Urinary catheters

Definition:

Any tube system placed in the body to drain and collect urine from the bladder.

Alternative Names:

How to insert a catheter; Suprapubic catheters; How to remove a catheter; Foley catheter

Information:

A Foley catheter is a soft plastic or rubber tube that is inserted into the bladder to drain the urine. Urinary catheters are sometimes recommended as way to manage urinary incontinence and urinary retention in both men and women. There are several different types of catheters which may be used for a variety of different reasons.

URINARY CATHETERS:
Urinary catheters may be used to drain the bladder. This is often a last resort because of the possible complications associated with continuous catheter usage. Complications of catheter use may include: urinary tract and/or kidney infections, blood infections (septicemia), urethral injury, skin breakdown, bladder stones, and blood in the urine (hematuria). After many years of catheter use, bladder cancer may also develop.

Your health care provider may recommend use of a catheter for short term use or long term use (indwelling). The catheter may be left in place during this time, or you may be instructed on a procedure for placing a catheter just long enough to empty the bladder and then remove it (clean intermittent self catheterization).

Catheters come in a large variety of sizes (12 Fr., 14 Fr.,... 30 Fr.), materials (latex, silicone, Teflon) and types (Foley catheter, straight catheter, coude tip catheter). It is recommended that you use the smallest size of catheter, if possible. Commonly, a size 14 Fr. or size 16 Fr. catheter is used. Some people may require larger catheters to control leakage of urine around the catheter or if the urine is thick and bloody or contains large amounts of sediment. Be aware that larger catheters are more likely to cause damage to the urethra. Some people have developed allergies or sensitivity to latex after long term latex catheter use; these people should use the silicone or Teflon catheters.

LONG TERM (INDWELLING) URETHRAL CATHETERS:
A catheter that is left in place for a period of time may be attached to a drainage bag to collect the urine. There are two types of drainage bags. One type is a leg bag, which is a smaller drainage device that attaches by elastic bands to the leg. A leg bag is usually worn during the day since it fits discreetly under pants or skirts, and is easily emptied into the toilet. The other type of drainage bag is a larger drainage device (down drain) that may be used during the night. This device is usually hung on the bed or placed on the floor.

HOW TO CARE FOR YOUR CATHETER:
Most experts advise against routine changing (replacing) of the catheters. If the catheter is clogged (obstructed), painful, or infected it may require immediate replacement. Routine care of the indwelling catheter MUST include daily cleansing of the urethral area (where the catheter exits the body) and the catheter itself with soap and water. The area should also be thoroughly cleansed after all bowel movements to prevent infection. Experts no longer recommend using antimicrobial ointments around the catheter as they have not been shown to actually reduce infections.

You should increase your fluid intake, unless you have a medical condition prohibiting large amounts of fluid intake, to reduce the risk of developing complications. You should discuss this issue with your health care provider.

The drainage bag must always stay lower than the bladder to prevent a back flow of urine back up into the bladder. The drainage device should be emptied at least every eight hours, or when the device is full. Care must be taken to keep the outlet valve from becoming infected. Wash your hands before and after handling the drainage device. Do not allow the outlet valve to touch anything. If the outlet becomes obviously dirty, it should be cleaned with soap and water.

HOW TO CLEAN YOUR DRAINAGE BAG:
Some experts recommend cleaning the drainage bag periodically. Remove the drainage bag from the catheter (attach the catheter to a second drainage device during the cleansing). Cleanse and de-deodorize the drainage bag by filling the bag with 2 parts vinegar and 3 parts water. Chlorine bleach can be substituted for the vinegar and water mixture. Let this solution soak for 20 minutes. Hang the bag with the outlet valve open to drain and dry the bag.

WHAT TO DO FOR A LEAKING CATHETER?
Some people have occasional leakage of urine around the catheter. This may be caused by a catheter that is too small, improper balloon size, or bladder spasms. If bladder spasms occur, you should check to see that the catheter is draining properly. If there is no urine in the drainage bag, the catheter may be obstructed by blood or thick sediment, or kinking of the catheter or drainage tubing. If you have been instructed on irrigation (flushing the catheter) procedure, try to irrigate the catheter and see if this helps. If you have not been instructed on irrigation and urine is not flowing into your collection device, you should contact your health care provider immediately. Other causes of urine leakage around the catheter include constipation or impacted stool, or urinary tract infections.

POTENTIAL COMPLICATIONS:
Notify your health care provider if you develop any of the following:

the urine has a strong smell or becomes thick and/or cloudy.
fever, chills
urethral swelling around the catheter
bleeding into or around the catheter
catheter draining little or no urine despite adequate fluid intake
leakage of large amounts of urine around the catheter.

