TAKING THE

FEAR OUT OF
INDWELLING
CATHETER CARE

BY
KARL PARR
REGISTERED NURSE / BENTLEY MANOR

©Copyright(2021) – Karl Parr – Harbour Health care

 CASE STUDY
• A new resident with early onset of dementia, is admitted to Bentley Manor from hospital with a long
term in-dwelling catheter. The gentleman was unable to administer his own care catheter, and often it
was found to be swing outside of his trouser, putting unnecessary weight on his urinary tract.
• He was often emptying it himself, thinking he was helping us.
• Had recurrent Urinary Tract Infections (UTI) and frequent antibiotic treatment
• Managed to remove his catheter, once with balloon inflated, and resulted in hospital admission for
possible trauma – Urethral bleeding.
• 2nd Removal tubing snapped - Wight
• Carers often had to ask how to empty the bag
• Carers often had to ask how to clean the bag.
• Carers often didn’t want to due to fear of doing wrong-doing change the day/ night bag.
 RISKS
• This resident often had recurrent UTI, due to poor catheter care, and staff being fearful, because they
had not been trained.
• Staff often didn’t know how to secure the bag, thus the bag was swinging around in his trouser leg or
out the front of his trousers, thus putting un-nesry weight on his urinary tract, risk of catheter being
pulled out, and trauma, which did actually result in hospitalization.
• Due to tap being left open was often urinary incontinent resulting in loss of dignity, risk of infection
and further antibiotic treatment.
 SO WHAT IS A CATHETER?
• A urinary catheter is a flexible plastic tube used to drain urine from the bladder when a person cannot
urinate. A doctor will place the catheter into the bladder by inserting it through the urethra. The urethra
is the opening that carries urine from the bladder to the outside of the body
 WHAT IS A CATHETER?

When the catheter is in the bladder, a small balloon is

inflated to keep the catheter in place. The catheter
allows urine to drain from the bladder into a bag that is
usually attached to the thigh. Urinary catheters can be
used in both men and women. An indwelling catheter is
one that stays in for a longer period of time.

A catheter may be needed because of certain medical

conditions. These include an enlarged prostate or
problems controlling the release of urine. It may be
used after surgery on the pelvis or urinary tract. Urinary
catheters are also used when the lower part of the
body is paralyzed.
If you are helping a resident with a catheter, try to be as
relaxed as possible. Caring for a catheter can be
embarrassing for both of you. This may be especially true
if you are caring for someone of the opposite sex. If you
are not embarrassed or upset, the person may feel more
comfortable.
 CATHETER CARE

Always wash your hands before and after handling a catheter. Follow all of the instructions the nurse / doctor has given.

Also:Make sure that urine is flowing out of the catheter into the urine collection bag.

Make sure that the catheter tubing does not get twisted or kinked.

Keep the urine collection bag below the level of the bladder.

Make sure that the urine collection bag does not drag and pull on the catheter.

It is okay to shower with a catheter and urine collection bag in place, unless the doctor says not to.

Clean bag spout daily, preferable with a Alcohol wipe, to reduce risk of infection starting.
 CATHETER CARE (CONT.…)
Check for inflammation or signs of infection in the area around the catheter. Signs of infection include pus or irritated, swollen, red, or tender skin.

Clean the area around the catheter twice a day with soap and water. Dry with a clean towel afterward.

Do not apply powder or lotion to the skin around the catheter

Do not tug or pull on the catheter. Ensure its not caught/ trapped on resident legs, caught in cot side.
Ensure you have plenty of slack when moving resident / patient. Always ensure you know where it is.
N

Ensure you have penty of slack on the catheter tubing when moving a resident / patient. Never assume when you move a resident, the catheter is going to come with you.

Talk with your doctor about your options for sexual intercourse while wearing a catheter.

At night it may be helpful to hang the urine collection bag on the side of the bed.

https://vimeo.com/156234954
 TO EMPTY THE URINE COLLECTION BAG

You will need to empty the bag regularly. It is best to empty the bag when it's about half full or at bedtime. If the nurse (from
doctor instruction) has asked you to measure the amount of urine, do that before you empty the urine into the toilet.

• Wash your hands with soap and water. If you are emptying another person's collection bag, you may choose to wear
disposable gloves.

• Remove the drain spout from its sleeve at the bottom of the collection bag. Open the valve on the spout.

