Catheter securing and fixation devices:
their role in preventing complications
Ann Yates, Director of Continence Services, Cardiff and Vale University Health Board, discusses the
technology available to minimise urinary catheter-related complications, Ann.yates@wales.nhs.uk
U
rinary catheterisation is a
common procedure with many
complications that can arise not
only with regards to insertion
but also continuing catheter care and
management. There are justifiable clinical
reasons for the use of an indwelling catheter
(Royal College of Nursing (RCN), 2012;
European Association of Urology Nurses
(EAUN) 2012) (Box 1).
However, one of the most important but
often neglected aspects of any individuals
continuing catheter care management is
the use of securing and fixation devices. A
best–practice statement from NHS Quality
Improvement Scotland (2004) and similar
guidance from Ireland’s Health Protection
Surveillance Centre (2011) and the Wound,
Ostomy and Continence Nurses Society
(WOCN), (2012; 2016) all advise that the
catheter and drainage systems should be
well supported and secured in a comfortable
position to prevent complications for the
Box 1. Indications for urinary
catheterisation
■■ Acute/chronic retention
■■ Patients with voiding difficulties due to
neurological disorders
■■ Need for accurate measurements of urinary
output in critically ill patients
■■ Perioperative use in selected surgical
procedures
■■ Irrigate the bladder, i.e. following prostate
surgery
■■ Bypass an obstruction, i.e. enlarged
prostate/stricture
■■ Administer drugs directly into bladder, i.e.
cytotoxic therapy
■■ Carry out bladder function tests
■■ Improve comfort for end-of-life care
■■ To maintain skin integrity, i.e. 3–4 degree
pressure damage/incontinence-associated
dermatitis (IAD)
■■ To relieve incontinence only after all other
conservative strategies have failed
Adapted from RCN, 2012 and EAUN, 2012
290 
individual. These complications can include
catheter migration, unnecessary traction on
the catheter due to a heavy, unsupported
drainage bag, leading to potential
damage to the neck of the bladder, and
inflammation due to friction and movement
of the catheter, which can lead to necrosis,
infection and bypassing (Loveday et al, 2014).
It is the role of the professional to make sure
they are keep up to date with new devices
and use them in line with manufacturer’s
guidelines and only for the purpose each
was designed for (RCN, 2012).
For the purpose of this article ‘securing
devices’ will refer to the support required for
the drainage systems attached to the catheter
while ‘fixation devices’ will be those used for
the securing of the catheter itself.
Securing devices
Adjustable leg straps
Leg drainage bag systems are one of the most
common types of drainage systems associated
with indwelling catheters. Manufacturers
usually supply a pair of latex-free, non-slip,
adjustable leg straps, one for the top of the
bag and another for the bottom, with all
their leg bags (Figure 1). It is important that
both straps are used to support the leg bag
to evenly distribute the weight of urine
and provide adequate support (Yates, 2015;
Figure 1. Velcro leg straps
Downloaded from magonlinelibrary.com by 203.029.107.054 on May 3, 2018.
2016; 2017). The leg drainage bag should be
positioned and supported below the level of
the bladder, usually on the thigh or calf this
is to prevent any back flow to the bladder
which reduces complications and urinary
infections (National Institute for Health and
Care Excellence (NICE), 2012). The strap
material should be easy to clean, durable,
hypoallergenic and allow unobstructed flow
of urine into the bag.
Complications that may arise for some
individuals from the use of leg straps are
they can act as a tourniquet as there is
no guidance on the tension needed to
secure them and they can restrict venous
and lymphatic flow, increasing the risk of
deep vein thrombosis (DVT) in individuals
with impaired circulation (Freeman, 2009).
Straps, although made to be non–slip, do
have a tendency to work loose and slide
down the individual’s leg, which can mean
they are not giving full support. Straps are
contraindicated in some catheterised patients,
namely those with poor circulation, phlebitis
and advanced diabetes and may not be
appropriate for certain individuals—patients
who have had a cerebrovascular accident or
stroke may not feel the compression from
the device, and in individuals with cellulitis
the restriction from straps could cause
further damage (Freeman, 2009).
© 2018 MA Healthcare Ltd
Figure 2. Sleeve device
British Journal of Nursing, 2018, Vol 27, No 6
 CLINICAL FOCUS

CliniFix® - the Universal Hydrocolloid Securement Device

CliniFix, the unique multi-purpose medical tube holder, is the most comfortable and secure
way to hold catheters and most sizes of medical tubing in place. It can be used in two
distinct ways for different security needs - a hook and loop securement device for some
movement or an inner adhesive strip for extra security. The resealable design allows
repeated access. With a skin-friendly hydrocolloid base it can remain in
place for up to seven days and no rigid plastic edges, straps or clips means
CliniFix fits like a second skin anywhere on the body.
Wriggle control
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CliniFix patent number: GB 2 448 517B EP 1982743
PID 28

