Assisting with Elimination
Providing Catheter Care
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Safety
- Use Standard Precautions when handling body fluids.
- Evaluate the patient’s urinary output and serum electrolyte values. An hourly urine output of less than 30 mL/hr in 2 hours indicates the need for further evaluation.
- Identify the signs of dehydration and fluid overload. Begin measuring the patient’s intake and output (I&O) when there is an actual or anticipated change in fluid balance.
- Repeat the procedure if the labia accidentally close or the penis is dropped during catheter care.
- Instruct the patient to hold the urine collection bag below the level of the bladder while ambulating and not to disconnect the catheter from the collection tubing and bag.
- Be alert for cloudy, foul-smelling urine associated with other systemic symptoms, which may indicate a catheter-associated urinary tract infection, or CAUTI. Older adults may exhibit atypical signs and symptoms of CAUTI, such as altered mental status.
Equipment
(Roll cursor over items to see labels)
Basin
Waterproof pad
Clean gloves
Bath blanket
Soap
Washcloth & towel
PrintableDelegation
The skill of performing routine catheter care can be delegated to nursing assistive personnel (NAP). Be sure to inform NAP of the following:
- Report the characteristics of the patient’s urine, including color, clarity, odor, and amount.
- Report the condition of the patient’s genital area, for example, color, rashes, open areas, odor, soiling from fecal incontinence, and/or trauma to the tissues surrounding the urinary meatus.
- Report any patient complaints that might indicate a catheter-associated urinary tract infection (CAUTI), such as fever, chills, burning, flank pain, back pain, or blood in the urine.
Preparation
- Observe the patient’s urinary output and urine characteristics.
- Assess the patient for a history of or presence of bowel incontinence.
- Observe for any discharge, redness, bleeding, or tissue trauma around the patient’s urethral meatus.
- Assess the patient’s knowledge of catheter care.
- Explain the procedure to the patient. Discuss the importance of fluid intake in maintaining urinary health, and outline the signs and symptoms of a UTI. If applicable, teach the patient how to perform self‒catheter hygiene.
Follow-up
- Inspect the catheter and genital area for soiling, irritation, and skin breakdown. Ask the patient about any discomfort.
- Evaluate the patient for signs and symptoms of a urinary tract infection (UTI).
Documentation
- Record the time at which catheter care was performed, the appearance of the patient’s urine, and a description of the condition of the patient’s urinary meatus and catheter.
- Record any patient teaching related to catheter care and fluid intake.
Review Questions
1. What is the primary reason the nurse ensures that a patient’s indwelling urinary catheter drainage tubing is free of kinks?
Kinks in the tubing cause the patient unnecessary discomfort.- Kinks allow the drainage bag to become overly full.
Kinks are associated with the development of urinary tract infection (UTI).- Kinks result in scant, dark amber-colored urine.
INCORRECT. Kinking of the drainage tubing interferes with proper urine drainage, perhaps making the patient uncomfortable; preventing infection, however, is more important than promoting comfort.
INCORRECT. Kinks in the drainage tubing do not result in an overly full drainage bag. In fact, they do the opposite (obstruct urine drainage into the bag), which can cause UTI.
CORRECT. Kinks in the drainage tubing obstruct the flow of urine into the drainage bag, which can cause UTI.
INCORRECT. The development of scant, dark amber–colored urine is probably a result of dehydration, not kinked tubing. Kinks in the drainage tubing obstruct the flow of urine into the drainage bag, which can cause UTI.
2. The nurse has delegated measurement of a patient’s vital signs and catheter care to nursing assistive personnel (NAP). Which observation should the NAP report to the nurse immediately?
- Rectal temperature of 99.6° F
- Pulse rate of 88 beats per minute
- Redness noted on the external urethral meatus
- 200 mL of pale yellow urine in the drainage bag
INCORRECT. This temperature is within normal limits; a catheterized patient’s temperature should be closely monitored, however, since an elevated temperature may indicate that UTI has developed.
INCORRECT. This pulse rate is within normal limits; a catheterized patient’s pulse rate should be closely monitored, however, since tachycardia may indicate that UTI has developed.
CORRECT. Redness surrounding the external urethral meatus is a sign of impaired skin integrity and should be reported to the nurse immediately.
INCORRECT. This urine output and color are within normal limits; a catheterized patient’s urine output should be monitored closely, however, to observe its characteristics (color, odor, cloudiness) and volume for signs of UTI.
3. All of the following factors are known to increase the risk of urinary tract infection (UTI) except which one?
- History of fecal incontinence
- Use of an indwelling urinary catheter
- Drainage tubing is kinked
- Use of plain soap instead of an antiseptic cleanser for perineal hygiene
INCORRECT. E. coli is the most common cause of catheter-associated urinary tract infection (CAUTI). E. coli colonizes the bowel; soiling from fecal incontinence therefore increases the risk of CAUTI.
INCORRECT. The risk of UTI increases with the use of an indwelling catheter, particularly if the catheter is left in place for more than a few days.
INCORRECT. Kinks in the tubing obstruct the flow of urine into the drainage bag, which can cause UTI.
CORRECT. Use of an antiseptic cleanser has not been shown to decrease the risk of catheter-associated urinary tract infection (CAUTI). Mild soap and warm water are adequate for perineal hygiene during catheter care.
4. While performing catheter care, the nurse moves her hand, allowing the patient’s labia to close around the catheter. Why would the nurse repeat this part of the care?
- The catheter may have traumatized the labia.
- The labia have contaminated the area.
- The patient’s perineal area must be reassessed for infection.
- The nurse must ensure that the catheter is not pulling on the bladder.
INCORRECT. The catheter will not traumatize the labia. The nurse will repeat the cleansing to ensure cleanliness of the perineal area.
CORRECT. The nurse will repeat the perineal care because the labia closed around the catheter and contaminated the perineal area.
INCORRECT. The nurse will assess the patient’s perineal area for signs of infection and then repeat the perineal care to ensure cleanliness, not to re-assess for infection.
INCORRECT. The nurse must ensure that the catheter is not pulling on the bladder; however, the cleansing must be repeated because the labia closed around the catheter and contaminated the area.
5. What is the most effective way to prevent infection when providing catheter care for a patient?
- Properly dispose of soiled linen.
- Perform hand hygiene before positioning the patient.
- Secure the catheter to the patient’s leg or abdomen.
- Cleanse from the meatus outward.
INCORRECT. Properly disposing of soiled linen is an infection control measure, but its effect in preventing infection during catheter care is negligible.
INCORRECT. Performing hand hygiene before positioning the patient is an infection control measure, but its effect in preventing infection during catheter care is negligible.
INCORRECT. Securing the catheter to the leg (in a female patient) or abdomen (in a male patient) will prevent the catheter from pulling on the bladder and will therefore reduce the risk of CAUTI; however, it is not the most important infection control measure listed.
CORRECT. Securely holding the catheter and cleansing from the meatus outward is the most effective way to prevent infection when providing catheter care.
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