Things Nurses Should Know About Urinary Catheters

• More than 100 million urinary catheters are used globally, according to the International Society for Infectious Diseases.  
• The urinary catheterization procedure is commonly used to collect urine when a patient isn’t mobile. Other uses include relieving urinary retention and emptying the bladder before and during surgery.  
• Urinary catheters can potentially cause urinary tract infections, so proper care and checkups are necessary.

According to the International Society For Infectious Diseases, more than 100 million urinary catheters are used globally annually, which accounts for around 200 catheters being used every minute. In the United States, an estimated 30 million indwelling catheters are sold annually, and around 20% of hospitalized patients get a urinary catheter inserted at any given time.

According to the Centers for Disease Control and Prevention (CDC), about 5% of people residing in long-term facilities in the United States have a urinary catheter.   

These stats indicate that urinary catheterization is a standard procedure in clinical practice. In this blog, you’ll learn about urinary catheters, their types, why they are used, how to insert them, their removal procedure, and nursing care with them. 

What is a Urinary Catheter?

A urinary catheter is a hollow tube that collects and draws urine from the patient’s bladder directly to the attached drainage bag. It can be made of rubber, silicone, or PVC plastic and comes in various forms and sizes.

Uses of Catheters  

Urinary catheterization is most commonly done to collect urine when the patient is not ambulatory and cannot go to the toilet. It’s also used for other purposes, such as:  

• To relieve urinary retention that exerts pressure on the patient’s kidneys  
• To collect a sterile urine sample from a woman to obtain a urine culture  
• To measure the residual amount of urine in the bladder when it’s not emptied completely 
• To obtain urine samples when other ways are not possible (mostly when the patient is dependent on diapers) 
• To get the urinary bladder emptied before and during surgery and before some diagnostic examinations. 

Types of Catheters 

Generally, there are two types of catheters: internal and external.  

Internal catheters include straight, indwelling, and suprapubic.   

The straight catheter, a red rubber catheter or straight cath, has only a single lumen and lacks a balloon near the tip. It’s less commonly used and is inserted only for the time it takes to drain the bladder or obtain a urine specimen.

An indwelling catheter, also known as a Foley or retention catheter, has two lumens, one for urine drainage and the other for balloon inflation near the tip. Three-way Foley catheters contain three lumens and perform continuous or intermittent bladder irrigation.

Suprapubic catheters are inserted directly into the bladder by making an incision in the abdomen, done while the patient is under effects of general anesthesia.

The external catheter includes a condom catheter. It is generally used for people with a penis and remains outside the body. It covers the urethra like a condom, and a tube is attached to the drainage bag that collects urine. This type of catheter is used in patients who don’t have urinary retention problems but have some physical or mental disability. It has the benefit of posing a lower risk of urinary tract infections.

Grading of Catheters 

The grading of catheters is done on the French scale, according to the size of the lumen. For an adult female, numbers 14 and 16 French catheters are used. Usually, small catheters are not used as they have a small lumen size, which increases the time required to empty the bladder. Larger catheters distend the urethra, increasing the patient’s discomfort. Numbers 18 and 20 French catheters are most commonly used for male adults. However, if they seem significant, small catheters should be used. For children, French catheters numbers 8 and 10 are often used. 

Procedure for Catheter Insertion

To insert a urinary catheter, provide privacy to the patient and explain the procedure beforehand. The following steps are helpful in catheter insertion:  

• Place the patient in the supine position. For females, ask them to keep their knees up and legs apart, and for males, ask them to keep their legs flat and slightly apart.
• Open and set up the catheter kit using the sterile technique. Don sterile gloves and set up a sterile field.
• If placing an indwelling catheter, check for leaks and if balloons are inflating well by filling 5 ml of sterile water and removing the water.
• Lubricate the tip of the catheter and saturate cotton balls with a cleansing solution.
• Use your non-dominant hand, which will become contaminated, and use the dominant hand, which is sterile, to hold swabs with sterile forceps. For females, hold the labia apart and swab from front to back in the following order: labia farthest from you; labia nearest to you; the center of the meatus between the labia.
• Use one swab per swipe. For males, retract the foreskin and swab in a circular motion from the meatus outward. Repeat the procedure three times, using a different swab each time.   
• Gently insert the catheter into the urethra until you note return urine. Because of the difference in the sizes of their urethra, the insertion is about 2 to 3 inches in females and 6 to 9 inches in men. When using straight catheters, collect the specimen, drain the bladder, and remove and discard the catheter. For an indwelling catheter, insert an additional inch and inflate the balloon. 
• Using sterile technique, attach the catheter to the drainage bag and secure the catheter to the patient’s leg according to the hospital’s policy. 
• Place the drainage bag on the bed frame, below the bladder’s level.   
• Do not forget to document the type and size of the catheter and the amount and appearance of urine. Also document how the patient tolerated the procedure. 

