Catheter Care Basics for Families

Types of catheter

Indwelling urethral catheter. Passed through the urethra into the bladder, and held in place by a small balloon inflated with sterile water. It drains continuously into a bag. It is changed by a nurse at intervals set by the doctor or the manufacturer, often every few weeks to about three months, depending on the type.

Suprapubic catheter. Placed through a small cut in the lower abdomen directly into the bladder, by a doctor. It avoids the urethra, which can be more comfortable for long-term use and in some people with urethral problems. The skin site needs cleaning.

Intermittent catheter. A thin tube passed several times a day to empty the bladder and then removed. Taught to patients or carers by a nurse; used where the bladder does not empty naturally. It needs clean technique.

External (condom) catheter. A soft sheath that fits over the penis and drains into a bag; used for men with incontinence who can empty the bladder. It is not inserted. The skin must be checked, and the sheath changed daily or as advised.

Ask the nurse which type your parent has, why, when it is due for change and whom to call for help; write it in the health record; see keeping a health record at home.

Drainage bags

Leg bag. A small bag strapped to the thigh or calf, worn under clothes during the day; holds about 350 to 750 ml; emptied through a tap at the bottom.

Night (large) bag. A larger bag, usually about 2 litres, connected to the leg bag outlet or to the catheter at night, hung on a stand or hook off the floor.

Rules for all bags:

• Keep the bag below the level of the bladder at all times, so that urine does not flow back into the bladder; this reduces infection. Never lift the bag above the hips.
• Never place the bag on the floor, where it picks up germs; use a stand or a hook, or a clean holder.
• Keep the tubing free of kinks and loops that block drainage; do not let the person lie or sit on it.
• Do not pull the catheter or the tubing. Use a catheter securing device or a strap, as taught, to hold the catheter on the thigh or abdomen and prevent tugging.
• Empty the bag when it is about two-thirds full, or at least every few hours, and before bed, outing or transfer. Use a separate, clean container each time, and avoid touching the tap on the container; wipe the tap with an alcohol swab or tissue after emptying, as taught.
• Wash hands before and after handling.
• Avoid disconnecting the system unnecessarily; every disconnect lets germs in. Change bags at the schedule set by the nurse, using clean technique.
• Use the right bag for day and night, with the right connections.

Daily care

1. Hand hygiene. Wash hands with soap and water before and after any contact, and wear gloves for personal care. See infection control for home caregivers.

2. Cleaning the area. Wash the skin around the catheter, the genital area and the groin daily with mild soap and warm water, and after every bowel movement. Use a clean cloth or wipe, moving away from the catheter, from front to back. For women, clean the labia and the outside area; for men, gently retract the foreskin if present, clean the head of the penis and around the catheter, dry, and return the foreskin to its normal position, as the nurse has shown. See wipes and perineal hygiene done gently. Do not use antiseptic creams or powders unless prescribed. Wash the suprapubic site as instructed by the nurse, with sterile saline or soap and water, and keep dry and covered if advised.

3. Skin checks. Look at the skin in the genital area, thighs and abdomen for redness, soreness, swelling, discharge or pressure marks from the tubing or securing device. For condom catheters, check the penile skin at each change. See incontinence-associated skin damage: prevention and care.

4. Bathing. Showers are usually fine with the system in place; avoid long baths unless the nurse agrees, and dry well.

Fluids, diet and bowels

• Drink regularly through the day, about 1.5 to 2 litres in total unless the doctor has restricted fluids (for example in heart or kidney failure). Good fluid intake keeps urine dilute and flows well and helps prevent blockage and infection; see hydration for older adults.
• Urine colour should be pale yellow to straw. Dark, strong urine means more fluids are needed.
• Prevent constipation, which can press on the catheter or the bladder and cause leaks or blockage; see constipation in older adults and bowel incontinence and constipation in later life.

Common problems and what to do

Catheter is not draining (no urine in the bag). - Check for kinks, loops, a closed clamp, a bag above the bladder or a person lying on the tube. - Encourage fluids if allowed, change position, check for constipation. - If no urine drains for a few hours and the person has lower abdominal pain, swelling, discomfort or restlessness, the catheter may be blocked: call the nurse or doctor urgently. If the person is in severe pain, has a swollen, hard lower abdomen, fever or confusion, call 112. Do not flush or pull the catheter.

Leaking around the catheter (bypassing). - Possible causes include constipation, bladder spasms, a blocked catheter, a wrong size or an infection. Check for kinks and for constipation. Call the nurse; do not simply pad and wait. A nurse may need to change the catheter.

Bladder spasms or cramping. Painful tightening of the bladder, sometimes with leaking. Report to the nurse or doctor; medicines may help. Check for constipation and kinks.

Blood in the urine. A small amount of pink-tinged urine after a change or trauma may happen, but fresh red blood, clots, or sustained bleeding needs a call to the nurse or doctor the same day; heavy bleeding or clots with blockage is an emergency.

Cloudy, smelly urine or sediment. Common in people with long-term catheters. It does not always mean infection. If there are other signs (fever, pain, confusion), call the doctor. Do not request antibiotics for cloudy urine alone. See urinary tract infections in older adults: atypical signs.

Catheter has fallen out or been pulled out. Do not try to reinsert. Cover the area with a clean pad and call the nurse or doctor at once. If the balloon was inflated, the urethra can be injured; if there is bleeding, pain, no urine passed or a swollen abdomen, seek urgent help (112).

Person pulls at the catheter (dementia, discomfort). Keep it secure; use clothing that covers the area, such as a one-piece or trousers with back fastenings; check for pain, constipation, itching or the need to urinate. Seek advice from the nurse; see incontinence and dementia: routines and reassurance. Do not use restraints.

Signs of infection and emergencies

Call the nurse or doctor the same day for:

• Fever or chills, or a low temperature with shivering.
• New or worse confusion, drowsiness, restlessness, loss of appetite, or falls.
• Pain in the lower abdomen, back, side or at the catheter site.
• Cloudy, bloody or foul-smelling urine with other symptoms.
• Redness, swelling, pus or heat around the catheter or suprapubic site.
• Leaking or bypassing.
• Catheter blocked or not draining.
• A catheter that has moved or is pulled.

Call 112 for:

• High fever with shaking, fast breathing or heart rate, low blood pressure, cold clammy skin or very unwell appearance (possible sepsis); see fever in older adults: why it can be subtle and when to call.
• Severe pain, a swollen, hard lower abdomen and no urine.
• Heavy bleeding or large clots.
• Severe confusion or collapse.
• Catheter pulled out with heavy bleeding or severe pain.

Check temperature with a reliable thermometer when the person seems unwell; see digital thermometers: choosing and using them for older people.

Catheter changes and follow-up

Changes are done by a nurse or doctor at the planned interval, or earlier if the catheter is blocked or infected; book the next change in advance. Ask why the catheter is needed and whether it can be removed, since the risk of infection rises with time. Keep spare bags and clean gloves at home, and train any attendant before they help; see training a new attendant: first week.

When to ask a professional

Ask a nurse to teach you hand hygiene, bag emptying, cleaning and securing, and to give a written plan with phone numbers. Ask the doctor why the catheter is needed and when it can be reviewed. Ask a pharmacist about supplies. Call the nurse or doctor the same day for any warning sign above. Call 112 for sepsis signs, no urine with severe pain or swelling, heavy bleeding or a catheter that has been pulled out with severe pain or bleeding.