Urinary Catheters: Comprehensive Notes
Urinary Catheters
Objectives
Define key terms and abbreviations related to urinary catheters.
Explain the reasons for using urinary catheters.
Describe four different types of urinary catheters.
Explain the purpose of and rules for catheter care.
Describe two urine drainage systems.
Explain how to reconnect a catheter and drainage tubing.
Explain how to remove an indwelling catheter.
Explain how to apply a condom catheter.
Perform the procedures described in the chapter.
Explain how to promote PRIDE (Personal and Professional Responsibility, Rights and Respect, Independence and Social Interaction, Delegation and Teamwork, Ethics and Laws) in the person, the family, and yourself.
Key Terms
Catheter: A tube used to drain or inject fluid through a body opening.
Catheterization: The process of inserting a catheter.
Condom Catheter: A soft sheath that slides over the penis and is used to drain urine; also known as an external catheter, Texas catheter, or urinary sheath.
Foley Catheter: Another term for "indwelling catheter."
Gravity: A natural force that pulls things downward, essential for urine drainage.
Indwelling Catheter: A catheter left in the bladder so urine drains constantly into a drainage bag; also known as a retention or Foley catheter. A balloon near the tip is inflated with sterile water to prevent the catheter from slipping out.
Retention Catheter: Another term for "indwelling catheter."
Straight Catheter: A catheter that drains the bladder and then is removed.
Supra-pubic Catheter: A catheter surgically inserted into the bladder through an incision above (supra) the pubis bone (pubic), used when the urethra is blocked or long-term catheterization is needed.
Key Abbreviations
BM: Bowel movement
CAUTI: Catheter-associated urinary tract infection
ID: Identification
IV: Intravenous
mL: Milliliter
UTI: Urinary tract infection
Catheters
A catheter is a tube used to drain or inject fluid through a body opening. When inserted into the bladder, a urinary catheter drains urine.
Straight Catheter: Drains the bladder and is then removed.
Indwelling Catheter (Retention or Foley Catheter):
Left in the bladder, allowing continuous urine drainage into a bag.
A balloon by the tip is inflated with sterile water to prevent removal (see Figure 28-1).
Tubing connects the catheter to a urine drainage bag (see Figure 28-2).
Supra-pubic Catheter:
Surgically inserted into the bladder through an incision above the pubis bone (see Figure 28-3).
Less common, used when the urethra is blocked or for long-term needs.
Condom Catheter:
A soft sheath that slides over the penis; not inserted into the bladder.
See "Condom Catheters" on page 432.
Delegation Guidelines: Catheters
Inserting and removing straight and indwelling catheters are typically nursing responsibilities.
Some states and agencies may allow delegation of these tasks to trained nursing assistants with proper guidance and assistance.
Inserting and removing supra-pubic catheters are not nursing responsibilities and cannot be delegated to nursing assistants.
Purposes of Catheters
Keeping the bladder empty before, during, and after surgery: This helps prevent bladder injury during surgery, allows for monitoring of urine output, and reduces pressure on nearby organs post-surgery, which can cause pain or discomfort.
Promoting comfort for those too weak or disabled to use regular methods, such as dying persons, preventing incontinence.
Protecting wounds and pressure injuries from urine contact.
Enabling hourly urine output measurements.
Collecting sterile urine specimens.
Measuring residual urine (the amount left after voiding).
Catheters do NOT treat the cause of incontinence and should be a last resort.
Catheter-Associated UTIs (CAUTIs)
The urinary system is normally sterile; catheters increase the risk of infection. create a high risk of UTI, particularly in patients with compromised immune systems or other underlying health conditions.
A CAUTI occurs when microbes enter the urinary tract through the catheter.
Microbes can travel up the catheter, infecting the bladder and kidneys, leading to severe illness or death.
Proper catheter care is crucial to reduce CAUTI risk.
Catheter Care
Follow the rules outlined in Box 28-1 to ensure safety and comfort.
Box 28-1: Indwelling Catheter Care
Preventing Infection:
Adhere to medical asepsis principles.
Follow Standard Precautions and the Bloodborne Pathogen Standard.
Encourage adequate fluid intake as directed by the nurse and care plan.
The Drainage System:
Ensure urine flows freely through the catheter and tubing; prevent kinks and avoid pressure on the tubing.
Keep the catheter connected to the drainage tube; follow reconnection procedures if disconnection occurs.
Maintain the drainage tube and bag below bladder level to prevent backflow.
