29. CCA Study Notes: Urinary Catheters, Drainage Systems, and Catheter Care

The Big Picture

A urinary catheter is a tube placed in the bladder to drain urine. Some catheters drain the bladder once and are removed. Others stay in place and connect to tubing and a drainage bag.

Catheter care focuses on keeping urine flowing, keeping germs out of the drainage system, protecting the client from injury, and respecting privacy and dignity. CCAs also need to know what to observe, report, record, and check in the care plan.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

What Is a Urinary Catheter?

A catheter is a tube used to drain or inject fluid through a body opening. A urinary catheter goes into the bladder to drain urine.

Catheterization means inserting a catheter. Sorrentino’s Canadian Textbook for the Support Worker, 5th Edition identifies a nurse, physician, or a client who has learned the procedure as people who perform catheterization.

A physician sometimes orders catheterization after a client has already voided ⓘ. This checks how much urine remains in the bladder.

For example, a client who voids 200 mL and then has 300 mL drained by catheter has not emptied the bladder adequately. Sorrentino identifies this as urinary retention that requires medical treatment.

Types of Urinary Catheters

Straight Catheter

A straight catheter enters the bladder through the urethra.

It drains the bladder and is removed after one use.

In-Dwelling Catheter

An in-dwelling catheter stays inside the bladder. It is also called a Foley catheter or retention catheter.

The catheter passes through the urinary meatus and urethra ⓘ into the bladder. A balloon inside the catheter is inflated after insertion. The balloon keeps the catheter from slipping out.

Tubing connects the catheter to a drainage bag.

Suprapubic Catheter

A suprapubic catheter is surgically inserted through the abdomen above the pubic bone and into the bladder.

It is a type of in-dwelling catheter. It remains in the bladder and connects to a drainage bag through tubing.

Suprapubic catheters are used for some clients who need long-term catheterization and after certain surgeries.

The insertion site and tubing are cleaned daily with soap and water and covered with dry gauze. Follow the care plan and assignment sheet.

Care of a suprapubic catheter sometimes involves a sterile procedure or falls outside the worker’s job description. Check with the supervisor, agency policy and procedure manual, or care plan for clarification.

Why Urinary Catheters Are Used

Urinary catheters have several supported purposes.

• Before, during, and after surgery, a catheter keeps the bladder empty. This reduces the risk of accidental bladder injury during surgery and prevents pressure from a full bladder on nearby organs after surgery.
• Catheters allow hourly measurement of urinary output for clients with critical illnesses.
• Catheters have diagnostic uses, including collecting sterile urine specimens and measuring urine left in the bladder after voiding.

Urinary incontinence means loss of bladder control, or being unable to control the passage of urine from the bladder.

• A catheter is a last resort for managing urinary incontinence because it does not treat the cause and infection risk is high.
• A catheter is used in some situations to protect wounds and pressure sores from urine.
• A catheter provides comfort for some extremely weak clients or clients with disabilities who are unable to use a bedpan, commode, or toilet.

Closed Drainage Systems

An in-dwelling catheter, including a suprapubic catheter, uses a closed drainage system.

The system runs from the catheter through tubing to a drainage bag. Nothing should enter the system between the catheter and drainage bag.

Microbes ⓘ that enter the drainage system might travel through the tubing or catheter into the bladder and kidneys. Infection threatens the client’s health and, in serious cases, life.

Drainage Bag Positioning

Correct drainage bag placement is a major safety point.

• Keep the drainage bag below the level of the bladder.
• Never hang the bag from a bed rail.
• When the client is in bed, attach the bag to the bed frame.
• When the client sits in a chair, attach the bag to the back of the chair.
• When the client walks, keep the bag below the bladder.
• Never let the drainage bag rest on the floor.
• Move the drainage bag to the side of the bed where the client will turn. Move it before turning the client.

If the bag sits higher than the bladder, urine might flow backward into the bladder and lead to infection.

Protecting Privacy

A visible drainage bag might embarrass a client.

When visitors are present, carefully cover the drainage bag with a bed sheet or robe.

