What is a urinary catheter?
A urinary catheter is a soft flexible tube inserted into the bladder via the urethra to drain the urine.
There are several ways of draining urine from the bladder
- Indwelling urinary catheter: These are inserted into the bladder via the urethra andremain in the bladder for weeks at a time. They have a small balloon at the tip which is filled with sterile water to hold the catheter in place. The urine is drained into a bag attached to the end of the catheter. Suitable patients may have a valve at the end of the catheter instead of a bag. This allows the person to empty the urine from the catheterdirectly into the toilet.
- Intermittent catheter: These are used to drain the urine on an intermittent basis. They are not left in the bladder and do not have a balloon. Intermittent catheters are removed as soon as the bladder is emptied. This procedure is called intermittent catheterisation and can be easily at home or at the office.
- Suprapubic catheter: Are inserted into the bladder through the abdominal wall and just above the pubic bone. This method may be chosen to prevent damage to the urethra if a catheter is required for an extended period of time, or to prevent urethral discomfort, or for sexually active patients. The first suprapubic catheter is inserted in hospital under local anaesthetic. Subsequent suprapubic catheter changes can be done at home. Specific suprapubic catheter care involves 360o rotation of the catheter daily to prevent the catheter adhering to the tissues
Why are urinary catheters inserted?
In the short term an indwelling urinary catheter may be needed after surgery or temporarily if a person has difficulty voiding. In the long term these catheters are used for people with severe incontinence or those who are unable to pass urine.
How often does an indwelling urinary catheter need to be replaced
They are replaced on average every 4-12 weeks. The frequency of catheter changes is related to the period at which the catheter remains problem free and draining without leaking urine. The time of change is individualised to each patient.
Types of catheter bags
Day: During the day a 350ml, 500ml or 750ml bag is worn on the leg or upper thigh. This is secured in place by garter style straps. The bag needs to be emptied often, usually when it is approximately 2/3rds full.
Night: At night a larger volume ‘overnight’ bag is attached to the outlet of the day bag. The garter style leg bag straps are loosened for comfort. Night bags are designed to hold 2litres or more. The day bag tap is opened to allow flow of urine from day bag into the night bag and the night bag tap remains closed to contain the urine. Ensure that the night bag is lower than the bladder for effective drainage. Hang the night bag on a stand or place it into a clean basin to minimise risk of contamination from the floor. Do not place the night bag directly on the floor. Check the tubing to make sure it is not trapped under the body and make sure there are no kinks. This ‘closed system’ of overnight drainage minimises the risk of infection entering the catheter or drainage system.
Changing catheter bags
The urinary drainage bags should be changed weekly. Make sure the new bag comes in sterile packaging, do not use unsterile bags on an indwelling urinary catheter. Wash your hands before changing the bags. Kink the catheter tubing above the connection with the catheter bag just before disconnecting the bag to avoid urine leaking from the catheter during the bag change. The day bag should only be disconnected once a week at change time. Avoid disconnecting it at any other time, this will minimise the risk of infection entering the drainage system
Care of yourself and your catheter
Staying well hydrated will help prevent urine infections and catheter blockages.
Avoid constipation, as it can make the bladder spasm and leak urine around the outside of the catheter. Avoid kinks in the tubing as blockage leads to urine leaking around the outside of the catheter.
Keep the drainage bag lower than the level of the bladder to allow good drainage
Fix the catheter to the upper thigh leaving enough slack to move around and transfer without pulling on the catheter.
Care of yourself and your catheter continued
Fix the drainage bag to the lower leg or upper thigh using garter style straps to stop the weight of urine in the bag pulling on the catheter and causing injury. Rinse the area around the catheter daily with warm water and mild soap. Do not use detergents, chemicals or powders to clean around the catheter insertion. Females should wash genitalia from front to back. Males, if uncircumcised should retract the foreskin (if able) wash glans penis and replace foreskin to usual position
Signs of urine infection
Blood in urine, fever, feeling unwell or becoming confused, or more confused in people with dementia or Alzheimers disease. Offensive or cloudy urine, catheter blockage, bladder pain or bladder spasms are all signs of a urine infection. Bladder spasms can cause the urine to leak around the outside of the catheter
Treatment of catheter associated urinary tract infection
24hours after antibiotic treatment has started the urinary catheter should be changed. The antibiotics should continue for a further three days or as directed by your doctor. Note: a urine test showing infection with no symptoms usually does not require treatment- check with your doctor.
Catheter not draining/blocked
Check the tubing is not kinked and the bag is below the level of the bladder. Make sure you have had enough fluids to drink. If you have been taught by your health care professional you can ‘milk’ the catheter tubing or perform a ‘flush’ to try and dislodge the blockage. If the catheter remains blocked, seek assistance as it will have to be replaced.
Leaking around the catheter (or via the urethra with a suprapubic catheter in place)
Check the catheter is draining and not blocked. Empty the bag and make sure it is below the level of the bladder. Check that you are not constipated. If leakage of urine persists seek medical assistance as the problem may be an infection. Your healthcare professional may advise changing the size of the catheter, checking the catheter balloon or the type of catheter to help resolve the issue.
Catheter falls out
Seek nursing or medical assistance. Check the catheter, is the balloon still inflated or has it ruptured? If the indwelling urinary catheter is in place because you have urinary retention, you may not be able to pass urine until the catheter is reinserted. In the case of a suprapubic catheter falling out, it should be replaced by a healthcare professional as soon as possible. This may require a trip to hospital to have the catheter reinserted.
Infection in the bladder can cause blood in the urine. Irritation or trauma to the bladder wall from the catheter may also cause blood in the urine. Most light bleeding will settle on its own. If there are visible blood clots in the urine, if the bleeding is heavy or if the catheter becomes blocked seek immediate medical assistance.
Discharge from a suprapubic catheter site
A small amount of discharge from the suprapubic catheter site is common. A small dressing around the site will help to manage this. If the discharge is purulent or heavy, seek medical advice as it may be an infection. A raised red ‘fleshy’ material may be granulation tissue and can produce a discharge. Your healthcare professional can assist with this.
What are the other options
Discuss other treatment options for urinary incontinence or urinary retention with your doctor. One option may be intermittent (in out) catheterisation.
Where do you buy catheter supplies from
You can get independent advice from our Continence Nurse Advisor and also the Independent Living Centre, 11 Blacks Road Gilles Plains 1300 885 886
Some patients qualify for government funding towards the cost of incontinence products. This funding is availabe via Continence Aids Payment Scheme or Disability SA
Version: V2, July 2013