During bed/chair transfers, keep the bag lower than the bladder and secure it to the bed frame or chair.
Move the bag to the opposite side during repositioning.
Hang the bag from the bed frame, chair, wheelchair, or IV pole (but NOT on bed rails).
Position tubing to avoid tangling in wheelchair wheels.
Keep the bag below bladder level during ambulation.
Avoid letting the drainage bag touch the floor to prevent contamination.
Position tubing in a straight line or coil it on the bed, securing it to the bottom linens according to agency policy.
The Catheter:
Secure the catheter as directed by the nurse:
Females: to the thigh.
Males: to the abdomen (for long-term use) or the thigh.
Use a tube holder, tape, leg band, or other device to secure the catheter and prevent movement/friction at the meatus.
Check for leaks at connections and report any immediately.
Provide perineal and catheter care as per the care plan (daily, twice daily, after BM, or with vaginal discharge).
Measuring Urine (Output):
Empty the drainage bag and measure urine:
At the end of each shift.
When changing between a leg bag and a standard drainage bag.
When the bag is becoming full.
Before weighing the person.
Report any increase or decrease in urine amount.
Use a separate measuring container for each person to prevent microbe transmission.
Avoid letting the drain on the bag touch any surface.
Observations:
Report complaints immediately (pain, burning, urgency, irritation).
Report urine color, clarity, odor, and presence of particles or blood.
Observe for UTI signs/symptoms (fever, chills, flank pain/tenderness).
Report changes in urine (blood, foul smell, particles, cloudiness, oliguria).
Report changes in mental/functional status (confusion, decreased appetite, falls, decreased activity, tiredness).
Report urine leakage around the catheter.
Delegation Guidelines: Catheter Care
Catheter care is a routine nursing task that can be delegated.
Necessary information includes:
Frequency of catheter care.
Water temperature for perineal care.
Catheter securing location (thigh or abdomen).
Method of securing (tube holder, leg band, tape).
Drainage tubing positioning (straight or coiled).
Drainage tubing and bag securing location (bed, chair, wheelchair).
Method of securing drainage tubing (clip, bed sheet clamp).
Observations to report (pain, burning, irritation, abnormal drainage, urine characteristics, leaks). blood in the urine.
Promoting Safety and Comfort: Catheter Care
Follow agency policy and care plan for hygiene; perineal care may be sufficient.
Clean, rinse, and dry the catheter from the meatus down at least 4 inches in one direction.
Hold the catheter securely during care to avoid pulling at the insertion site.
Ensure tubing is not under the person to prevent blockage and skin breakdown.
Urine Drainage Systems
A closed drainage system is essential for indwelling catheters to prevent infection.
Two types of urine drainage bags:
Standard drainage bags: hold at least 2000 ml
ewline mL. (milliliters)Leg bags: attach to the thigh or calf with elastic bands or Velcro, holding less than 1000 ml
ewline mL, used when the person is up.
If the drainage system disconnects, inform the nurse immediately and avoid touching the catheter or tubing ends.
Box 28-2 describes how to reconnect the catheter and tubing.
Box 28-2: Reconnecting a Catheter and Drainage Tube
Practice hand hygiene. Put on gloves.
Wipe the end of the drainage tube with an antiseptic wipe.
Wipe the end of the catheter with another antiseptic wipe.
Do not put the ends down. Do not touch the ends after you clean them.
Connect the drainage tubing to the catheter.
Discard the wipes into a biohazard bag.
Remove the gloves. Practice hand hygiene
Leg bags are switched to standard bags when the person is in bed, ensuring gravity drainage.The drainage bag stay lower than bladder level.
Delegation Guidelines: Urine Drainage Systems
Changing and emptying urine drainage bags may be delegated.
Necessary information includes:
When to empty the bag.
Leg bag usage.
Type of leg bag straps (elastic or Velcro).
When to switch between standard and leg bags.
Whether to clean or discard the bag.
Observations to report (urine amount, color, clarity, odor, particles, blood, leaks, complaints).
Promoting Safety and Comfort: Urine Drainage Systems
Safety:
Gravity is essential for drainage; keep the bag below bladder level at all times. clamp is applied to the catheter not to the drainage tube.
Maintain surgical asepsis when opening sterile packages during bag changes.
Empty leg bags frequently, as they hold less urine.
Comfort:
Address potential embarrassment by positioning visitors away from the bag and emptying it before visits.
Use drainage bag holders to promote privacy.
