Urinary Catheter Management
Removing an Indwelling Urinary Catheter
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- » Inserting an Indwelling Urinary Catheter in a Female Patient
- » Inserting an Indwelling Urinary Catheter in a Male Patient
- » Irrigating a Urinary Catheter
- » Performing Intermittent Straight Catheterization
- » Obtaining a Specimen from an Indwelling Urinary Catheter
- » Removing an Indwelling Urinary Catheter
- » Caring for a Suprapubic Catheter
Take the Review Test:
Safety
- Limit the use of indwelling urinary catheters to essential conditions, and remove the catheter as soon as medically possible.
- In order to minimize trauma to the urethra, be sure the catheter balloon has been fully deflated when removing an indwelling urinary catheter.
- Use a voiding record or bladder diary to monitor voiding in the first 24 to 48 hours after catheter removal.
- Inform patients of their risk for infection, and provide information about prevention measures they may take. Let patients know what signs they need to report to their primary care provider. Symptoms of infection can develop two or more days after catheter removal.
Equipment
(Roll cursor over items to see labels)
10mL or larger syringe without needle
Waterproof pad
Clean gloves
Bath blanket
Graduated cylinder
Soap
Washcloth and towel
Basin
PrintableDelegation
The skill of removing an indwelling urinary catheter can be delegated to NAP; however, the nurse must first assess the patient’s status, verify the provider’s order, and validate that agency policy allows NAP to do so. Be sure to inform NAP of the following:
- Specify characteristics of the urine that NAP should report to you, including color, clarity, odor, and amount.
- Instruct NAP to report the condition of the patient’s genital area, including color, rashes, open areas, odor, soiling from fecal incontinence, and any trauma to the urinary meatus.
- Review how to check the size of the balloon and syringe needed to deflate the balloon; instruct NAP to report if the balloon does not deflate, and to report if there is bleeding after catheter removal.
- Remind NAP to report the time and amount of first voiding after the catheter is removed.
- Instruct NAP to report any patient complaints that might indicate a complication, such as dysuria, hematuria, urgency, frequency, lower abdominal pain, change in mental status, lethargy, fever, chills, burning, flank pain, back pain, or blood in the urine.
Preparation
- Review the patient’s medical record, including the health care provider’s order and documentation. Note how long the catheter has been in place and how much fluid was used to fill the catheter balloon.
- Assess the patient’s knowledge and prior experience with catheter removal.
- Assess the color, clarity, odor, and amount of the patient’s urine.
- Note any urethral discharge, irritation of the genital region, or trauma to the urinary meatus. This assessment may be deferred until just before catheter removal.
Follow-up
- Inspect the catheter and genital area for soiling, irritation, and skin breakdown. Ask the patient if he or she has any discomfort.
- Observe the time of first voiding after catheter removal, and measure the amount. Evaluate the patient for symptoms of a UTI, such as dysuria, hematuria, urgency, frequency, lower abdominal pain, change in mental status, lethargy, fever, chills, burning, flank pain, back pain, or blood in the urine.
Documentation
- Record and report the time of catheter removal, the condition of the urethral meatus and catheter, and the time, amount, and characteristics of the first voided urine.
- Record any teaching related to catheter removal and fluid intake.
- Report any hematuria, dysuria, inability to void or difficulty voiding, and any new incontinence after a catheter has been removed.
Review Questions
1. When preparing to discharge a patient who had an indwelling urinary catheter removed 24 hours ago, the nurse would offer patient education regarding which common complication?
INCORRECT. Urinary incontinence is not a common complication of indwelling urinary catheter removal.
CORRECT. A urinary tract infection may develop 2 to 3 days after indwelling urinary catheter removal, and the nurse would educate the patient to be alert for signs and symptoms of such an infection.
INCORRECT. Adequate hydration is not a complication of indwelling urinary catheter removal, but an intervention.
INCORRECT. The presence of kidney stones is not a common complication of indwelling urinary catheter removal.
2. Which action would best minimize a patient’s risk for infection during removal of an indwelling urinary catheter?
The nurse or nursing assistive personnel (NAP) removing the catheter must employ clean technique. 
A registered nurse, not NAP, must remove the catheter.- Catheter removal must be executed within 10 minutes of beginning the procedure.
- Catheter removal must take place within 5 days of catheter insertion.
CORRECT. Using clean technique is the best way to minimize the risk of introducing pathogens to the patient’s urinary tract.
INCORRECT. Trained NAP may remove an indwelling urinary catheter if allowed by agency policy.
INCORRECT. Although the procedure should be accomplished in a timely manner, doing so will not minimize the risk of infection.
INCORRECT. Although it is best to limit the use of an indwelling urinary catheter to the shortest time possible, doing so will not affect the risk of infection during the actual removal process.
3. Which statement might the nurse make to nursing assistive personnel (NAP) caring for a patient who has just had an indwelling urinary catheter removed?
- “Teach the patient the signs of a urinary tract infection.”
- “Tell me when and how much the patient first voids.”
- “Explain that voiding might be uncomfortable for 4 to 5 days.”
- “Assess the patient for a distended bladder before the end of the shift.”
INCORRECT. Patient education cannot be delegated to NAP.
CORRECT. The nurse may delegate to NAP the task of reporting the time and amount of the patient’s first voiding after removal of an indwelling urinary catheter.
INCORRECT. Initial postremoval void might be uncomfortable but after that, uncomfortable
INCORRECT. Patient assessment cannot be delegated to NAP.
4. Which nursing action minimizes a patient’s risk for injury during removal of an indwelling urinary catheter?
- Using a 5-mL syringe to deflate the balloon
- Using sterile scissors to cut the valve to deflate the balloon
- Tugging gently on the catheter to pull the balloon through the urethra
- Checking the documentation for the volume of fluid used to inflate the balloon
INCORRECT. A 5-mL syringe may not be large enough to accommodate the volume of fluid used to inflate the balloon.
INCORRECT. The valve on the catheter should not be cut to deflate the balloon.
INCORRECT. An inflated balloon should not be pulled through the urethra, no matter how gently. Doing so can damage the bladder and urethra.
CORRECT. Checking the volume of fluid used to inflate the balloon in order to ensure the balloon is completely deflated before removal is the nursing action that will minimize a patient’s risk for injury during removal of an indwelling urinary catheter.
5. Which is not an expected outcome on a first voiding after catheter removal?
INCORRECT. Many patients experience mild burning with their first voiding after catheter removal.
CORRECT. The nurse would instruct the patient to report signs of a urinary tract infection, such as fever and back pain. These signs are unlikely to be present during the patient’s first voiding after catheter removal.
INCORRECT. Many patients produce only a small volume of urine with their first voiding after catheter removal.
INCORRECT. Many patients experience discomfort with their first voiding after catheter removal.
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