Some clients use a leg bag when they are out of bed. The leg bag attaches to the thigh or calf. Clothing or a robe covers the bag.

Keep Urine Flowing Freely

Check that urine flows freely through the catheter and tubing.

• Keep the tubing free of kinks ⓘ.
• Do not let the client lie on the tubing.
• Keep the catheter tubing slack during movement.
• Never leave the catheter tubing taut or pulling.
• Coil drainage tubing on the bed and secure it to the bottom linen according to employer policy.
• Do not let the tubing loop below the drainage bag.

For clients with female genitalia, the catheter is secured to the inner thigh. For clients with male genitalia, it is secured to the thigh.

The care plan directs how the catheter is secured. Some agencies avoid certain adhesive tapes because they irritate the skin.

Caring for the Drainage System

Follow medical asepsis and Standard Practices when caring for an in-dwelling catheter.

Check that the catheter remains connected to the drainage tubing. Check the connection for leaks and report leaks immediately.

Do not let the drainage bag drain or spout touch another surface. Each time after draining the bag, wipe the end of the drainage spout with an antiseptic wipe. Follow agency policy for the procedure.

Encourage fluid intake when the care plan instructs you to do so.

Catheter Care and Perineal Care

Catheter care includes cleaning the part of the catheter tube outside the body.

When ordered, catheter care is provided once or twice a day. Some employers consider perineal care alone sufficient. Catheter care is also needed in some situations after fecal elimination or when vaginal drainage is present.

Follow the care plan.

Provide perineal care:

• daily
• after bowel movements
• when vaginal drainage is present

Measuring Urinary Output

Urinary output means the amount of urine a person excretes. The care plan determines whether it is measured every hour, at the end of a shift, at the end of a day, or not at all.

When measuring urine from a drainage bag, follow Standard Practices.

Never rely on the measurement markings printed on the drainage bag. Those markings are inaccurate and unreliable for measuring the collected urine.

Use a clean, dry measuring container for each client.

To read the measurement correctly:

1. Put the clear graduated or measuring cup on a flat surface.
2. Bring your eyes as close as practical to the level of the urine measurement.
3. Read the amount while the container remains on the flat surface.

Do not hold the measuring container in the air while reading it.

After measuring, empty the urine into the toilet or bedpan flusher. Do not empty urine into a sink because it contaminates the sink and produces an unpleasant odour.

Rinse and clean the measuring container according to agency policy.

When Drainage Bags Are Emptied

Drainage bags are emptied according to the care plan and employer or agency requirements.

Common times include:

• at the end of each shift
• when changing a leg bag to a drainage bag
• when changing a drainage bag to a leg bag
• when a leg bag becomes full

In many situations, the urine is measured before the bag is emptied.

What to Report and Record

Report and record supported observations according to employer policy.

Important information includes:

• the amount of urine measured
• increases or decreases in urine amount
• urine colour
• urine clarity
• urine odour
• particles in the urine
• complaints of pain
• complaints of burning
• irritation
• a feeling of needing to urinate
• leaks in the drainage system

Actions, observations, and basic assessments are reported and recorded for legal reasons and to keep the health care team informed.

Accidental Disconnection of the Drainage System

A catheter and drainage system sometimes become disconnected accidentally.

Report: Inform the supervisor immediately.

Do not touch the ends of the catheter or tubing.

Follow this sequence:

1. Practise proper hand hygiene.
2. Put on gloves.
3. Wipe the tubing end with an antiseptic wipe according to employer policy.
4. Use a separate antiseptic wipe for the catheter end.
5. Do not place the cleaned ends on another surface.
6. Do not touch the ends after cleaning them.
7. Reconnect the tubing and catheter.
8. Put the used wipes in a biohazard plastic bag.
9. Remove the gloves.
10. Practise proper hand hygiene.

Follow facility or employer policy for cleaning and reconnecting a disconnected drainage system.

Leg Bags and Role Limits

A leg bag is often used when a client is out of bed. A regular drainage bag replaces it when the client returns to bed.

