Urinary catheters are used to
drain the bladder. Your health care provider may recommend that you
use a catheter if you have:
Urinary incontinence (leaking urine or being
unable to control when you urinate) Urinary
retention (being unable to empty your bladder when you need to)
indwelling catheter:
"Indwelling" means inside your body. This
catheter drains urine from your bladder into a bag
outside your body. Common reasons to have an indwelling
catheter are urinary incontinence (leakage), urinary
retention (not being able to urinate), surgery that made this
catheter necessary, or another health problem.
External catheter:
External Catheters, also commonly referred to
as condom catheters or male
catheters, are used by men to treat urinary
incontinence. This type of catheterconsists of a
flexible sheath that slides over the genitalia just like a
condom.Bladder dysfunction cause determines whether short- or
long-term catheter use is required which, in turn,
determines whether an indwelling, intermittent, or external
catheter should be used.
Short-term catheter;
Urethral catheters are small
tubes passed into the bladder via the urethra (outlet for urine).
They are often used for a short time after major
surgery. Urethralcatheters are also used if a
person is unable to empty the bladder when they need to (urinary
retention ).Of note, manufacturers classify duration of
catheterisation according to catheter material; latex, coated latex
and plastic (PVC) catheters being suitable for up to 4
weeks, whereas 100% silicone can be used for up to 12
weeks.
The patient's who need indwelling catheters are as follows;
Common reasons to have an indwelling catheter are urinary
incontinence (leakage), urinary retention (not being able to
urinate), surgery that made this catheter
necessary, or another health problem
External catheter:
Condom catheters are a good way of collecting urine in men who
have no urinary retention or urinary obstruction and can use their
hands well enough to be able to use the catheter themselves. With
condom catheters, the risks of damaging the urethra and of
infection are less.
short-term catheters.
Urethral catheters are small tubes passed into the bladder via
the urethra (outlet for urine). They are often used for a short
time after major surgery. Urethral catheters are
also used if a person is unable to empty the bladder when they need
to (urinary retention ).
signs and symptoms of CAUTI
- cloudy urine
- blood in the urine
- strong urine odor
- urine leakage around your catheter
- pressure, pain, or discomfort in your lower back or
stomach
- chills
- fever
- unexplained fatigue
- vomiting
The assessment includes:
Patients should be asked about symptoms such as dysuria,
frequency, urgency, suprapubic pain, flank pain or tenderness,
fever, or hematuria in noncatheterized patients.
The nurse should assess the color of the urine, nature, odor
etc.
Assess the area of catheterization for any color change itching,
oozing.
Assess the vital sings for any fever.
Collecting urine samples;
Insert the needle gently into Foley catheter
(if the catheter is a self-sealing type) at a 45
degree angle, or if Luer-lock connection, twist on a sterile
syringe to the port and slowly withdraw 20-30 mL of
urine. 7. Remove needle from Foley
catheter and push urine into sterile
specimen container.
Draining the bedside bag
- Wash your hands with soap and clean, running water or an
alcohol-based hand sanitizer that contains at least 60%
alcohol.
- Hold the drainage tube over a toilet or measuring
container.
- Unclamp the tube and let the bag drain.
- Don't touch the tip of the drainage tube or let it touch the
toilet or container.
Cleaning the drainage tube
- When the bag is empty, clean the tip of the drainage tube with
an alcohol wipe.
- Clamp the tube.
- Reinsert the tube into the pocket on the drainage bag.
Cleaning your skin and tubing
- Clean the skin near the catheter with soap and water.
- Wash your genital area from front to back.
- Wash the catheter tubing. Always wash the catheter in the
direction away from your body.
- You will be told when and how to change your bag and
tubing.
- Don't try to remove the catheter by yourself.
- You may shower with the catheter in place.
Emptying a leg bag
- Wash your hands.
- Remove the stopper on the bag.
- Drain the bag into the toilet or a measuring container. Don't
let the tip of the drainage tube touch anything, including your
fingers.
- Clean the tip of the drainage tube with alcohol.
- Replace the stopper.
Follow-up
Make a follow-up appointment as directed by your healthcare
provider
When to call your healthcare provider
Call your healthcare provider right away if you have any of the
following:
- Chills or fever above 100.4?F (38?C)
- Leakage around the catheter insertion site
- Increased spasms (uncontrollable twitching) in your legs,
abdomen, or bladder. Occasional mild spasms are normal.
