A catheter is a tube used to drain or inject fluid through a body opening. Inserted through the urethra into the bladder, a urinary catheter drains urine. Catheterization is the process of inserting a catheter. With proper training and supervision, some states and agencies let nursing assistants insert and remove urinary catheters.

See Focus on Surveys: Urinary Catheters.

See Promoting Safety and Comfort: Urinary Catheters.

Focus on Surveys

Urinary Catheters

Surveys are done to determine if the person is receiving appropriate treatment and services. The surveyor may ask you questions about:

• Your understanding of the person’s bladder management program

• Your training related to handling catheters, catheter tubing, drainage bags, catheter care, urinary tract infections (UTIs), catheter-related injuries, dislodgment, and skin breakdown

• What observations to report, when to report them, and to whom you should report observations

Answer questions the best you can. If you do not know an answer, tell the surveyor who you would ask or where you would find the answer.

Promoting Safety and Comfort

Urinary Catheters

Safety

Urinary catheter procedures often involve exposing and touching the perineum. Sexual abuse has occurred in health care settings. The person may feel threatened or actually may be abused. He or she needs to call for help. Keep the call light within the person’s reach at all times. And always act in a professional manner.

Urine may contain microbes and blood. Follow Standard Precautions and the Bloodborne Pathogen Standard when performing the procedures in this chapter.

Purposes and Types of Catheters

These types of catheters are common.

• A straight catheter drains the bladder and then is removed.

• An indwelling catheter (retention or Foley catheter) is left in the bladder. Urine drains constantly into a drainage bag. A balloon near the tip is inflated with sterile water after the catheter is inserted. The balloon prevents the catheter from slipping out of the bladder (Fig. 25-1).

FIGURE 25-1 Indwelling catheter. A, Indwelling catheter is in the female bladder. The inflated balloon at the tip prevents the catheter from slipping out through the urethra. B, Indwelling catheter with the balloon inflated in the male bladder.

See Figure 25-2 for parts of an indwelling catheter. Tubing connects the catheter to the urine drainage bag. See Figure 25-3 for the parts of the urine drainage system.

FIGURE 25-2 Parts of a Foley catheter (indwelling catheter).

FIGURE 25-3 Parts of the urine drainage system.

Catheters create a risk for UTIs. However, they are used:

• To keep the bladder empty before, during, and after surgery. This reduces the risk of bladder injury during surgery. Also, the amount of urine can be monitored. After surgery, a full bladder causes pressure on nearby organs. Such pressure can lead to pain or discomfort.

• To promote comfort. Some people are too weak or disabled to use the bedpan, urinal, commode, or toilet. Dying persons are examples. For them, catheters can promote comfort and prevent incontinence.

• To protect wounds and pressure ulcers from contact with urine.

• For hourly urine output measurements.

• To collect sterile urine specimens.

• To measure the amount of urine in the bladder after the person voids. This is called residual urine.

Catheters do not treat the cause of incontinence. They are a last resort for incontinence.

Catheter Care

You will care for persons with indwelling catheters. The risk of UTI is high. Follow the rules in Box 25-1 to promote safety and comfort.

Box 25-1

Indwelling Catheter Care

Preventing Infection

• Follow the rules of medical asepsis.

• Follow Standard Precautions and the Bloodborne Pathogen Standard.

• Encourage fluid intake as directed by the nurse and the care plan.

The Drainage System

• Allow urine to flow freely through the catheter and drainage tube. Tubing should not have kinks. The person should not lie on the tubing.

• Keep the catheter connected to the drainage tube. Follow the measures on p. 412 if the catheter and drainage tube are disconnected.

• Keep the drainage tube and bag below the bladder. This prevents urine from flowing backward into the bladder. When transferring the person to or from the bed or chair, keep the drainage bag lower than the bladder. Secure the drainage bag to the bed or chair after the transfer. See Figure 25-4.

FIGURE 25-4 A, Urine drainage bag secured to the bed frame. B, Urine drainage bag secured to a chair.

• Move the drainage bag to the other side of the bed when the person is turned and re-positioned on his or her other side.

• Hang the bag from the bed frame, back of the chair or wheelchair, or lower part of the IV (intravenous) pole.

• Do not hang the drainage bag on a bed rail. Otherwise the bag is higher than the bladder when the bed rail is raised.

• Hold the bag lower than the bladder when the person walks.

• Do not let the drainage bag touch or rest on the floor. This can contaminate the system.

• Position drainage tubing in a straight line or coil the drainage tubing on the bed. Secure it to the bottom linens (Fig. 25-5, p. 410). Follow the nurse’s directions and agency policy. Use a clip, bed sheet clamp, tape, or other device as the nurse directs. Tubing must not loop below the drainage bag.

The Catheter

• Secure the catheter as the nurse directs. The nurse tells you where to secure the catheter.

• Females: to the thigh (Fig. 25-5, A).

• Males:

• To the abdomen (Fig. 25-5, B). This site is common for long-term catheter use. The drainage bag remains below the bladder. Drainage is not affected.

• To the thigh (Fig. 25-5, C)

• Use a tube holder, tape, or other device to secure the catheter to the thigh or abdomen. The nurse tells you what to use. Securing the catheter prevents excess catheter movement and friction at the insertion site (meatus). Catheter movement and friction can damage the meatus.

