Urinary catheterization is a common intervention that is employed for patients facing complaints such as urinary retention and urinary incontinence. It demands adherence to strict protocols by both the healthcare provider and the patient to ensure the best patient outcomes and to prevent the development of any serious complications.
Many individuals require catheterization outside the medical facility as well and therefore, need assistance or training themselves to properly take care of the catheterization system. Therefore, this literature has been articulated to help you better understand some important protocols that are needed to be practiced by patients and caretakers for a safe catheterization experience.
What Is a Urinary Catheter?
A urinary catheter is a thin, flexible tube that is placed inside the bladder to drain urine when an individual is unable to urinate conventionally. It is approximated that around 4 million Americans undergo urinary catheterization annually, in both hospital and home settings.
When Is a Urinary Catheter Needed?
There are multiple medical conditions where catheterization may be needed, such as:
- Enlarged prostate,
- Post-surgical procedures of the pelvis or urinary tract,
- Paralysis of the lower body,
- Obstruction at the urethra,
- Dysfunction in urinary control.
Types of Urinary Catheterization?
The following are a few types of urinary catheterization that are selected from depending upon the cause behind urinary dysfunction.
Intermittent Catheterization
It is the brief insertion of the catheter at regular intervals to drain urine without leaving it inside for any longer duration. It is a gold standard procedure done to manage bladder emptying dysfunction. It is considered more beneficial than indwelling catheters as the risk of catheter-associated urinary tract infection is relatively low in intermittent catheterization. However, this practice may be difficult for many patients to perform at home without supervision and may require further assistance from family and professional caregivers.
This type of catheterization is accepted in the following conditions:
- To collect urine samples,
- To empty the bladder,
- To measure the residual volume of the bladder,
- To administer medication,
- And to administer contrast material into the bladder for imaging, etc.
Indwelling Urethral Catheterization
An indwelling catheter practice is the insertion of a catheter into the bladder via urethra and securing it in position with balloon retention. The indications for indwelling urethral catheterization include;
- To monitor urine output in critically ill patients,
- To manage acute urinary retention,
- And to provide continuous outflow in pre-operative patients.
Suprapubic Catheterization
It is employed when the urethra is already damaged or obstructed. It is the insertion of a catheter in the bladder via an incision made on the anterior abdominal wall for urinary drainage. Similar to other indwelling catheters it is left in place with balloon retention. The suprapubic catheterization is usually performed at a medical facility under local or general anesthesia by trained medical personnel. It has a greater risk of infection in comparison to urethral catheterization.
Suprapubic catheterization is indicated in the following conditions:
- In patients with an anatomical deformity in the lower urinary tract,
- In complete urethral or prostatic obstruction,
- In patients with a history of pelvic or urethral floor trauma,
- And when a patient has weak pelvic floor muscles that are unable to hold the urethral catheter in place.
How Is Catheter Care Carried Out?
Urinary catheterization is, fortunately, a safe procedure that comes with relatively few complications with the most feared complication being catheter-associated urinary tract infections. However, it is crucial to regularly monitor the urinary catheter to ensure it is functioning properly at all times.
General Measure:
- Adequate hydration must be maintained during the period of catheterization.
- Strenuous physical activities should be avoided after a week or two of catheter placement.
- All parts of the catheterization system should be cleaned regularly, such as the genital areas, catheter tube, and the drainage bag.
- The hands of the individual performing the cleaning should be thoroughly washed with soap and water before and after the procedure.
- The catheter should not be disconnected frequently.
- The tubing should be straightened out to remove any kinks if the urine is observed to be not moving.
Cleaning Catheter Tube and Skin:
- Most patients are allowed to take showers while a catheter is attached to them, however, bathing in bathtubs is advised against as it can increase the risk of contamination. For suprapubic catheters waterproof bandages should be used in the initial days of the procedure.
- The catheter and the site of its attachment to the body should be cleaned with mild soap and water. It is recommended that thorough cleaning of genital areas should be done routinely to reduce any risk of infections.
- The catheter tube should be washed from the site of its exit from the body to its attachment to the urinary bag. It should always be done from near to away from the body and never the other way around.
- The catheter tube should be held in hand to prevent its tugging outward during cleaning.
- A change of bindings securing the catheter in place is advised to be done every time after cleaning and gentle drying.
- The application of creams, sprays, and powders at the site of catheter entrance should be avoided.
- For a suprapubic catheter, the skin around the entrance of the catheter should be cleaned with a washcloth frequently with the application of fresh bandages around it.
Changing Drainage Bag:
In most cases, the changing of the drainage bag is advised to be changed two times a day, which can be done by the patient or with the help of assistance.
- The contents of the drainage bag should be emptied in the toilet, ensuring no part of the drainage bag comes in contact with the toilet or any other surface.
- The emptied drainage bag is then to be detached from the tube and discarded. The catheter end is to be cleaned with an alcohol or disinfectant wipe and reattached to a new drainage bag.
Caring For Leg Bag:
This kind of bag with small tubing and capacity is attached to the leg of the patient and used during the daytime.
- The leg bag should be attached below the knee to facilitate drainage.
- The tubing should be accurately measured from its point of exit from the body to down the calf with the leg slightly extended.
- The tubing and the bag should be secured with straps on the thigh and leg respectively, ensuring they lose enough to allow blood circulation without falling off.
- The leg bag should be emptied as frequently as every two to four hours or when it is half-filled and should be replaced with a new bag every 5-7 days.
- The patient should not lie down while the leg bag is attached to the catheter.
Caring for Night Bag
Another bag called the night bag can be attached which has longer connection tubing for overnight use.
- A night bag should always be kept below the level of the bladder and off the floor at all times.
When to Call A Healthcare Provider?
Medical personnel should be immediately notified in the following cases:
- If the catheter tube slips out of the body. No attempts should be made by the patient to reinsert the tube themselves,
- If the patient develops a fever (101°C or higher),
- If the urine output is significantly reduced than usual,
- If the urine collected in bag smells foul or is cloudy in color,
- If the blood clots or red color urine is observed in the drainage bag,
- If patient experiences burning sensation or pain in the bladder or pelvis,
- If the patient experiences pain around the sides or lower back with absent urine output.
REFERENCES:
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Madeo M, Roodhouse AJ. Reducing the risks associated with urinary catheters. Nursing Standard (through 2013). 2009 Mar 25;23(29):47.
https://www.mskcc.org/cancer-care/patient-education/caring-your-urinary-foley-catheter
Herter R, Kazer MW. Best practices in urinary catheter care. Home Healthcare Now. 2010 Jun 1;28(6):342-9.
Roberts JR. Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care E-Book. Elsevier Health Sciences; 2017 Dec 12.
Cifu DX. Braddom’s physical medicine and rehabilitation E-book. Elsevier Health Sciences; 2015 Aug 2.
Sultana CJ. Bladder drainage and urinary protective methods. Urogynecology and Pelvic Reconstructive Surgery, 2nd ed. Edited by MM Karram and MD Walters. St. Louis: Mosby. 1999:419-26.