• Let the urine flow out of the bag and into the toilet or a container. Do not let the tubing or drain spout touch anything.

• After you empty the bag, close the valve and put the drain spout back into its sleeve at the bottom of the collection bag.

• Wash your hands with soap and water.

 DO’S AND DON’T

Don’t let the spout touch the floor

Always where full PPE (Personal Protective Equipment) – Gloves, Apron Visor/Mask

Avoid rapid movement of catheter when draining to prevent spattering, and risk of eye splash.

ALWAYS ensure spout tap is closed, (beware of single use catheters, where tap WILL NOT CLOSE once been opened.

ALWAYS when applying a new night bag or day bag, you write date and time on back catheter bag to ensure it not used longer than
necessary.

ALWAYS ensure catheter day bag is attached to patient / residents legs.

SUPUA PUBIC
CATHETER
Due to medical reason, some patients may
have a reason to which the urethra is not
suitable for a in-dwelling catheter e.g
enlarged prostate

Therefore, a supa-pubic cather is inserted in

a minor surgical procedure (often emergency
due to urinary retention)

The care for these is exactly the same,

Like anywhere, also document your catheter care, and cleaning.
instead of cleaning the penal or vaginal area
you will be required to clean supa-pubic Record the site, red, swollen, inflamed, puss discharge (often green discharge).
area, often utilizing the belly button. ? Bleeding.

Unnecessary movement
 WHEN TO SUMMON HELP
No urine or very little urine is flowing into the collection bag for 4 hours or more.

There is new pain in the belly or pelvic area.

The urine has changed Colour, is very cloudy, looks bloody, has a bad smell, or has large blood clots in it.

The place where the catheter goes into the body (the insertion site) becomes very irritated, swollen, red, or tender, or there is pus draining from the site.

Urine is leaking from the insertion site (BY-PASS)

There are signs of a kidney infection, such as a fever of 38°C (100.4°F) or higher or back or flank pain. (Possible infection / Sepsis)

Symptoms such as nausea, vomiting, or shaking chills occur.

If you are unsure – never be afraid to summon help.

AFTER THE CATHETER IS REMOVED

Sometimes for many reason. E.g resident does not need catheter, is not coping and causing to
many contra-indicating issues, may require removal.

Many people call this removing the catheter, but a medical person maybe use to saying, “Today
resident B, has been TWOC’ed today”.

This will even though it has been removed, some require some element of continuing catheter
care and importantly monitoring.

Even if catheter has been in for a short period of time e.g. few days following surgical / medical
intention or many months and years, then the bladder and bladder sphincter will have become
lazy causing difficulty in micturition (Def:- Act of Urinating).

Therefore, it is VITAL we monitor their urine output, and ensure they are not going into further
urinary retention.
AFTER THE CATHETER IS REMOVED
(TWOC) – Trial without catheter (Hospital term)

* A person may have trouble urinating. If this happens, try sitting in a few centimetres of warm water (sitz bath). If the urge to urinate comes during the
sitz bath, it may be easier to urinate while still in the bath.
• Some burning may happen when urinating for the first few times. If the burning lasts longer, it may be a sign of an infection.
• Drink plenty of fluids. If fluids need to be limited because of kidney, heart, or liver disease, talk with the doctor before increasing the amount of fluids.
• If the catheter causes irritation or a rash, wearing loose cotton underwear may help.
• Also, it is important to know when there is a problem and when to call your doctor. After catheter removal, call your doctor if:
• No urine comes out within 8 hours after the catheter is taken out.
• The bladder or belly feels full or is painful.
• You see signs of a urinary infection. Signs include:
• Blood or pus in the urine.
• Pain in the back just below the rib cage. This is called flank pain.
• Fever, chills, or body aches (? Infection / SEPSIS – Medical emergency)
• Pain when urinating.
 URINARY RETENTION

(Def:- Urinary retention is a condition in which you cannot empty all the urine
from your bladder. Urinary retention can be acute—a sudden inability to urinate,
or chronic—a gradual inability to completely empty the bladder of urine.

Urinary retention can be caused following a removal of a cather.

Urinary Retention can be caused whilst a catheter is in place e.g. blockage, tip
crusting caused by calcification build up on catheter tip.

Trauma to catheter site, blockage, e.g blood clots (Often requiring bladder wash
out.
QUESTIONS