Sleeve device Fixation devices catheter and drainage system by stabilising

An alternative to the strap system is a sleeve
that encompasses the leg bag and can again
be used either on the thigh or calf (Figure 2).
It comes in a variety of sizes and has a small
opening for the tap to go through for easy
access to empty the bag. This device has
some advantages over straps as it provides a
more even distribution of weight and places
less tension on the leg but only if the right
size is provided. It still presents a hygiene
problem and requires regular washing. The
sleeve device may be a better option for
individuals with frail skin as it distributes
the weight of the bag more evenly. However,
it is important to measure for the correct
size as if the device is too small it can also
restrict circulation and if too large will not
give adequate support. Professionals need
to consider who will apply this device as if
© 2018 MA Healthcare Ltd
Fixation devices should be used in
conjunction with catheter securing devices
and are designed to assist in support of the
Table 1. Benefits of fixation devices
Benefit
Prevent excessive traction on an indwelling
catheter
Anchors catheter and prevents excessive
movement
Can minimise the need for untimely catheter
replacement
Decrease potential risk of obstruction of urine
flow
Decrease in potential risk of pressure damage
and anchoring the catheter and to act as a
shock absorber to prevent any unwanted
traction, which can cause complications.
Potential damage if not used
Penile necrosis, penile cleaving or damage to the
labia in women due to traction by balloon
Pain/bleeding/swelling/inflammation, urethral
erosion, necrosis
Accidental catheter displacement by pulling
Occlusion of catheter from sitting or lying on
unsecured catheter tubing and drainage devices
Pressure damage to skin and tissues due to
patients lying or sitting on unsecured tubing,
especially immobile or bed-bound individuals

Reduced potential risk for catheter-associated In/out piston-type movement of catheter can
patient has impaired dexterity or eyesight urinary tract infection promote pathogen penetration
they may not be able to distinguish which
end is the top of the device and insert the Reduced clinical time and cost related to Extra time and materials needed to address
additional materials complications
drainage bag correctly.
Source: WOCN, 2012, Yates 2015