Changing from one bag to another opens a drainage system that was previously closed. This raises the risk of microbes entering the system.

Some employers do not permit support workers to replace leg bags with drainage bags.

Role limit: A worker performing this delegated task must have formal training, supervision, and monitoring. Follow employer policies and procedures.

Always check the care plan before changing an in-dwelling catheter drainage bag to a leg bag.

When the care plan includes the change, follow the required aseptic technique.

Condom Catheters

A condom catheter is also called an external catheter or urinary sheath.

It is a soft sheath that slides over the penis. Tubing connects it to a drainage bag.

Condom catheters are often used for clients with male genitalia who have urinary incontinence.

Some agencies no longer use them because the tape used to hold the catheter in place irritates the penis.

Before applying a condom catheter:

• wash the penis thoroughly with soap and water
• dry the penis
• follow the manufacturer’s application instructions
• follow the care plan

A new condom catheter is usually applied daily or every few days according to the care plan.

Elastic Tape Versus Adhesive Tape

Use the elastic tape supplied with the condom catheter. Some condom catheters already have elastic material inside them.

Elastic tape expands with penis size and allows blood flow.

Avoid: Never use adhesive tape to secure a condom catheter. Adhesive tape does not expand and might cut off blood flow, causing harm to the penis.

When applying elastic tape during the procedure, wrap it in a spiral. Do not wrap the tape completely around the penis.

Follow medical asepsis and Standard Practices when removing and applying a condom catheter.

What to Report and Record With a Condom Catheter

Report and record:

• reddened areas on the penis
• open areas on the penis
• swelling of the penis
• urine colour
• urine clarity
• urine odour
• particles in the urine

Core Values During Catheter Procedures

Catheter procedures should support the client’s:

• dignity
• independence
• individualized care
• preferences
• privacy
• safety

Privacy measures, covering, draping, safe bed positioning, and explaining the procedure are part of the supported catheter-care procedures.

Urethral Catheter Care

Catheter care follows an ordered procedure. Keep the order in mind as three phases: prepare, provide care, then finish safely.

Before Urethral Catheter Care

1. Identify the client according to employer policy.
2. Explain the procedure.
3. Practise proper hand hygiene.
4. Collect items for perineal care, gloves, a bed protector or incontinence pad, and a cover or bath blanket when one is available.
5. Provide privacy.
6. Raise the bed to a comfortable working height when this step applies in the care setting.

Collecting equipment before starting keeps the needed supplies nearby and avoids leaving the client’s side.

Providing Urethral Catheter Care

7. Lower the bed rail near you if it is raised and this step applies.
8. Put on gloves.
9. Cover the client with a cover or bath blanket when available. Move the top linen toward the foot of the bed.
10. Drape the client for perineal care.
11. Expose only the genital area needed for care.
12. Place a bed protector under the buttocks. Ask the client to flex the knees and raise the buttocks.
13. Provide perineal care.
14. Put soap on a clean, wet washcloth.
15. For a client with female genitalia, separate the labia. For an uncircumcised client with male genitalia, retract the foreskin. Check for crusts, abnormal drainage, or secretions.
16. Hold the catheter near the urinary meatus, the insertion point. This helps prevent accidental tugging.
17. Clean from the meatus down the catheter for about 10 cm (4 in.).
18. Clean downward and away from the meatus in one stroke. Do not tug or pull the catheter. Repeat with a clean part of the washcloth and use another clean washcloth when needed. Provide perineal care.
19. Rinse the catheter.
20. Secure the catheter.
21. Coil and secure the tubing.
22. Remove the bed protector.
23. Cover the client and remove the cover or bath blanket when one was used.
24. Remove the gloves.
25. Practise proper hand hygiene.

Cleaning away from the meatus moves pathogens away from the urinary opening. Securing the catheter reduces the chance of injury from pulling or tugging.