- Burning in the urinary tract or genital area
- Nausea and vomiting
- Aching in the lower back
- Cloudy or bloody (pink or red) urine, sediment or mucus in the
urine, or foul-smelling urine
instruction on how the client would change over to a leg bag if
he/she has to go to work.
The leg bag is attached to your leg and allows you to move
around more easily. Because the bag is hidden under your clothes,
it may also make you feel more comfortable about the catheter.
To attach or remove a leg bag, you will need the following
materials:
- Clean leg bag(s)
- Leg straps or tape
- Cotton balls and alcohol pads
- White vinegar
- Water and a towel
- Regular (large) drainage bag
To attach or remove the leg bag:
- Wash your hands with soap and water for 15 seconds.
- Empty the large drainage bag. The different types of drainage
bags open in different ways: a drain spout that you remove from its
sleeve, a clamp that you open to the side, or an opening that you
twist. Whichever method you use, be sure to not touch the tip when
you let the urine flow out of the large drainage bag into the
container or toilet.
- Place a towel under the connection between the catheter and the
bag.
- Pinch off the soft rubber tube (the catheter tube) so that
urine doesn't leak out.
- Disconnect the urinary (Foley) catheter tube from the current
large drainage bag with a twisting motion. Keep pinching the soft
rubber tube (the catheter tube) so that urine does not leak
out.
- Be careful not to pull on the catheter. Place the old large
drainage bag on the towel.
- Prepare to place the leg bag in the catheter tube from which
you just disconnected the large drainage bag. Remove the protective
coating from the tip of the leg bag drainage tube. (Save this tip
to use later when you change back). Clean the tip with an alcohol
pad, wiping away from the opening to avoid getting the tube dirty.
Insert the tip in the catheter tube.
- Fasten the straps of the leg bag to your thigh. Secure the
catheter itself to your leg with tape. Be sure to leave some slack
in the catheter so that you don't put too much pressure on the
bladder, urethra, and other parts of the body. Don't fasten the
straps on the leg bag too tightly to your leg, as that may
interfere with your circulation. If the leg strap gets dirty, wash
it with soap and water.
Emptying the leg bag
Please note that because a leg bag is smaller than a regular
drainage bag, it will have to be emptied more frequently.
- Empty the leg bag when it is half-full, or at least twice a
day.
- Place a large plastic or metal container on the floor next to
you. You may also empty the urine into the toilet. The nurse may
give you a container to use at home.
- Wash your hands with soap and water.
- The different types of drainage bags open in different ways: a
drain spout that you remove from its sleeve, a clamp that you open
to the side, or an opening that you twist. Whichever method you
use, be sure to not touch the tip when you let the urine flow out
of the urine bag into the container or toilet.
- When the bag is empty, close the clamp or twist on the cap on
the leg bag.
- Wash your hands with soap and water.
- Write down how much urine was in your bag, if your caregivers
have asked you to keep a record.
It is a good idea to occasionally change your leg bag from one
leg to the other. The best time to do this is right after you
shower.
Cleaning the bag
- When you are ready to go to sleep, change out the leg bag and
put on the drainage bag. Rinse out the leg bag with 1 part vinegar
and 3 parts water. Soak the bag for 20 minutes. Rinse the bag out
with warm water and hang it up to dry.
- In the morning, take off the drainage bag, put on the leg bag,
and clean out the drainage bag the same way.
- Clean your leg bag every day and replace it whenever your
doctor tells you to. This is usually once a month.
Other care tips
- Drink plenty of liquids. You should drink at least 8 cups of
healthy liquids a day, if your health care provider approves.
- Do not pull or tug on the tubing. This can cause bleeding and
hurt the area in which the water-filled balloon is located.
- Do not step on the tubing when you are walking. Hold the tubing
curled in your hand, with the urine bag below your bladder when you
are walking. You may also want to clip or pin the tubing to your
clothing.
- Arrange the catheter tubing so that it does not twist or loop.
When you are getting into bed, hang the urine bag beside the bed.
You can sleep in any position as long as the bedside bag is below
your bladder. Do not place the urine bag on the floor.
- Always keep your urine bag below your bladder, which is at the
level of your waist. This will prevent urine from flowing back into
your bladder from the tubing and urine bag, which could cause an
infection. Also, do not go to bed or take a long nap while wearing
the leg bag.
