What is a urethral catheter?
A tube inserted via the urethra into the bladder. Usually the urine drains via the tube into a bag. (Sometimes a valve is used in suitable patients to just release urine intermittently instead of using a bag). A balloon inflated with a small amount of water on the end of the catheter holds it in place in the bladder. Placing a urethral catheter is a simple procedure that can be performed in the office or at home.
What is a suprapubic catheter?
A catheter inserted through the lower abdominal wall just above the pubic bone, directly into the bladder. It may be preferred in sexually active patients, to prevent urethral discomfort and to prevent damage to the urethra over a long time. Initial placement in hospital and can be done with general, sedation or local anaesthesia. Subsequent catheter changes can be done at home. Rotate the catheter 360° each day to prevent adhesions.
Why are catheters placed?
It may be temporary after surgery or due to temporary difficulty voiding. It may be used long term to manage severe incontinence or in people who are unable to pass urine.
How often does it need to be replaced?
This varies, usually every 6-12 weeks or earlier if problems.
A 350, 500 or 750ml ‘day’ bag is worn on the leg using straps during the day. This needs to be emptied when 2/3 full. A larger 2L ‘night’ bag is connected to this bag overnight to allow more urine to be collected without the need to empty the bag until morning. Connecting the night bag to the day leg bag instead of disconnecting the leg bag keeps a closed system and reduces the risk of infection. To connect the night bag remove the cap from the end of the tubing and put this end into the outlet of the leg bag. Then open the outlet from the leg bag so the urine drains from the leg bag into the night bag. At night make sure the night bag is lower than the bed to allow good drainage and hang the bag on a stand or place in a clean basin, rather than placing on the floor. Ensure there are no kinks in the tubing. Use clean hands when emptying or changing your bags. Use a new bag each week or as directed. Pinch the end of the catheter to prevent loss of urine when changing the leg/day bag each week.
Things to do:
Stay well hydrated to help prevent urine infections and catheter blockages. Avoid constipation and avoid kinking the tubing. Keep the bag lower than the level of your bladder to allow good drainage. Use tape to fix the catheter to your leg leaving enough slack to avoid pulling on the catheter and use straps to fix the leg bag. Rinse the area around the catheter daily with mild soap and water. Don’t use detergents, chemicals or powders around the catheter insertion. For urethral catheters women should wash front to back, and uncircumcised men if able, should retract the foreskin when washing and then replace when finished.
These can be common in patients wth catheters. Signs may be bleeding, offensive or purulent urine, bladder pain, bladder spasms which may cause leakage around the catheter, catheter blockage, bleeding, fevers, unwell or confusion. Ideally change the catheter 24 hours after starting antibiotics and continue the antibiotics for at least another 3 days, as directed by your doctor. (A urine test will usually show infection but if there are no symptoms it usually doesn’t require treatment – check with your doctor).
Catheter not draining / blocked:
Checked the tubing is not kinked and the bag is below the level of the bladder and that you have had enough fluids to drink. Some patients are shown how to ‘milk’ the tubing to help dislodge a blockage or even flush their catheter. If the catheter remains blocked, seek assistance as it will need 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 and the bag is not full and below the level of your bladder. Treat constipation. Seek medical assistance if it persists. It can be due to infection. Some medications can be used to prevent bladder spasms. Sometimes changing the size of the catheter or the balloon or the type of catheter may help.
Catheter falls out:
Check if the balloon was still inflated or if it had burst. Seek nursing or medical assistance. If the catheter was for urinary retention you may not be able to pass urine until it is replaced. If a suprapubic catheter falls out it should be replaced as soon as possible and if unable to be replaced, you may need to return to hospital to have it reinserted. In the meantime a urethral catheter may be placed.
This may be due to infection, but bleeding just due to irritation/trauma to the bladder wall or urethra from the catheter is common and will usually settle on its own. Increase your fluid intake. Seek medical assistance if heavy, if clots block the catheter, or if it persists.
Discharge from a suprapubic catheter site:
A small amount of discharge, which may be blood stained, is common and a small dressing over the site will help to manage this. If heavy, seek advice as it could be an infection. Granulation tissue at the site can produce a discharge and can be treated.
What are the other options?
Discuss other treatment options for incontinence or urinary retention with your doctor. Performing intermittent (in and out) self catheterisation may be an option.
Where to buy catheter supplies from:
You can get independent advice from our Continence Nurse Advisor and also the Independent Living Centre, 11 Blacks Rd Gilles Plains 1300 885 886.
Some patients qualify for government funding towards costs via CAPS or Disability SA.
Version: V2, July 2013