Nursing & Healthcare Programs

Indwelling Catheter Care

Written by Amanda R. McDaniel, MS, BSN, RN
Amanda is a BSN/RN with a MS in Physiology and a BA in English. She worked as a medical writer in the pharmaceutical industry for 11 years before pursuing a career in nursing. She now works as a nurse on a NeuroTelemetry unit and continues to write and edit on a freelance basis. Amanda’s LinkedIn

Indwelling catheters allow urine to drain from the bladder. They are used when residents are unable to urinate on their own or when the process of cleaning the resident after urination would be difficult for the resident to tolerate (such as during end of life care). Caring for the catheter appropriately is a vital part of preventing infection and skin breakdown.

Caring for an Indwelling Catheter

  1. Gather your supplies:
    • Gloves
    • Washcloth, soap, and basin or disposable bath wipes
    • Towels
    • Absorbent pad
    • New catheter securement device or tape (if needed)
  2. Give the resident privacy by closing the door or curtain.
  3. Perform hand hygiene and don gloves.
  4. Arrange your supplies within easy reach. A bedside table covered in a towel is often most convenient.
  5. Fill the basin with warm water.
  6. Raise the bed to a comfortable working height and help the resident to a supine position. The head of the bed can be at the angle most comfortable for the resident. Lower the side rail near you.
  7. Fold back the top linens to provide access to the perineal area. Offer a blanket to cover the resident’s upper body.
  8. Place the absorbent pad under the resident’s buttocks. If the resident is unable to assist by lifting their buttocks, logroll the resident. The absorbent pad will help prevent the need to change the bottom linens.
  9. Inspect the perineal area for secretions or drainage. If the male resident is uncircumcised, carefully retract the foreskin. Gently separate the labia of female residents.
  10. Perform perineal care with washcloths, soap, and the warm water from the basin or with bath wipes. Remember to clean front-to-back on female residents and under the foreskin of uncircumcised males.
  11. Remove the catheter from the securement device or tape on the leg. If the securement device is soiled, remove it according to the manufacturer’s instructions.
  12. Carefully grasp the catheter at the urinary meatus.
  13. Clean the catheter from the meatus to at least 4 inches from the meatus with a wet, soapy wash cloth or bath wipe. Always clean starting at the meatus and clean in a single stroke, no scrubbing. Do not pull on the catheter as you clean it. Repeat until the catheter is clean.
  14. Rinse the catheter with a clean, wet washcloth (not necessary if using no-rinse soap or wipes).
  15. Dry the catheter and perineal area with a towel. You may now let go of the catheter.
  16. If the resident is an uncircumcised male, allow the foreskin to return to its normal position.
  17. Secure the catheter with an appropriate securement device or fresh tape. Ensure that the drainage tubing has no dependent loops.
  18. Remove the absorbent pad, raise the side rail, and lower the bed back to the lowest position. Arrange bedding so the resident is comfortable.
  19. Discard and clean supplies, and remove gloves and perform hand hygiene.
  20. Document the procedure per institution or unit policy. Inform the nurse of any skin irritation or new discharge per policy.

References

S. A. Sorrentino, & L. N. Remmert. (2012). Urinary elimination. In Mosby’s textbook for nursing assistants (8th ed., pp 421-423). St. Louis, MO: Elsevier Mosby.

More Resources

Offering the Bedpan

When a resident is bed-bound, they must use a bedpan to urinate and defecate. This can be embarrassing for the resident, so it should be done with sensitivity to the resident’s privacy and dignity. There are two types of bedpans. A regular bedpan is the deeper and more rounded of the two. A fracture pan has a relatively flat upper end with a trough at the lower end. Fracture pans are used for residents who have difficulty, or restrictions against, moving their hips and/or backs.

Handwashing for CNAs

Handwashing is considered the single most important practice to prevent the spread of infection. Even when hands look clean, they could potentially be crawling with dangerous microorganisms and pathogens. Using soap and friction during handwashing helps loosen the oils on the skin, allowing dirt and pathogens to be rinsed away.

Measuring the Apical Pulse

The apical pulse rate is the most accurate non-invasive measurement of heart rate because it is measured directly over the apex of the heart. Apical pulse is preferred in cases when the radial pulse is difficult to palpate, when the pulse is irregular, greater than 100 beats per minute, or less than 60 beats per minute when measured by other means (electronic, radial, etc.).

Performing Ostomy Care

Residents who have had a portion of their intestines removed due to illness or trauma may have a temporary or permanent ostomy, which is an opening in the abdomen that is created for the elimination of urine or feces. The portion of the intestine that is connected to the abdominal wall and is visible is called the stoma. A pouch is placed over the stoma to collect feces.

Making an Occupied Bed

If a patient is bedridden or on bedrest, the bed linens will need to be changed while the patient is in the bed. For safety reasons, the nurse’s aid should avoid making an occupied bed if the patient is able to get out of bed. Bed linens should be changed according to the facility’s policy or anytime they are wet or soiled.

Using a Gait / Transfer Belt to Assist the Resident to Ambulate

Walking (aka, ambulating) helps residents maintain mobility and independence, and prevents complications. However, ambulation must be done safely so that the resident does not have a fall or injury. A gait or transfer belt, when properly used, can increase resident safety. Gait belts can vary between facilities, so make sure you know how to use the one in your facility.