Changing a Leg Bag to a Standard Drainage Bag
This procedure requires sterile technique to prevent contamination of the urinary tract.
Gather supplies: gloves, standard drainage bag and tubing, antiseptic wipes, waterproof under-pad, sterile cap and plug, catheter clamp, paper towels, bedpan (optional), bath blanket.
Explain the procedure to the patient.
Apply gloves and position the patient comfortably.
Empty the leg bag and clamp the catheter to prevent further urine flow.
Use antiseptic wipes to clean the ends of both the catheter and the drainage tube after disconnecting them.
Insert the sterile plug into the catheter end and place the sterile cap on the end of the leg bag drainage tube.
Connect the new standard drainage bag to the catheter and remove the clamp.
Emptying a Urine Drainage Bag
Gather supplies: gloves, graduate (measuring container), paper towels, antiseptic wipes.
Explain the procedure to the patient.
Apply gloves and place a paper towel on the floor with the graduate on top.
Open the clamp on the drain and allow all urine to drain into the graduate, ensuring the drain doesn't touch the graduate itself.
Clean the end of the drain with an antiseptic wipe, then clamp it and position it in the holder.
Measure the urine and record the amount.
drain does not touch the inside of the graduate
Removing Indwelling Catheters
Indwelling catheters have two lumens: one for sterile water to inflate the balloon and one for urine drainage. (see Figure 28-14).
To remove, deflate the balloon by removing all the water using a syringe.
Requires a doctor's order.
Dysuria and urinary frequency are common after removal.
Focus on Communication: Removing Indwelling Catheters
Explain the procedure to the person before starting and during the procedure.
Also, tell the person about possible discomfort and when it might be felt.
Have the person tell you at once if pain is felt or if you should stop.
Ask the person to breathe out (exhale) when removing the catheter to distract the person and promote relaxation.
Focus on Math: Removing Indwelling Catheters
To remove indwelling catheters, you must know how to measure liquid using a syringe.
Syringes are marked in milliliters (mL).
The amount of water removed should equal the amount injected.
Subtract the amount removed from the amount injected. If there is a difference, tell the nurse before removing the catheter.
Delegation Guidelines: Removing Indwelling Catheters
Removing an indwelling catheter is a nursing responsibility.
Promoting Safety and Comfort: Removing Indwelling Catheters
The catheter package prescribes the amount of water needed to inflate the balloon.
For proper inflation, the amount of water used is greater than the balloon size. (see Figure 28-16).
Before removing the catheter, you must know the amount of water in the balloon.
You must remove all water from the balloon.
Do not remove the catheter if water remains in the balloon. Call for the nurse at once.
Condom Catheters
Condom catheters are often used for incontinent men, also known as external catheters, Texas catheters, and urinary sheaths.
A condom catheter is a soft sheath that slides over the penis and is used to drain urine.
Tubing connects the condom catheter to the drainage bag.
Many men prefer leg bags.
Condom catheters are changed daily after perineal care.
Thoroughly wash and dry the penis before applying the catheter.
Some condom catheters are self-adhering.
Non-adhering catheters are secured with elastic tape.
Use the elastic tape packaged with the catheter.
Apply the tape in a spiral. This allows blood flow to the penis.
Only use elastic tape.
Never use such tapes to secure condom catheters. Blood flow to the penis is cut off, injuring the penis.
thoroughly wash your hands before and after handling the catheter to prevent infection and ensure proper hygiene. Additionally, always check for any signs of leakage or blockage in the catheter to maintain optimal function and patient comfort. condom catheters are changed daily after perineal care.
Delegation Guidelines: Condom Catheters
Removing and applying a condom catheter is a nursing responsibility that may be safely delegated to you. In some states and agencies, it is a routine nursing task.
Promoting Safety and Comfort: Condom Catheters
Do not apply a condom catheter if the penis is red, irritated, or shows signs of skin breakdown. Report your observations at once.
Blood must flow to the penis. If tape is needed, use the elastic tape packaged with the catheter. Apply it in a spiral.
To apply a condom catheter, you need to touch and handle the penis. This can embarrass the man. Some men become sexually aroused. Act in a professional manner.
To mitigate discomfort, ensure that the environment is private and respect the patient's dignity throughout the procedure.
test
1c
2a/d(remove a kink from the drainage is safe)
3a
4a
5c
6b
7d
8b/c(gloves and antiseptic wipes to cover the catheter during insertion and minimize the risk of infection. )
9a
10b
11a
12d