SUPRAPUBIC CATHETERS:
A suprapubic catheter is basically an indwelling catheter that is placed directly into the bladder through the abdomen. The catheter is inserted above the pubic bone. This catheter must be placed by a urologist during an outpatient surgery or office procedure. The insertion site (opening on the abdomen) and the tube must be cleansed daily with soap and water and covered with a dry gauze.

These catheters usually are changed by qualified medical personnel. The catheter may be attached to the standard drainage bags described above. A suprapubic catheter may be recommended in people who require long term catheterization, after some gynecological surgeries, and in people with urethral injury or obstruction.

Complications of suprapubic catheter use may include: urinary tract and/or kidney infections, blood infections (septicemia), urine leakage around the catheter, skin breakdown, bladder stones, and blood in the urine (hematuria). After many years of catheter use, bladder cancer may also develop.

HOW TO INSERT A CATHETER (MEN):
1. Assemble all equipment: catheter, lubricant, sterile gloves, cleaning supplies, syringe with water to inflate the balloon, drainage receptacle.

2. Wash your hands. Use betadine or similar cleansing product (unless instructed otherwise) to clean the urethral opening.

3. Apply the sterile gloves. Make sure you do not touch the outside of the gloves with your hands.

4. Lubricate the catheter.

5. Hold the penis on the sides, perpendicular to the body. Stretch the penis away from the body.

6. Begin to gently insert and advance the catheter.

7. You will meet resistance when you reach the level of the external sphincter. Try to relax by deep breathing, and continue to advance the catheter.

8. Once the urine flow starts, continue to advance the catheter to the level of the "Y" connector. Hold the catheter in place while you inflate the balloon. Some men have developed urethral injuries due to the balloon being inflated in the urethra. Care must be taken to ensure the catheter is in the bladder. You may try to irrigate the catheter with a few ounces of sterile water. If the solution does not easily return, you may not have the catheter far enough in the bladder.

9. Secure the catheter, and attach the drainage bag.

HOW TO INSERT A CATHETER (WOMEN):
1. Assemble all equipment: catheter, lubricant, sterile gloves, cleaning supplies, syringe with water to inflate the balloon, drainage receptacle.

2. Wash your hands. Use betadine or cleansing product to clean the urethral opening. In women clean the labia and urethral meatus using downward strokes. Avoid the anal area.

3. Apply the sterile gloves. Make sure you do not touch the outside of the gloves with your hands.

4. Lubricate the catheter.

5. Spread the labia and locate the meatus (opening which is located below the clitoris and above the vagina).

6. Slowly insert the catheter into the meatus.

7. Begin to gently insert and advance the catheter.

8. Once the urine flow starts, advance the catheter another 2 inches. Hold the catheter in place while you inflate the balloon. Care must be taken to ensure the catheter is in the bladder. If pain is felt which inflating the balloon, stop; deflate the balloon; advance the catheter another 2 inches; and attempt to inflate the balloon again.

9. Secure the catheter, and attach the drainage bag.

HOW TO REMOVE A CATHETER:
Indwelling catheters may be removed in two ways. One method is to attach a small syringe to the inflation port on the side of the catheter. Draw out all the fluid until you are unable to withdraw any more fluid. Slowly pull the catheter out until it is completely removed.

Some health care providers instruct their patient's to cut the inflation port tubing before it reaches the main tubing of the catheter. After all the water has drained out, slowly pull out the catheter until it is completely removed. Be careful not to cut the catheter anywhere else.

If you cannot remove the catheter with only slight pulling, notify your health care provider immediately.

Notify your health care provider if you are unable to urinate within 8 hours after catheter removal, or if your abdomen becomes distended and painful.

SHORT TERM (INTERMITTENT) CATHETERS:
Some people may only require catheterization on a occasional basis. These people can be taught to catheterize themselves to drain the bladder when needed without having to constantly wear an external device. People who may benefit from intermittent catheterization include people with neurological disorders, women after certain gynecological surgeries, men with large prostates, and anyone who is unable to properly empty their bladder. The process is similar to the above described procedures except the balloon inflation is not performed and the catheter is removed after the flow of urine has stopped. See - clean intermittent self catheterization (CISC).

Review Date: 11/5/2001
Reviewed By: David R. Knowles M.D., Department of Urology, New York-Presbyterian Hospital Columbia Campus, New York, NY. Review provided by VeriMed Healthcare Network.

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