Genitourinary: Urinary catheters and routine indwelling catheter care (for nursing assistant training)

A urinary catheter is a tube that goes into the bladder that drains urine. This is commonly used in a variety of situations, such as before, during, or after an operation, in order to keep the bladder empty.

It’s also used to monitor the amount of urine produced by people with urinary incontinence, in those with wounds or pressure ulcers that need to be protected from contact with urine, or to collect sterile urine samples.

Catheter care is essential for preventing urinary tract infections because an indwelling catheter is a pathway for bacteria to move up from the perineum into the bladder.

This is important because, during normal urination, the urine flow acts as a natural way to “flush” bacteria out of the urinary tract.Now, the most common types of urine catheters are straight, indwelling, and suprapubic catheters.

Both straight and indwelling catheters are inserted into the bladder through the urethra, but the difference is that a straight catheter is removed once the urine is drained, while an indwelling urinary catheter, also called Foley catheter or retention catheter, remains in the bladder and lets the urine drain continuously into a drainage bag.

With the suprapubic catheter, “supra-” means above and “pubic” refers to the pubic bone, so it is inserted into the bladder through a surgical incision made above the pubic bone.

Let’s focus on the indwelling catheter. This consists of a soft balloon that is inflated inside the bladder to keep the catheter from slipping out and a length of tubing, which connects the catheter with a drainage bag for collecting urine.

Indwelling catheters may have two or three lumens. In double-lumen indwelling catheters, one is for urine drainage and the other one is used to inflate the balloon.

In triple-lumen indwelling catheters, the additional lumen is used to regularly deliver irrigation fluid into the bladder.

This can help prevent blood clots from forming, which is important in certain cases, like after a prostate surgery.Before we talk about how to provide the best catheter care, here are some general considerations.

Remember to close the room’s door and bedside curtain and respect the patient’s privacy. Before beginning the procedure, unclip the catheter tubing from the bed linens.

When caring for a client, make sure you do not pull or tug on the catheter. When you are finished, secure the catheter tubing again and make sure that it doesn’t have any kinks and that the patient is not lying on top of it.

You also need to make sure that the drainage bag is placed below the level of the bladder to prevent the urine from flowing back into the bladder.

Okay, for routine indwelling catheter care, start by making sure that the wheels on the bed are locked and the side railings on the working side are down.

Lower the head of the bed so that the bed is flat. Fill the wash basin with water and check that the temperature is comfortably warm.

Cover the over-bed table with paper towels and use it to place the basin together with soap, towels, and washcloths. Next, put your gloves on, position a waterproof bed pad under the patient’s buttocks to protect the bed linens, and cover them with a bath blanket, exposing only the genital area.

Ask them to open their legs and bend their knees, if they can; if not, help them to do so. Wrap a washcloth around one hand, wet it with warm water, and apply soap.

Now, if the patient is female, use your other hand to separate the labia. Next, move the washcloth downwards from the top of the vulva towards the anus.

Remember to use a different part of the washcloth with each swipe and repeat until the area is clean. Then make sure to rinse and dry the washed areas rigorously.

Now, if the patient is a circumcised male, start by placing your washcloth-covered hand at the top of the penis; while in an uncircumcised male, first retract the foreskin by gently pushing the skin down toward the base of the penis.

In both cases, continue by washing in a circular motion downwards to the base of the penis. Repeat using a different part of the washcloth until the area is clean.

Once again, make sure to rinse and dry the washed areas. Next, clean the catheter in a circular motion, starting near the urinary meatus and moving away from the body and along its length for about 10 cm, or 4 inches.

In an uncircumcised male, remember to reposition the foreskin. Then you can remove your gloves and help the patient go back into the supine position.

Help them get dressed and make sure their clothing and bedsheet is clean. Finally, return the side rails and the head of the bed to the raised position.You might be asked to empty a urine drainage bag.

This must be done routinely: at the end of every shift, or as soon as they become full. For this procedure, you’ll need gloves, paper towels, a graduate, and alcohol wipes.

Start by putting on the gloves. Place the graduate on the floor underneath the urine drainage bag.

Unhook the drainage bag emptying spout from its holder and unclamp it, allowing the urine to drain into the graduate. Check to see if there are any kinks in the tube and make sure the entire tube is drained because it’s important to keep track of the quantity of urine for some clients.

After the urine has drained into the graduate, clean the emptying spout with an alcohol wipe, re-clamp it, and place it back into its holder.

Use the graduate to measure and record how much urine is collected before emptying the contents into the toilet. Remove your gloves.It’s also important to recognize signs, symptoms, or situations where you should notify the nurse immediately.

These include changes in the color, clarity, or odor of the urine; the presence of blood or particles in the urine; urine not flowing freely through the tubing; complaints of pain, burning, or irritation related to the catheter; redness, swelling, or discharge from the catheter insertion site; or urine leaks.

After both types of procedures, make sure to document the date and time as well as additional details of the procedure, like the condition of the skin after routine indwelling catheter care and the color, volume, and quality of the urine after emptying a urine drainage bag.

##SummaryAlright, as a quick recap… Urinary catheters are commonly used to allow urine to drain out of the bladder. The most common types of urine catheters are straight, indwelling, and suprapubic catheters.

Indwelling catheters consist of a balloon, tubing, and a drainage bag and can have two or three lumens. Providing good care for indwelling catheters is important to prevent urinary tract infections.

Emptying a urine drainage bag should be done after each shift or whenever it gets full. After every procedure, remember to report any unusual signs