• Check for leaks. Check the connections to the drainage tube and the drainage bag. Report any leaks to the nurse at once.

• Provide perineal care and catheter care according to the care plan—daily, twice a day, after bowel movements (BMs), or when vaginal discharge is present. (See procedure: Giving Catheter Care, p. 411.)

Measuring Urine (Output)

• Empty the drainage bag and measure urine:

• At the end of the shift

• When changing to and from a leg bag and a standard drainage bag (p. 413)

• When the bag is becoming full

• Report an increase or decrease in urine amount.

• Use a separate measuring container for each person. This prevents the spread of microbes from 1 person to another.

• Do not let the drain on the drainage bag touch any surface.

• See procedure: Emptying a Urine Drainage Bag, p. 415.

Observations

• Report complaints to the nurse at once—pain, burning, the need to void, or irritation. Also report the color, clarity, and odor of urine and the presence of particles or blood.

• Observe for signs and symptoms of a UTI. Report the following at once.

• Fever.

• Chills.

• Flank pain or tenderness. The flank area is in the back between the ribs and the hip (Fig. 25-6, p. 410).

FIGURE 25-6 Shading shows the flank area.

• Change in the urine—blood, foul smell, particles, cloudiness, oliguria.

• Change in mental or functional status—confusion, decreased appetite, falls, decreased activity, tiredness, and so on.

• Urine leakage around the catheter.

See Delegation Guidelines: Catheter Care, p. 410.

See Promoting Safety and Comfort: Catheter Care, p. 410.

See procedure: Giving Catheter Care, p. 411.

Delegation Guidelines

Catheter Care

When delegated catheter care, you need this information from the nurse and the care plan.

• When to give catheter care—daily, twice a day, after BMs, or when vaginal discharge is present

• What water temperature to use for perineal care

• Where to secure the catheter—thigh or abdomen

• How to secure the catheter—tube holder, tape, or other device

• How to position the drainage tubing—straight line or coiled on the bed

• How to secure drainage tubing—clip, bed sheet clamp, tape, or other device

• What observations to report and record:

• Complaints of pain, burning, irritation, or the need to void (report at once)

• Crusting, abnormal drainage, or secretions

• The color, clarity, and odor of urine

• Particles in the urine

• Blood in the urine

• Cloudy urine

• Urine leaking at the insertion site

• Drainage system leaks

• When to report observations

• What patient or resident concerns to report at once

Promoting Safety and Comfort

Catheter Care

Comfort

The catheter must not pull at the insertion site. This causes discomfort and irritation. Hold the catheter securely during catheter care. Then properly secure the catheter. Make sure the tubing is not under the person. Besides obstructing urine flow, lying on the tubing is uncomfortable. It can also cause skin breakdown. To promote comfort, see Box 25-1.

Giving Catheter Care

Quality of Life

• Knock before entering the person’s room.

• Address the person by name.

• Introduce yourself by name and title.

• Explain the procedure before starting and during the procedure.

• Protect the person’s rights during the procedure.

• Handle the person gently during the procedure.

Pre-Procedure

1. Follow Delegation Guidelines:

• Perineal Care (Chapter 22)

• Catheter Care

See Promoting Safety and Comfort:

• Perineal Care (Chapter 22)

• Urinary Catheters, p. 407

• Catheter Care

2. Practice hand hygiene.

3. Collect the following.

• Items for perineal care (Chapter 22)

• Gloves

• Bath blanket

4. Cover the over-bed table with paper towels. Arrange items on top of them.

5. Identify the person. Check the ID (identification) bracelet against the assignment sheet. Use 2 identifiers (Chapter 13). Also call the person by name.

6. Provide for privacy.

7. Fill the wash basin. Water temperature is about 105°F to 109°F (40.5°C to 42.7°C). Measure water temperature according to agency policy. Ask the person to check the water temperature. Adjust water temperature as needed.

8. Raise the bed for body mechanics. Bed rails are up if used.

9. Lower the bed rail near you if up.

Procedure

10. Practice hand hygiene. Put on the gloves.

11. Cover the person with a bath blanket. Fan-fold top linens to the foot of the bed.

12. Position and drape the person for perineal care (Chapter 22).

13. Fold back the bath blanket to expose the perineal area.

14. Ask the person to flex the knees and raise the buttocks off the bed. Place the waterproof under-pad under the buttocks.

15. Check the drainage tubing. Make sure it is not kinked and that urine can flow freely.

16. Separate the labia (female). In an uncircumcised male, retract the foreskin (Chapter 22). Check for crusts, abnormal drainage, or secretions.

17. Give perineal care (Chapter 22). Keep the foreskin of the uncircumcised male retracted until step 25.

18. Apply soap to a clean, wet washcloth.

19. Hold the catheter at the meatus. Do so for steps 20 through 24.

20. Wash around the catheter at the meatus. Use a circular motion (Fig. 25-7, A, p. 412).

FIGURE 25-7 Cleaning the catheter. A, The catheter is cleaned with a circular motion at the meatus. B, The catheter is cleaned starting at the meatus. At least 4 inches of the catheter are cleaned.

21. Clean the catheter from the meatus down the catheter at least 4 inches (Fig. 25-7, B, p. 412). Clean downward, away from the meatus with 1 stroke. Do not tug or pull on the catheter. Repeat as needed with a clean area of the washcloth. Use a clean washcloth if needed.