- When you take a shower, you can keep the larger drainage bag in
place and hang it on the rail in the shower area. You can also use
a plug that is inserted in the place where the catheter connects to
the drainage bag. Lay the drainage bag aside with a cover over the
connection piece while you shower, and reconnect when you are done.
It is important to put a cap on the end of the drainage bag tubing
so it does not become contaminated.
- If you dislodge the catheter, it will stop draining or it will
leak. Call your doctor if this happens. Leakage can happen from
many things: dislodgement, bladder spasms, or blockage. In all
cases, notify your doctor.
- Check the catheter and drainage tube on a regular basis to make
sure the tube isn't squeezed or tangled.
Benefits of indwelling catheterization
Urinary catheterisation is a medical procedure used to drain and
collect urine from the bladder. A urinary catheter might be used
long term:
- to treat urinary retention (inability to empty the bladder when
needed)
- when there is obstruction in the urinary tract (such as a
bladder stone or, in men, a swollen prostate gland) and the
obstruction can’t be removed immediately
- to treat urinary incontinence(leaking urine or being unable to
control urination) if all other types of treatment have failed
- to remove urine from the bladder if nerve damage interferes
with bladder control (this is called neuropathic bladder)
- in bed-bound people too weak to go to the toilet normally
Advantages of intermittent catheterization;
- It’s Fairly Simple: While it may seem a little
intimidating at first, self-cathing can become a relatively quick
and simple procedure after a little bit of practice. Many people
are able to catheterize themselves or do so with the help of a
caregiver.
- It’s an Effective Solution: Neglecting to
empty your bladder regularly can lead to urinary tract infections
or even bladder infections. Intermittent catheterization is an
effective solution to helping those who have difficulty emptying
their bladders and helping prevent such health problems if done
correctly.
- It’s Safe to Use: Compared to indwelling Foley
catheters, intermittent catheters have been found to cause fewer
infections. Since Foley catheters stay in the body for longer
periods of time, urinary tract infections can become a constant
problem for some. By using an intermittent catheter, the chance of
experiencing these side effects is greatly reduced.
- Inexpensive: Some healthcare and medical
products can be relatively expensive out of pocket. Depending on
your insurance provider, they may or may not cover certain items.
Intermittent straight catheters are often the best option for those
who are uninsured or underinsured because they are rather
inexpensive.
- Promotes Independence: Because intermittent
catheters allow you to gain control of your bladder and care for
yourself, they help promote independence and, more importantly,
allow you a better quality of life.
Neurogenic bladder is bladder
dysfunction (flaccid or spastic) caused by neurologic damage.
Symptoms can include overflow incontinence, frequency, urgency,
urge incontinence, and retention. Risk of serious complications
(eg, recurrent infection, vesicoureteral reflux, autonomic
dysreflexia) is high.
While neurogenic bladder can't be
cured, necessarily, it can most
definitely be managed. Most cases of neurogenic bladder
can be managed with medication and intermittent
catheterization. The minority of children with the condition need
major reconstructive surgery.
drugs used for the treatment are, patch form of oxybutinin
causes fewer side effects than oral oxybutynin.
Otheranticholinergic drugs used for neurogenic
bladder include: Tolterodine, a drug that is
highly specific to the bladder, giving it a lower overall side
effect profile than otheranticholinergic
drugs9.
The main treatments for neurogenic bladder are the
following:
- Clean intermittent catheterization (CIC):
Catheters are thin, flexible tubes that can be inserted through the
urethra and into the bladder to drain urine.
- Drugs: These include anticholinergic
medications (oxybutynin, tolterodine, and others.)
- Injections of botulinum A toxin (Botox®): A
doctor injects Botox into the bladder or urinary sphincters.
- Bladder augmentation (augmentation
cystoplasty): This is a surgery in which segments of the
intestine (sigmoid colon) are removed and attached to the walls of
the bladder. This reduces the bladder's internal pressure and
increases its ability to store urine.
- Ileal conduit: Part of the small bowel is used
to make a urine stoma. This stoma drains to a bag attached to the
outside of the body.
- Lifestyle changes: These might include
avoiding certain foods or drinks that can irritate the bladder.
These include certain caffeinated drinks like coffee, carbonated
beverages, spicy foods, and citrus fruit. Losing weight can ease
stress on the bladder. A behavioral treatment called delayed
voiding may help some people with urine control.
Absorbent undergarments, pads, panty shields, panty liners, and
adult diapers can help prevent wetness and odors while protecting
skin and clothing. Bed pads can protect sheets and mattresses.