Skip to content

Urinary catheters and routine indwelling catheter care: Clinical skills notes

Notes

Notes

Genitourinary

Urinary Catheters and Routine Indwelling Catheter Care

Introduction

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.

Types of catheters

The most common types of urine catheters are:
 
  • Straight: inserted into the bladder through the urethra; removed once the urine is drained
  • Indwelling (a.k.a. Foley / retention catheter): inserted into the bladder through the urethra; remains in the bladder and lets the urine drain continuously into a drainage bag
  • Suprapubic: inserted into the bladder through a surgical incision made above the pubic bone

Figure 1: The three most common types of urinary catheters are straight, indwelling, and suprapubic. 

Parts of an indwelling catheter

The indwelling catheter 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 (Fig. 2a).
  • 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 especially important in certain cases, like after a prostate surgery (Fig. 2b).

Figure 2: The differences between A. double-lumen and B. triple-lumen indwelling catheters.

Common care tips

  • Remember to close the room’s door and bedside curtain and respect the client’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. Make sure that it doesn’t have any kinks and that the client is not lying on top of it.
  • Place the drainage bag below the level of the bladder to prevent the urine from flowing back into the bladder.

Figure 3: One common care tip is to remember to place the drainage bag below the level of the bladder.

Routine indwelling catheter care

Supplies

First, gather the supplies you will need, including:

  • gloves
  • a wash basin
  • paper towels
  • soap, towels, and washcloths
  • a waterproof bed pad
  • a bath blanket

Figure 4: Supplies needed to perform routine indwelling catheter care.

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. 
  2. 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. 
  3. Put your gloves on. 
  4. Position a waterproof bed pad under the client’s buttocks to protect the bed linens and cover them with a bath blanket, exposing only the genital area. 
  5. Ask the client to open their legs and bend their knees, if they can; if not, help them to do so. 
  6. Wrap a washcloth around one hand, wet it with warm water, and apply soap. 
  7. If the client has phenotypically female genitalia (Fig. 5a),
    • Use your other hand to separate the labia. 
    • 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. 
    • Rinse and dry the washed areas rigorously. 
  8. If the client has a circumcised penis (Fig. 5b), start by placing your washcloth-covered hand at the top of the penis; if the client has an uncircumcised penis, 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. 
    • 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 four inches. 
    • If the client has an uncircumcised penis, remember to reposition the foreskin.
  9. Remove your gloves and help the client back into the supine position. Help them get dressed and make sure their clothing and bedsheet are clean. 
  10. Return the side rails and the head of the bed to the raised position.

Figure 5: How to care for a client's genitalia using a washcloth.

Emptying a urine drainage bag

Supplies

Urine drainage bags must be emptied 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 
  • alcohol wipes

Figure 6: Supplies needed when emptying a urine drainage bag,

Procedure

  1. Put on the gloves. 
  2. Place the graduate on the floor underneath the urine drainage bag.
  3. 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. 
  4. Clean the emptying spout with an alcohol wipe, re-clamp it, and place it back into its holder.
  5. Use the graduate to measure and record how much urine is collected.
  6. Empty the contents into the toilet.
  7. Remove your gloves.

Documentation

The following should be reported to the healthcare provider:

  • changes in the color, clarity, or odor of the urine 
  • the presence of blood or particles in the urine
  • reports of pain, burning, or irritation related to the catheter
  • redness, swelling, or discharge from the catheter insertion site

After both providing routine indwelling catheter care and emptying a urine drainage bag, make sure to document:
 
  • the date and time 
  • additional details of the procedure, like 
    • the condition of the skin after routine indwelling catheter care 
    • the color, volume, and quality of the urine after emptying a urine drainage bag