British Journal of Nursing, 2018, Vol 27, No 6 291

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Figure 3. Variety of fixation devices
Box 2. Benefits of fixation devices for
individual patients
■■ Reduced levels of anxiety associated with
pulling or dislodging the catheter (and
resulting pain/trauma), which Increases
comfort and peace of mind
■■ Reduction in internal damage to bladder,
bladder neck and urethra and discomfort
relating to catheter movement and traction
■■ Reduced risk of inadvertent migration of
balloon from bladder into urethra leading to
reduction in bladder irritability/spasms and
of meatal tearing, erosion, inflammation and
cleaving
■■ Reduced external trauma to distal urethra,
penile or labia tissue for urethral/suprapubic
catheters, therefore reducing erosion,
tearing/cleaving and lowering incidence of
accidental removal of catheter
Source: WOCN, 2012
Box 3. Considerations when selecting a
fixation device
■■ Must be designed for the purpose of securing
a urinary catheter (RCN,2012)
■■ Should be secure but place no tension on the
urethral/abdominal tissues
■■ Individuals must be assessed for the most
appropriate product to suit their individual
needs
■■ Should be easy to apply and maintain/keep
clean
They have been identified as having many
benefits (Table 1). They are available in two
forms: strap or adhesive (Figure 3).
Fixation devices have been identified as
an important part of the management of
indwelling urinary catheters by national
guidelines i.e. Royal College of Nursing,
(2012), National Institute for Health
and Care Excellence, (2012), and epic3
(Loveday et al, 2014), however, they are not
used routinely. These devices can also have
292 
Figure 4. The Coloplast G Strap
This is an elastic strap that is attached
around the leg or waist
many benefits for patients themselves, as
shown in Box 2.
Types of fixation devices
There are several different types of device.
One such device comes in the form of a
non-latex strap that wraps around either
the thigh or abdomen, with a smaller strap
that wraps around the catheter and is
secured with Velcro (Figure 4). They come
in different sizes and can be used with both
urinary or suprapubic catheters. This type
of design may be contraindicated in some
catheterised patients, namely those with
poor circulation, phlebitis, lymphoedema
and advanced diabetes (Carignan, 2004) as
it could lead to venous compression and
oedema if applied too tightly. There is also
risk for soiling of tubing or strap (WOCN,
2012). Some examples of these devices are
Coloplast G strap, Bard Lok–strap. Great
Bear GB Fix–it, Optimum Medical Ugo fix
catheter strap.
Another device available is an adhesive
device with a swivel-hinged plastic clamp
that secures the catheter near the bifurcation
point. This swivel clip allows the user plenty
of movement without the loss of security.
This device can be placed on the thigh or
abdomen as required and supplied with an
acrylic skin protectant. The device can be
used for up to 7 days and is removed by
either alcohol (gel or wipes) or adhesive
remover. Although water resistant the
device requires protection when bathing
or showering. Adhesive devices should be
used with caution if the patient has fragile
skin as the device could possibly tear or
damage skin, and should not be used if the
patient has a known allergy to the adhesives.
Example are Bard Statlock (Figure 5), or
Downloaded from magonlinelibrary.com by 203.029.107.054 on May 3, 2018.
Figure 5. The Statlock® Foley Stabilisation
Device
Optimum Medical Ugo Fix Gentle.
An alternative design is to hold the
catheter in a channel created by a foam
insert and a fabric loop overstrap. This
device does not use adhesive to secure the
catheter in place allowing for freedom of
movement and patient comfort. There also is
a multi-purpose Foley catheter holder that
comes in single and dual tabs. The large tab
holder has a 3-inch centre tab that wraps
around for large tubing and secures tightly
in place using hook-and-loop tape fasteners.
It can be opened and closed repeatedly,
no re-taping needed and fits most Foley
catheters. An example is Clinimed Clinifix
Universal Tube Fixation.
Selection of appropriate devices
All devices should be used according to
manufacturer’s instructions and are available
on prescription. Health professionals must be
aware of the points in Box 3 when selecting
fixation devices. Individual assessment of
patients for the ease of use, comfort and
tolerability for these devices is important
as it can mean the difference between
maintaining a person’s independence or
their requiring some degree of assistance.
Individual devices will have different
beneficial properties for individual patients
and it is vital that the health professional
recognises these differences and discusses this
with the individual before deciding on the
appropriate product.
© 2018 MA Healthcare Ltd
Conclusion
National guidance recommends that catheter
fixation devices are used in all patients
requiring an indwelling catheter. Careful
British Journal of Nursing, 2018, Vol 27, No 6
assessment of the individual will ensure
the correct device is chosen and prevent
complications. They should always be
used in line with manufacturer’s guidance.
With all the best practice evidence their
use should be made a compulsory clinical
requisite in the care and management of
indwelling urinary catheters.  BJN
European Association of Urology Nurses. Catheterisation:
indwelling catheters in adults. Urethral and suprapubic.
Evidence–based guidelines for best practice in
urological health care. 2012. http://tinyurl.com/
ph9vtec (accessed 7 March 2018)
Freeman C. Why more attention must be given to
catheter fixation. Nurs Times. 2009; 105(29):35-36.
Health Protection Surveillance Centre. Guidelines
for the prevention of catheter associated urinary
tract infections. Developed by the Strategy for the
Control of Antimicrobial Resistance in Ireland
(SARI) subgroup. 2011. http://tinyurl.com/yb4j6ay4
(accessed 7 March 2018)
Loveday HP, Wilson JA, Pratt RJ et al. epic3: National
evidence-based guidelines for preventing healthcare-
associated infections in NHS hospitals in England. J
Hosp Infect. 2014. 86(suppl 1): S1-S70. https://doi.
org/10.1016/S0195-6701(13)60012-2
NHS Quality Improvement Scotland. Urinary
catheterisation and catheter care: best practice
statement. 2004. http://tinyurl.com/6amdlx9
(accessed 8 March 2018)
National Institute for Health and Care Excellence.
Healthcare-associated infections: prevention and
control in primary and community care. Clinical
guideline 139. 2012, updated February 2017. https://
https://tinyurl.com/y8g7nb5h (accessed 28 February
2018) .
Royal College of Nursing. Catheter care. RCN guidance
for nurses. 2012. http://tinyurl.com/pcqpoh4
(accessed 7 March 2018)
Wound, Ostomy and Continence Nurses Society.
Indwelling urinary catheter securement: best practice
for clinicians. Mt Laurel, NJ: WOCN; 2012
Wound, Ostomy and Continence Nurses Society. Care
and management of patients with urinary catheters:
a clinical resource guide. 2016. http://tinyurl.com/
yayjhkvl (accessed 7 March 2018)
Yates A. Catheter securing and fixation devices: do
they really matter? Nursing and Residential Care.
2015; 17(9): 498-50. https://doi.org/10.12968/
nrec.2015.17.9.498
Yates A. Catheter securement: a need for the right device.
Nursing and Residential Care. 2016. 18(5):188-189.
https://doi.org/10.12968/nrec.2016.18.5.252
Yates A. Urinary catheters 3—catheter drainage and
support systems. Nursing Times (online). 2017.
http://tinyurl.com/y8rten4e (accessed 7 March
2018)

Community Matrons:
Caring for people with
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Community Matrons:
Caring for people with Sue Lillyman, Ann Saxon
long term conditions
• Includes reflections on case studies that
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