Caring for a Person With an Indwelling Urinary Catheter

Indwelling urinary catheters are connected by a length of tubing to a urine drainage bag. Urine drains continuously from the bladder, through the catheter, down the tubing, and into the drainage bag .

There are several different types of urine drainage bags that you will see in the health care setting. Some urine drainage bags have a long length of tubing that allows them to be carried or secured to a bed frame or the back of a wheelchair. Other urine drainage bags,
called “leg bags,” are connected to the catheter by a short length of tubing and secured to the person’s thigh with straps. Leg bags are useful because they can be concealed underneath a person’s clothing and they allow the person to move around freely.

When a regular urine drainage bag with a long length of tubing is being used, the tubing is secured loosely to the person’s body near the insertion site using a catheter strap or adhesive tape. Securing the tubing to the person’s body prevents the catheter from being accidentally pulled out during repositioning. In women, the tubing is attached to the thigh. In men, the tubing is attached to the thigh or lower abdomen. A little bit of slack is left in the tubing to prevent the catheter from pulling against the bladder outlet and the urethral opening. The remaining length of tubing is then gently coiled and secured to the bed linens using a plastic clip. Coiling the tubing prevents the tubing from becoming bent or kinked, which would stop the free flow of urine into the drainage bag. Coiling the tubing and securing it to the bed linens also keeps the weight of the tubing from pulling against the person’s body. The drainage bag is then secured to the bed frame or the back of the person’s wheelchair, at a level lower than the person’s bladder. If
the drainage bag and tubing are higher than the person’s bladder, then gravity could cause old, contaminated urine to run back down the tubing and into the person’s bladder, causing an infection.

All urine drainage bags have a connection adapter (where the catheter tubing attaches) and an emptying spout that is opened to allow urine to drain from the bag. Because the inside of the catheter and tubing are sterile, it is safer for the person if the bag is not disconnected from the tubing once the catheter is in place. Disconnecting the bag from the tubing can allow harmful bacteria to enter the catheter. Occasionally, the tubing has to be disconnected from the bag (for example, to change the bag if it is leaking, to replace a regular drainage bag with a leg bag, or to perform certain procedures).

If you must disconnect the tubing from the bag, be sure to prevent the end of the tubing from touching anything, and wipe the exposed tubing with an antibacterial wipe before reconnecting the drainage bag.

Providing Catheter Care
Although you may not be permitted to catheterize your patients or residents, you will most likely be responsible for providing catheter care. Catheter care involves thorough cleaning of the perineal area (especially around the urethra) and the catheter tubing that extends outside of the body, to prevent infection. Providing good catheter care is important because the catheter provides a pathway for bacteria to travel up from the perineum into the bladder, where they can cause infection. In addition, having a catheter in place eliminates the “flushing” action of normal urination, which helps to remove bacteria from the urinary tractnaturally. Because bacteria can be introduced into the body both when a urinary catheter is inserted and after it is in place, urinary tract infections in catheterized people are among the most common health care– associated infections (HAIs). (Remember that HAIs are
acquired in the health care setting.) In an effort to reduce the risk of HAIs in people who are catheterized, many facilities require catheter care to be provided routinely (for example, once or twice daily), and again whenever the perineal area becomes soiled (such as when a person is incontinent of feces). Soap and water should be used when providing cathether care

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