Urinary Catheter Guidelines

Urinary catheters are frequently used in the hospital and nursing home setting to manage urinary incontinence and urinary retention. They are also used when highly accurate fluid intake and output must be monitored. Some patients have an indwelling catheter, which is a catheter designed for long-term use. Catheters are designed to drain urine from the bladder.

Types of Catheters

• A standard catheter used in hospitals is a Foley. It has a large plastic bag which can hold a little over 1 liter of urine. A small bag, called a leg bag, can be secured to the leg and worn discreetly under clothing. A straight catheter is used by patients who insert the catheter long enough to drain the urine, then remove it.

Catheter Care

• The use of catheters has come under fire in recent years due to increased chances of urinary tract infection. Hospitals and other facilities have strict protocols in place to prevent infections. Catheters remain in place for the shortest time possible. The urethral area (where the catheter is inserted) must be cleaned daily with soap and warm water. Clean the area and tubing thoroughly after a bowel movement.

  Wash hands before and after catheter care, and wear gloves when handling a catheter. Be sure the urine collection bag is below bladder level (usually on the floor or hanging on the bed) to prevent urine from backing up into the bladder and causing infection.

Troubleshooting

• A catheter may leak around the insertion site if the catheter is too small, the balloon is not fully inflated, or because of bladder spasms. A small balloon is inflated in the bladder to hold the catheter in place. If not inflated enough, urine leakage can occur. Be sure to see if balloon is inflated with enough saline as directed by manufacturer. Standard Foleys use 10 cc of saline to fully inflate the bulb. If the tube size is too small, the catheter may need to be removed and replaced with a larger size.

  If no urine is draining, the catheter may be gently irrigated to see if there is a clot blocking urine flow. To irrigate, use sterile gloves, sterile saline, and a sterile syringe. Draw up 30 cc of sterile saline in the syringe. Disinfect the area around the rubber catheter and plastic drainage tubing. Disconnect the drainage tube from the catheter while folding the catheter to prevent urine leakage. Attach the syringe to the catheter, releasing the folded area. Very gently squeeze the syringe and infuse about 10 cc into the catheter. Draw back slowly to see if urine flows into syringe. Is it clear, bloody, or are clots present? Repeat this process slowly using no more than 30 cc of sterile saline. If clots are noted, flush again to see if any more are present. Then reconnect the drainage tubing to the catheter. Monitor urine flow for color and any more clots.

  If no urine drains, check the tubing to be sure it isn't kinked or twisted. If none of these solutions work, contact the health care provider immediately.

Warnings

• Monitor urine output frequently, especially in patients with kidney disease, for adequate output. Each facility will have guidelines; many hospitals use a standard of 30 cc per hour in patients with adequate kidney function. If urine production slows down or stops, notify the health care provider immediately.

  Be sure the genital area is cleaned daily and after every bowel movement. Monitor for skin breakdown around genitals and on legs where tubing may lie. Secure tubing to leg using facility-approved tubing device. When turning or moving patient, be sure there is enough slack on tubing to prevent pulling. Frequently move tubing to keep from damaging skin on patients who are not able to move on their own.

  Monitor vital signs, especially fever. If patient should develop fever, be prepared to send a urine sample for urinalysis. Also monitor for wide fluctuations in blood pressure, which could indicate blockage or inadequate output.