Urinary catheter care for caregivers

If you are a caregiver and the person you are caring for has a urinary catheter, the following catheter care tips will help reduce the risk of problems with catheter care at home and highlight concerns that may need assessment by their health care provider.

Catheter position:

• A catheter can cause pressure injuries to the skin and so should not be positioned underneath the leg or buttocks. Check the catheter position regularly to make sure it has not become trapped.

• A catheter can be a tripping hazard. A leg bag that is attached to the leg with a strap is recommended during the day if the person is able to get up and move around. If the person you are caring for is not mobile but tries to get out of the bed or chair at certain times, it is also a good idea for them to wear a leg bag to help prevent tripping or the catheter accidentally being pulled out.

Fluids:

Unless otherwise instructed by the doctor, the person  should:

• Drink at least 8 to 10 (250 ml) glasses of fluid a day (around 3000 ml of decaffeinated liquid) if possible. This flushes the kidneys, bladder, and catheter. Avoid or limit alcohol and caffeine intake as they can cause bladder irritability and leaking or bypassing of the catheter.
• Drink 125 ml (half a glass) of pure cranberry juice a day as it helps to prevent infections. Good quality cranberry capsules can also be used (check the label – they should contain at least 36 mg/g of proanthocyanidins).

Hygiene:

• Wash the genital area thoroughly with mild soap and water, rinse well, and dry well every day. The urinary catheter does not need to be disconnected from the bag for bathing or showering (the more often a catheter is disconnected from the bag, the higher the risk of an infection developing).
• A leg bag should be worn on the calf using an extension tube between the urinary catheter and the leg bag. This will promote good drainage and prevent pulling on the catheter which can cause bladder spasms, leakage, and sometimes accidental removal.
• Always keep the night bag off the floor by either hanging it on the side of the bed or if necessary, placing it in a plastic basin on the floor. The basin needs to be washed at least weekly and more often if possible.
• The urinary catheter bag should not be hung from the bed if there is a risk that the person may get up and forget that it is hanging on the side. This increases the risk of the catheter accidentally being pulled out as the person walks away.

Diet:

• Fibre is important to avoid constipation which may hinder catheter drainage.
• If the person is unable to have a bowel movement daily, consult with their nurse or physician about whether a medication is recommended. Foods that promote a good bowel movement are fruit, dried prunes, dates, figs, nuts, chia and hemp seeds, flax meal, and whole wheat products (unless gluten intolerant). These all have a high fibre content.

Common problems with urinary catheter care at home:

Leaking around the catheter

This may be caused by bladder spasms.  Check the tubing and bag – if you can see urine, the catheter is still draining.  Although this can be distressing, it is not an emergency. Put a pad in place to absorb leakage and let the health care provider know.  If the person in your care reports pain and/or there is no urine in the tubing or bag, there could be a blockage (see below for directions). Some people with diseases like multiple sclerosis, Parkinson’s disease, paraplegia and quadriplegia experience muscle spasms that will also affect the bladder. If the person you are caring for is having symptoms of their illness that day, they may also have more problems with their bladder.

If there has been no drainage in a four hour period, check the following:

• Has the person been drinking at least 8-10 glasses of fluid in the last 24 hours?
• Is the tubing kinked?
• Has the person been sitting or lying on the tubing or catheter?
• Is the catheter connected to the bag properly?
• Is the drainage bag below the level of the bladder?

You can also try helping the person you are caring for to change position or move around as much as possible. This may help the catheter start to drain again.

If the catheter is still not draining, contact the person’s nurse or health care provider so that arrangements can be made to assess the situation.

Catheter falling out

• Make sure that the catheter is anchored to the inside of the leg.
• Always use extension tubing with a leg bag. This will keep the leg bag in place on the calf and prevent tension on the catheter. The extension tubing can be cut to fit the length of the person’s leg. A nurse can help you decide what length is required.

Remember to keep a large loop in the catheter tubing from the point where it exits the body to the extension tubing in order to prevent tugging or tension and the catheter from accidentally being pulled out.

Infections

• Keep in mind that once the urinary catheter is in place, there will always be some bacteria in the bladder. This is considered the new norm.

• If the bacteria causes symptoms of an infection such as fever, chills, or abdominal pain, an antibiotic will need to be prescribed. Confusion is another symptom of a systemic urine infection. If any of these symptoms are present, notify the person’s doctor or nurse practitioner straight away.

• As mentioned earlier, drinking fluids to flush the kidneys and bladder can help reduce the risk of infections.

• Check that the catheter is draining well and assist the person to change position at regular intervals throughout the day. This will promote catheter drainage.

• Pure cranberry juice or capsules can help prevent bacteria from adhering to the bladder wall and establishing a colony which may  result in a systemic infection.

Changing the urinary catheter bag

The visiting nurse will teach you how to change the catheter bag and answer any questions that you may have.

Always use the following instructions when changing and/or emptying the bag or disconnecting the catheter to help reduce the risk of bladder infections:

1. WASH YOUR HANDS for 10 seconds before and after handling the catheter or drainage bags.
2. Wipe the connection between the catheter and the drainage bag with alcohol and scrub for 1 minute.
3. Carefully separate the bag tubing from the catheter making sure not to pull on the catheter.
4. Clean the tip of the drainage bag tubing that will be connected to the catheter with alcohol (unless it is a new sterile catheter bag that was sealed in the packaging).
5. Insert the tip of the drainage bag tubing into the catheter.
6. Secure the catheter to the inside of the leg with a catheter anchor strap, fixation device, or tape to prevent the catheter from pulling or kinking. There should be a large loop in the catheter tubing to prevent pulling or tension.
7. Empty the used bag. Clean it by running cool (not hot) water through from top to bottom. Fill with a solution of 1 part vinegar to 3 parts water. Swish it around and then let it soak for 30 minutes.
8. Drain the vinegar solution out and hang the bag to dry. It should be open to the air with the bottom clamp open and the cap off of the tip until the next use.
9. WASH YOUR HANDS FOR 10 SECONDS WITH SOAP AND WATER.

See also our article on Hand Washing and Infection Control