Procedure for Catheter Removal

Urinary catheters have to be removed with utmost care and expertise. To remove the catheter, adhere to the following steps: 

• Disinfect your hands, and don gloves with a sterile technique while observing standard precautions.   
• Use a 10 ml syringe to withdraw all water from the balloon. Withdraw and discard the water until no more can be removed because some catheter balloons are overinflated or have up to a 30 ml balloon volume. 
• With the non-dominant hand, hold a clean 44 at the meatus. Gently pull the catheter outside with the dominant hand. Don’t be forceful if you encounter resistance in pulling out the catheter. Instead, stop and check if the balloon is completely deflated. However, inform the physician if the balloon seems wholly deflated and the catheter doesn’t come out quickly.   
• To prevent urine leakage, wrap the tip in clean 4×4 as it is withdrawn. If a culture of the catheter tip is required, make sure to use a sterile 4×4.   
• Note and document the time when the catheter was removed.   
• After catheter removal, inform and assist the patient in urinating differently. Provide a bedpan and urinal or help them go to the bathroom when needed. Also, document the amount and time of spontaneous voids. If the patient does not urinate within eight hours of catheter removal, palpate the bladder or assess the bladder volume using a bladder scan and inform the physician. 

Caring for Patients with Indwelling Catheters

Urinary catheters need delicate care and monitoring. Ensure that the drainage bag always remains below the level of the patient’s bladder. Make sure the tubing doesn’t have any kinks or loops and that the patient is not lying over it. Do not pull or tug on the catheter.  

Inform the patient not to use powder around catheter entry sites and watch the area for any signs of irritation, such as swelling, drainage, redness, and tenderness. If not contraindicated by health, offer the patient fluids frequently. 

At the end of every shift, or as directed by a physician, record urine output, empty the collection bag, and note the urine for clarity, odor, color, and presence of sediment.  

Notify the physician if you notice any of the following signs:  

• Blood, foul odor, or cloudiness in the urine specimen  
• Decreased urine output, less than 30 ml per hour 
• Signs of irritation, such as redness, tenderness, swelling, drainage, or leaking  
• Fever, flank pain, or abdominal pain that indicates an infection 

Patients with indwelling catheters require more care as they are at increased risk of developing a urinary tract infection. The following tips can help care for a patient with an indwelling catheter:  

• Wash your hands thoroughly and disinfect before and after touching the patient with an indwelling catheter.   
• Ask the patient to thoroughly clean the perineal area, especially around the meatus, twice a day and after every bowel movement. This practice helps prevent microorganisms from entering the bladder and causing UTIs.   
• Clean the perineal area with soap and detergent and rinse the area well with running water.   
• Ensure the patient maintains adequate fluid intake (if there are no fluid restrictions). 
• Encourage the patient to stand up and walk as the physician has ordered.   
• Document the patient’s daily fluid intake and output and note the volume and character of urine.   
• Educate the patient about maintaining personal hygiene, especially after every bowel movement. Also, tell them to wash their hands with soap and water after using the toilet. 
• Encourage the patient to promptly report any signs of infection. Symptoms of a UTI are cloudy urine, burning, itching or irritation at the meatus, a strong odor of the urine, fever, and tachycardia. 
• The length of time a catheter stays in place can range from five days to two weeks. Change them only when necessary. The less a catheter is changed, the less likley a UTI will occur.   

The Bottom Line

Catheters are helpful when the patient is non-ambulatory. They also help collect urine specimens for culture when it is not possible otherwise. However, they pose a risk of urinary tract infections. Appropriate care and checkups with indwelling catheters are necessary. Educate your patients on why they require an indwelling catheter and when they can live a catheter-free life. Compel them to inform you if the catheter causes any problems or leakage. 

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