethral lumen or bladder wall.2
Most drainage bags have a plastic clamp on the tubing to attach them to the sheet. Attach the drainage bag below bladder level to the bed frame.2,3
If necessary, clean residue from the previous tape site with an adhesive remover. Then dispose of all used supplies in a waste receptacle.
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