After Urethral Catheter Care

26. Provide for safety and comfort.
27. Place the call bell within reach when this step applies.
28. Return the bed to its lowest position and follow the care plan for bed rail use when these steps apply.
29. Clean and return reusable equipment. Discard disposable items.
30. Remove privacy measures.
31. Handle soiled linen according to employer policy.
32. Practise proper hand hygiene.
33. Report and record actions, observations, and basic assessments according to employer policy.

Some bed, bed-rail, and call-bell steps do not apply in every community setting.

Suprapubic Catheter Care and the CCA Role

The care needed for a suprapubic catheter depends on the client and circumstances.

Some suprapubic catheter care involves a sterile procedure. In some situations, the procedure falls outside the worker’s job description.

Check:

• the client’s care plan
• agency policies and procedures
• the supervisor

Do not assume that the procedure belongs within your assignment.

Changing a Drainage Bag to a Leg Bag

Changing from one bag to another opens a previously closed drainage system and places the client at risk for urinary infection. Always check the care plan before changing an in-dwelling catheter bag to a leg bag. If the change is in the care plan, practise proper aseptic technique.

Equipment

Collect:

• gloves
• drainage bag and tubing
• antiseptic wipes
• bed protector
• sterile cap and catheter plug
• catheter clamp
• paper towels
• bedpan
• cover or bath blanket when available

Before the Bag Change

1. Identify the client according to employer policy.
2. Explain the procedure.
3. Practise proper hand hygiene.
4. Collect all equipment.
5. Arrange paper towels and equipment in the work area.
6. Provide privacy.

Changing the Bag

7. Have the client sit on the side of the bed.
8. Put on gloves.
9. Help the client lie back down. Raise the bed to a comfortable working height when this step applies.
10. Cover the client. Expose the catheter and drainage tubing. Put the bed protector under the leg.
11. Clamp the catheter, not the drainage tubing.
12. Let urine below the clamp drain into the drainage tubing.
13. Open the antiseptic wipes and place them on the paper towels.
14. Open the package containing the sterile cap and plug. Do not touch the sterile cap or plug.
15. Open the package with the leg bag drainage tubing, and attach the drainage bag to the bed frame.
16. Disconnect the catheter from the drainage tubing. Do not let anything touch either end.
17. Remove the cap from the leg bag drainage tubing. Do not touch the ends.
18. If there is doubt that an end stayed untouched, wipe both ends with antiseptic wipes.
19. Insert the catheter end into the leg bag drainage tubing.
20. Put the sterile cap on the old drainage bag tubing.
21. If that tubing end became contaminated, clean it with an antiseptic wipe before applying the sterile cap.
22. Remove the clamp from the catheter so urine drains again.
23. Loop the tubing and secure it to the client’s leg.
24. Remove the old drainage tubing from the bed and place it in the bedpan in case it leaks.
25. Remove and discard the bed protector, or place a washable protector in the hamper.
26. Cover the client and remove the cover or bath blanket when one was used.
27. Take the bedpan to the bathroom.
28. Drain the old drainage bag into a measuring cup.
29. Note the urine measurement.
30. Empty the measuring cup into the toilet.
31. Rinse the measuring cup.
32. Record the amount when agency policy requires it.

After the Bag Change

33. Remove gloves and practise proper hand hygiene.
34. Provide for safety and comfort.
35. Put the call bell within reach when this step applies.
36. Return the bed to its lowest position and follow the care plan for bed rail use when these steps apply.
37. Remove privacy measures.
38. Discard the old drainage tubing and bag or clean the bag according to employer policy.
39. Return the bedpan and other supplies to their proper places.
40. To reconnect a regular drainage bag later, reverse the bag-change procedure.
41. Report and record actions, observations, and basic assessments according to employer policy.

