Urinary Catheter Bag – Emptying

The bladder is an expandable hollow organ made of muscle, located in the pelvis behind the pubic bone. It collects and stores urine from the kidneys and there is variation in its size and position depending on the volume of urine it holds (Marshall et al. 2017). There are many reasons why a patient may need a urinary catheter inserted for either short- or long-term use. Indications for urinary catheterisation are outlined briefly in Box 1. 

When a patient has a urinary catheter inserted, a drainage device must be selected. The two main types of drainage equipment are drainage bags and catheter valves (Carr 2019).  Catheter valves are becoming increasingly popular because they afford the patient some comfort, they are convenient, more discreet and enable independence/social life thereby restoring an acceptable quality of life. Also, it protects the bladder neck, which can be damaged by the weight of urine in leg bags. However, they are not suitable for all patients or situations and with hospitalised or acutely/critically ill patients it is more likely that a drainage bag will be used (Yates 2016).

The choice of drainage bag will depend on the reason for catheterisation, the expected duration of the catheterisation and patient preference (where possible) (Yates 2017). Drainage bags are available in a range of sizes and shapes that include 2-litre or body-worn bags (leg and belly) (Nazarko 2020). The leg bags come in three different lengths (direct inlet, short tube or long tube) with various capacities; these are 350 mL, 500 mL and 750 mL (Yates 2017). Large bags (up to 2 litres) can be used for bedbound patients and at night for extra capacity for those who use a leg bag during daytime but according to Yates (2017) it is crucial that the ‘link system’ is adopted. This system requires the 2-litre bag to be attached to the outlet drainage tube of the bag connected to the catheter. The outlet tap on the leg bag must be left open so the urine collects in the 2-litre bag. It is disconnected and disposed of each morning. Some bags have reservoirs for facilitating hourly measurement of urine without necessitating opening the ‘closed’ system. Most drainage bags have an anti-reflux valve and an outlet to facilitate emptying. Available also are fabric-backed leg bags, which can be used when plastic backing causes skin irritation (Nazarko 2020).

Authors:

Based on Nicol: Essential Nursing Skills 4E
Adapted by Christine Evans BA(Hons) Ed CertEd (PCeT)  DipRSA RGN RT; Sue Faulds BSc(Hons) MA(Ed) DipHE RN
Updated by:  Juliana Tinhunu RN, BSc (Hons)Nursing Studies and MSc (Health Management)
Last updated: October 2020

Learning Objective

The purpose of this learning material is to provide you with a resource to: • Facilitate the development of new knowledge • Build on existing knowledge • Test knowledge • Assess the skill in practice

INTRODUCTION

The bladder is an expandable hollow organ made of muscle, located in the pelvis behind the pubic bone. It collects and stores urine from the kidneys and there is variation in its size and position depending on the volume of urine it holds (Marshall et al. 2017). There are many reasons why a patient may need a urinary catheter inserted for either short- or long-term use. Indications for urinary catheterisation are outlined briefly in Box 1. 

When a patient has a urinary catheter inserted, a drainage device must be selected. The two main types of drainage equipment are drainage bags and catheter valves (Carr 2019).  Catheter valves are becoming increasingly popular because they afford the patient some comfort, they are convenient, more discreet and enable independence/social life thereby restoring an acceptable quality of life. Also, it protects the bladder neck, which can be damaged by the weight of urine in leg bags. However, they are not suitable for all patients or situations and with hospitalised or acutely/critically ill patients it is more likely that a drainage bag will be used (Yates 2016).

The choice of drainage bag will depend on the reason for catheterisation, the expected duration of the catheterisation and patient preference (where possible) (Yates 2017). Drainage bags are available in a range of sizes and shapes that include 2-litre or body-worn bags (leg and belly) (Nazarko 2020). The leg bags come in three different lengths (direct inlet, short tube or long tube) with various capacities; these are 350 mL, 500 mL and 750 mL (Yates 2017). Large bags (up to 2 litres) can be used for bedbound patients and at night for extra capacity for those who use a leg bag during daytime but according to Yates (2017) it is crucial that the ‘link system’ is adopted. This system requires the 2-litre bag to be attached to the outlet drainage tube of the bag connected to the catheter. The outlet tap on the leg bag must be left open so the urine collects in the 2-litre bag. It is disconnected and disposed of each morning. Some bags have reservoirs for facilitating hourly measurement of urine without necessitating opening the ‘closed’ system. Most drainage bags have an anti-reflux valve and an outlet to facilitate emptying. Available also are fabric-backed leg bags, which can be used when plastic backing causes skin irritation (Nazarko 2020).

