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Removing indwelling catheters: Clinical skills notes

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Notes

Genitourinary

Removing Indwelling Catheters

INTRODUCTION
An indwelling urinary catheter is also called Foley catheter or retention catheter. It is a tube that goes through the urethra into the bladder where it remains, allowing urine to drain continuously into a drainage bag. It consists of a balloon that can be inflated inside the bladder to keep the catheter from slipping out, a long tubing, and the drainage bag that collects urine.  
Figure 1: The parts of an indwelling urinary catheter.
COMMON CARE TIPS
  • Before beginning the procedure, confirm the exact amount of water that had been used to inflate the balloon, and the port on the balloon catheter; this will tell you the recommended volume used to inflate the balloon. 
  • It’s important to remove all the water; otherwise, a partially inflated balloon could cause trauma to the urethral wall during the removal.
  • Close the room’s door and bedside curtain and respect the client’s privacy.
  • Keep in mind that using an indwelling catheter can lead to decreased muscle tone and temporary urinary incontinence after the catheter is removed.
  • Inform the client that it’s normal to experience a burning sensation and decreased urine volume the next time they void.  
REMOVING AN INDWELLING CATHETER

Supplies

First, gather the supplies you’ll need, including:
  • gloves
  • a bath blanket
  • a disposable bag
  • the correctly sized syringe (confirm this size is correct by double-checking the number stated on the balloon port of the catheter)
Figure 2: Supplies needed to remove an indwelling catheter.

Procedure

  1. Make 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 and at a comfortable working height. 
  2. Put your gloves on and cover the client with a bath blanket, exposing only the genital area. 
  3. Ask the client to open their legs and bend their knees, if they can. If not, help them to do so. 
  4. Unclip the catheter tubing from the bedsheet. 
  5. Slide the syringe plunger up and down several times to loosen it and then pull the plunger back to the 0.5 milliliter mark.(Fig. 3a).
  6. Insert the hub of the syringe to the catheter's balloon port and allow the fluid to fully drain into the syringe (Fig. 3b).
    • Let gravity pull the fluid down naturally and do not pull back on the syringe because this can cause ridges to form on the balloon, leading to discomfort or trauma. 
    • Make sure that the entire amount of fluid that had been originally inserted has been removed. 
  7. Pull the catheter out gently in one slow, smooth action without using any force (Fig. 3c). Inspect the catheter once it’s fully out to make sure no part is left in the client. 
  8. Provide perineal care, making sure the client is dry and comfortable. 
  9. Discard the used catheter into the appropriate container.
Figure 3: Steps 5, 6, 7 in removing an indwelling catheter.
DOCUMENTATION
After the procedure, notify the healthcare provider if you notice:
  • dysuria that persists
  • discharge from the catheter insertion site  

Make sure to document these, along with:
  • the date and time
  • the amount of urine present in the drainage bag
COMMONLY ENCOUNTERED PROBLEMS
  1. If the catheter can’t be removed smoothly with minimal force, try deflating the balloon and retrying the process. In clients with phenotypically male genitalia, gently applying a small amount of traction on the penis can help straighten the urethra. 
  2. If water in the balloon does not drain into the syringe, repositioning the client can help straighten kinks in the catheter. If that fails, detach and replace the syringe with a new one.