Emptying a Urinary Drainage Bag

Equipment

Collect:

• a graduate or measuring container
• gloves
• paper towels

Ordered Procedure

1. Identify the client according to employer policy.
2. Explain the procedure.
3. Practise proper hand hygiene.
4. Collect the equipment.
5. Provide privacy.
6. Put on gloves.
7. Put paper towels on the floor and place the measuring container on the paper towels.
8. Position the measuring container under the drainage bag drain.
9. Open the drainage bag clamp and direct the drain into the measuring container.
10. Let all urine drain into the container. Do not let the drain touch the container.
11. Close the clamp securely.
12. Wipe the drain tip with an antiseptic wipe according to agency policy and return the tip to its proper position.
13. Measure the urine.
14. Remove and discard the paper towels.
15. Empty the urine into the toilet. Do not use the sink.
16. Rinse the measuring container and empty the rinse water into the toilet.
17. Return the measuring container to its proper place.
18. Remove gloves and practise proper hand hygiene.
19. Record the time and amount on the intake and output (I&O) record.
20. Remove privacy measures.
21. Report and record actions, observations, and basic assessments according to employer policy.

Removing and Applying a Condom Catheter

Some agencies allow only registered staff to perform this procedure.

Role limit: Follow agency policy before performing condom catheter care.

Equipment

Collect:

• a condom catheter
• elastic tape
• a new drainage bag or leg bag
• a cap for the drainage bag
• a basin of warm water
• soap
• a towel and washcloths
• a cover or bath blanket when available
• gloves
• a bed protector
• paper towels

Before the Procedure

1. Identify the client according to employer policy.
2. Confirm that agency policy permits you to perform the procedure.
3. Explain the procedure.
4. Practise proper hand hygiene.
5. Collect the required equipment.
6. Arrange equipment on paper towels in the work area.
7. Provide privacy.
8. Raise the bed to a comfortable working height when this step applies.

Remove the Old Condom Catheter

9. Lower the bed rail near you if it is raised.
10. Cover the client and lower the top linen to the knees.
11. Ask the client to raise the buttocks or turn away from you.
12. Slide the bed protector under the buttocks.
13. Help the client return to the back.
14. Secure the drainage bag to the bed frame, not the bed rail, or prepare the leg bag. Close the drain.
15. Expose only the genital area needed for care.
16. Put on gloves.
17. Remove the elastic tape.
18. Roll the old sheath off the penis.
19. Disconnect the drainage tubing from the condom catheter.
20. Cap the drainage tubing.
21. Discard the old tape and condom catheter.

Provide Care and Apply the New Condom Catheter

22. Provide perineal care.
23. Observe the penis for skin breakdown or irritation.
24. Remove the protective backing from the new condom catheter.
25. Hold the penis firmly.
26. Roll the condom catheter onto the penis.
27. Leave 2.5 cm (1 in.) between the penis and the end of the catheter.
28. Secure the condom catheter with elastic tape.
29. Apply the elastic tape in a spiral.
30. Do not wrap the tape completely around the penis.
31. Connect the condom catheter to new drainage tubing.
32. Coil extra tubing on the bed or attach a leg bag.
33. Remove the bed protector.
34. Remove gloves and practise proper hand hygiene.
35. Cover the client and remove the cover or bath blanket when one was used.

Using a new drainage bag whenever the condom catheter is changed reduces the spread of pathogens. Correct tubing placement allows urine to drain away from the penis. Old urine that collects around the penis can cause skin irritation.

After the Procedure

36. Provide for safety and comfort.
37. Put the call bell within reach when this step applies.
38. Return the bed to its lowest position and follow the care plan for bed rail use when these steps apply.
39. Remove privacy measures.
40. Practise proper hand hygiene and put on clean gloves.
41. Measure and record the urine in the drainage bag.
42. Clean or discard the drainage bag according to employer policy.
43. Discard disposable items.
44. Clean and return the wash basin and other reusable equipment.
45. Remove gloves.
46. Practise proper hand hygiene.
47. Report and record actions, observations, and basic assessments according to employer policy.

Common Mix-Ups

Wrong Idea	Better Idea
Use the drainage bag markings to measure urine.	Use a clean measuring container on a flat surface.
Use adhesive tape to secure a condom catheter.	Use the elastic tape supplied with the condom catheter.
A support worker always replaces a leg bag with a drainage bag.	Some employers do not allow this. If delegated, formal training, supervision, and monitoring are required.