Catheters are a source of infection and a sterile, closed urinary drainage system is fundamental and its maintenance is one of the most important aspects of preventing the development of a catheter-associated urinary tract infection (CAUTI) (Royal College of Nursing (RCN) 2019). The drainage bag should be changed when clinically indicated; for example, discoloration, the presence of sediment, evidence of damage or an offensive smell  (Loveday et al. 2014). Also, they must be changed at least every 7 days or according to manufacturer’s instructions (Davis 2019, RCN 2019). They must never be washed and reconnected, and antiseptic or antimicrobial solutions should not be added to them. Drainage bags must always be positioned below the level of the bladder and must not be in contact with the floor (National Institute of Health and Care Excellence (NICE) 2014).

The emptying of the drainage bag should be undertaken with the aim of minimising risk to the patient and others (Loveday et al. 2014, NICE 2014). It should be emptied frequently to maintain urine flow and prevent reflux and it must never be more than three-quarters full (Loveday et al. 2014).  
 
The connection between the urinary catheter and the drainage bag should not be broken unless clinically indicated or if changing the bag in line with manufacturer’s recommendations (NICE 2014).   

PREPARATION AND SAFETY

• Explain the procedure to the patient and obtain their consent although it should not cause any discomfort.

• The patient may prefer the bed to be screened.

• If the patient is ambulant and has a leg bag, they can empty this into the lavatory.

• Perform hand hygiene.

• Put on a disposable apron and non-sterile gloves.

• Personal protective equipment should be worn where necessary.

PROCEDURE

1. Take the jug, paper towel, and 2 alcohol swabs to the bedside. Rationale – It is important to collect all the equipment you need prior to commencing the procedure.

2. If the drainage bag is on a floor stand, it does not need to be removed from the stand for emptying. Rationale – Always ensure that the bag into which the urine is flowing is at a level lower than the bladder to facilitate drainage.

3. Hold the bag over the jug, making sure that the drainage port does not touch the jug. Rationale – To prevent the risk of cross-contamination and the introduction of any bacteria into the catheter system.

4. Clean the drainage port with an alcohol-impregnated swab. Rationale – To reduce the risk of infection.

5. Open the drainage port and allow all the urine to flow into the jug. Rationale – To ensure all urine has been emptied from the bag into a suitable receptacle.

6. Close the drainage port. Rationale – To maintain the closed drainage system and prevent the urine leaking onto the floor.

7. Wipe the outlet tap again with the alcohol-impregnated swab. Rationale – To prevent urine dripping onto the floor and reduce the risk of cross-contamination and the introduction of any bacteria into the catheter system.

8. Reposition the catheter bag as necessary to ensure that the drainage port is not touching the floor and the tubing is not kinked, to allow free drainage into the bag. Rationale – To prevent the risk of cross-contamination and the introduction of bacteria into the catheter system, and to ensure the urine can  drain freely into the bag.

9. Cover the jug and take it to the sluice to measure the amount of urine, and discard. Rationale – To prevent contamination of the environment.

ONGOING CARE, MONITORING, AND SUPPORT

• Remove gloves and apron and perform hand hygiene.

• Clean or discard the urine jug according to local policy. If disposable, it will be discarded. If not disposable, it may be disinfected, or placed in a bedpan washer, or returned to the sterile supplies department for decontamination. 

• Ensure the drainage tube at the top of the catheter bag is upright to allow free drainage of urine into the bag.

• If the patient’s condition allows, encourage oral fluids.

• Record the amount of urine on the patient’s fluid balance chart if appropriate.

• If the urine contains blood, debris or has a strong odour, a urine sample may be required to check for infection.

DOCUMENTATION AND REPORTING

• Document the amount of urine drained according to local policies and guidelines.

• Report any abnormalities or complications, such as blood, debris or a strong odour.

EQUIPMENT

• Disposable apron and non-sterile gloves.

• Measuring jug or container according to local policy; it may be single use or one that is disinfected after each use. If using a disinfected jug, it should be one that is used only for urine. This should be a different colour or design from those used for drinking water.

• Paper towel to cover the jug when full.

• Alcohol impregnated swabs.

• If hourly urine measurement is required, a special drainage bag is used, which incorporates a small reservoir that can be emptied into the drainage bag without opening the ‘closed’ system.