Urinary Catheter Management
Caring for a Suprapubic 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
- Be sure to assess the patient for allergies, such as sensitivity to tape, latex, or antiseptic solution.
- Monitor for complications, such as urinary tract infection (UTI), skin site infection, decreased urinary output, and catheter occlusion.
- Observe the catheter insertion site for erythema, edema, discharge, and tenderness. Check the dressing at least every 8 hours.
- Avoid placing tension on the catheter, since doing so may be uncomfortable for the patient and can damage the bladder wall or dislodge the catheter.
- Keep the drainage bag below the level of the bladder.
Equipment
(Roll cursor over items to see labels)
Clean gloves
Sterile normal saline solution
Sterile surgical drainage sponge
Sterile gauze dressing
Washcloth and towel
Soap
Basin
Metapore Tape
PrintableDelegation
The skill of caring for a newly established suprapubic catheter cannot be delegated to nursing assistive personnel (NAP); however, care of an established suprapubic catheter may be delegated. Refer to your agency’s policy for the role of NAP in caring for a patient with a suprapubic catheter. Be sure to inform NAP of the following:
- Instruct NAP to report to you if the patient has any discomfort related to the suprapubic catheter.
- Review the schedule for emptying the drainage bag and the procedure for documenting the urinary output on the I&O record.
- Instruct NAP to report to you any change in the amount or character of the urine.
Instruct NAP to report to you any sign of redness, foul odor, or drainage around the catheter insertion site.
Preparation
- Assess the urine in the drainage bag for amount, clarity, color, odor, and sediment.
- Observe the dressing for drainage and intactness.
- Assess the catheter insertion site for the growth of over-granulation tissue and for signs of inflammation: pain, erythema, edema, and drainage. Ask the patient if there is any pain at the site; if so, ask the patient to rate the pain on a scale of 0 to 10.
- Assess the patient for elevated temperature and chills.
- Assess the patient’s knowledge of the purpose for the catheter and its care.
- Check for any patient allergies.
Follow-up
- Ask the patient to rate any pain or discomfort from the suprapubic catheter on a scale of 0 to 10.
- Monitor for signs of infection, such as fever or an elevated white blood count, and observe the urine for clarity, sediment, and unusual color or odor.
- Observe the catheter insertion site for erythema, edema, discharge, or tenderness. Check the dressing at least every 8 hours.
Documentation
- Record and report the character of the urine, the type of dressing change, including assessments of the insertion site and the patient’s comfort level with the catheter and dressing change.
- Record the patient’s urine output on the I&O flow sheet. If the patient has both suprapubic and urethral catheters, record each output separately.
Review Questions
1. A patient with a suprapubic catheter is complaining of pain. What will the nurse do first to help this patient?
Ensure that the patient is not lying on the drainage tubing 
Instruct the patient to increase his or her oral fluid intake - Observe the rate of drainage in the urine collection bag
- Notify the health care provider
CORRECT. The nurse will first ensure that the patient is not lying on the drainage tubing, since doing so could obstruct urine flow and cause pain.
INCORRECT. Increasing oral fluids will not reduce pain associated with a suprapubic catheter.
INCORRECT. The nurse would observe the rate of drainage in the collection bag only after ensuring that the flow of urine had not been obstructed by the weight of the patient's body on the tubing.
INCORRECT. Notifying the health care provider of the patient's complaint of pain would not be the nurse's first action.
2. What is the primary reason the nurse applies sterile gloves rather than clean ones when caring for a patient with a newly inserted suprapubic catheter?
- To protect the nurse and other patients from pathogens
- To collect a sterile urine sample
- To reduce the patient's risk of infection
- To reduce the patient’s risk of injury
INCORRECT. Although it is important to protect the nurse and other patients from pathogens, doing so is not the primary reason the nurse applies sterile gloves rather than clean ones when caring for a newly inserted suprapubic catheter.
INCORRECT. A sterile urine sample need not be collected from a patient with a newly established suprapubic catheter unless the provider has ordered one.
CORRECT. This is the correct answer. When providing care for a newly inserted suprapubic catheter, the nurse wears sterile gloves to reduce the risk of infecting the wound at the catheter insertion site.
INCORRECT. Putting on gloves, sterile or clean, does not reduce the patient’s risk of injury.
3. Which statement might the nurse make to nursing assistive personnel (NAP) assigned to care for a patient with an established suprapubic catheter?
- "Tell me if the catheter site looks inflamed."
- "I need to know the patient's temperature each time it's taken."
- "Wear sterile treatment gloves when you remove the dressing."
- "Let me know if the patient's catheter is infected"
INCORRECT. Patient assessment cannot be delegated to NAP.
CORRECT. Temperature measurement can be delegated to NAP. This statement is appropriate for the nurse to make.
INCORRECT. Wearing sterile gloves is not needed when removing the dressing of an established suprapubic catheter.
INCORRECT. Patient assessment cannot be delegated to NAP. In addition, the dressing should be changed at least once per shift regardless of whether it looks soiled.
4. Which nursing action reduces the risk of injury in a patient with a suprapubic catheter?
- Applying sterile gloves before cleaning the catheter insertion site
- Cleansing the skin surrounding the insertion site
- Securing the catheter to the abdomen
- Keeping the drainage bag above the level of the patient's bladder
INCORRECT. Applying sterile gloves when cleaning the catheter insertion site will reduce the patient’s risk of infection, but this action does not pertain to injury.
INCORRECT. Cleansing the skin around the insertion site will reduce the patient’s risk of infection but will not prevent injury.
CORRECT. Securing the catheter to the abdomen will reduce the risk of injury to the patient by ensuring that excess tension is not applied to the catheter. Such tension could damage the bladder.
INCORRECT. Keeping the drainage bag above the level of the patient's bladder is incorrect. Should be below the bladder.
5. A newly inserted suprapubic catheter becomes dislodged. What action should the nurse perform first?
- Notify the health care provider
- Apply pressure over the site
- Cover the site with a sterile dressing
- Help the patient into a side-lying position
INCORRECT. When a newly inserted suprapubic catheter becomes dislodged, the nurse's first action is to cover the site with a sterile dressing. The nurse would then notify the health care provider.
INCORRECT. When a newly inserted suprapubic catheter becomes dislodged, the nurse's first action is to cover the site with a sterile dressing. Pressure need not be applied over the site, and doing so might further injure the wound tissue.
CORRECT. When a newly inserted suprapubic catheter becomes dislodged, the nurse's first action is to cover the site with a sterile dressing.
INCORRECT. When a newly inserted suprapubic catheter becomes dislodged, the nurse's first action is to cover the site with a sterile dressing. There is no reason to move the patient into a side-lying position.
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