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Indwelling (Transurethral and Suprapubic) Catheters

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Book cover Clinical Application of Urologic Catheters, Devices and Products

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Abstract

Indwelling urinary catheters have been utilized to empty the bladder since as early as 3000 B.C. Today, IUCs are used in selected patients for urinary retention, prevention of UTIs in those with incomplete bladder emptying, prevention of upper urinary tract deterioration, for comfort in the terminally ill patient, as well as for many other indications. Indwelling urinary catheters can be made from many different materials, come in an array of sizes, shapes, and designs allowing for easier insertion, improved patient comfort, as well as a potential reduction in associated complications. However, despite their widespread use, very little research has been conducted on these commonly used devices. With recent regulatory and financial pressures directed toward reducing catheter-associated urinary tract infections in hospitals, attention has been refocused toward the use of IUC in this setting. Now, more than ever, research is being conducted to see what measures can be initiated to reduce hospital acquired catheter-associated urinary tract infections. Such measures include catheter checklists with algorithms to decrease unindicated catheter use and enhance appropriate and timely removal of catheters when no longer required.

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Author information

Authors and Affiliations

  1. Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA

    Diane K. Newman

  2. Department of Urology, Medical University of South Carolina, 96 Jonathan Lucas St CSB 620, Charleston, SC, 29482, USA

    Rebecca Patton Cumbee & Eric S. Rovner

Authors
  1. Diane K. Newman
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  2. Rebecca Patton Cumbee
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  3. Eric S. Rovner
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Corresponding author

Correspondence to Rebecca Patton Cumbee .

Appendices

Appendix 1: Guide to Catheterization

Care and Use of an Indwelling Urinary Catheter Patient Education Tool

What Is an Indwelling Urinary Catheter?

A catheter is a soft hollow tube that drains the urine from your bladder. The catheter, often called a Foley, has a small balloon near the tip, which is filled with water to help hold it in place. The balloon sits at the bottom of your bladder and keeps the catheter tube from falling or being pulled out. The catheter is attached to a long tube that carries the urine to a drainage bag, which collects the urine. There are two types of drainage bags, a larger “overnight” bag that can be hung on the side of your bed during the night, and a smaller “leg” bag that is used during the day since it can be fastened under your clothes, hidden away. Once the catheter and bag are put in place, it is a closed system and should never be opened unless you are told to do so by your doctor or nurse. The catheter is made from latex or other materials, such as silicone. Catheters must be prescribed by a prescribing clinician and are usually changed by a nurse.

Why Do I Need an Indwelling Catheter?

Some people need help to empty urine from their bladder because of certain medical problems that do not let the bladder empty completely. If this happens, a tube called a catheter is put into the bladder to drain the urine. The catheter can be put in your bladder in one of two ways:

The most common way to put a catheter in the bladder is through the urethra (the urethra carries urine from your bladder to the outside). The picture to the right shows a catheter that has been placed through the urethra of a man. The balloon is inflated and sits at the bottom of the bladder.

A second way is through an opening or hole made in your lower stomach, above your pubic bone. This catheter is referred to as a suprapubic catheter or “SP tube.” The picture to the right shows a catheter that has been placed through the stomach, above the pelvic bone and into the bladder of a woman. The balloon is inflated and sits at the opening into the bladder.

How Does a Catheter Feel?

You may sometimes feel burning or spasms when urine passes through the catheter. This is normal, so don’t be alarmed. The spasms may cause some urine to leak out around the catheter. If the leaking does not stop, call your doctor or nurse. You may be prescribed medication to stop the spasms. Spasms may also be a sign that the catheter needs to be changed.

How to Care for Your Catheter?

ALWAYS wash your hands before and after touching the catheter, tube, or bag. You can wash the skin around the catheter with a liquid soap and water every day and after you empty (move) your bowels. You can also wash the part of the catheter that is outside the body. You can use antibacterial soap for washing . As shown in the picture to the right, start cleaning where the catheter leaves the body and clean along the catheter for about 6 in. with mild liquid soap and water. You may notice dried, crusted material on the catheter where it leaves your body. This can be washed away by gently wiping with a wet cloth.

How to Position Your Catheter and Drainage Bag

Your catheter will be connected to a drainage bag. You can use either a small leg bag or a large bag at night, when you are asleep. When you go to bed, hang the night bag on the side of your bed or put it in a small wastebasket lined with a clean plastic trash bag next to your bed. The picture on the right is a large bag. Keep drainage bags below the level of the bladder at all times. Avoid kinks or loops in the catheter and tubing that could stop the flow of urine. You should empty the bag at least every 4–6 h or if when it is half filled.

Securing the Catheter

As shown in the picture to the right, the catheter should be attached to your upper thigh by a strap. An SP tube should be taped or secured to your stomach with an adhesive holder. With both types, leave some slack on the catheter to prevent tension on the bladder.

How to Prevent Infections

Drink plenty of non-alcoholic liquids daily (at least 6–8 glasses, 8-oz size), unless your doctor or nurse tells you otherwise. Liquids include water, tea, coffee, ice cream, sherbet, fruit juice, Popsicles, Kool-Aid, lemonade, and the like. Take 500–1000 mg of vitamin C (true ascorbic acid) two times a day, or drink three 8-oz glasses of cranberry juice, or take two 500 mg cranberry pills each day.

Can I Have Sex with the Catheter in My Bladder ?

Sexual intercourse with a catheter in place may require some adjustment. Several women said that they position the catheter to the side and make sure that the tubing is out of the way.

What to Do and What Not to Do

  1. 1.

    Do—drink enough liquids during the day as this will help keep fluids moving through the catheter and prevent infection. Keep glasses of water or a jug of water around the house, near you.

  2. 2.

    Do—wash your hands before and after emptying or changing drainage bags.

  3. 3.

    Do—shower if you have a catheter. Keep the drainage bag connected to the catheter while in the shower.

  4. 4.

    Do Not—use alcohol to wash the catheter or skin around the catheter as this can be irritating, sting and cause the skin to dry.

  5. 5.

    Do Not—pull on the catheter, tubing, or bag and never pull out the catheter yourself.

  6. 6.

    Do Not—disconnect any part of the catheter system unless your doctor or nurse has allowed you to use a leg bag during the day and an overnight bag at night. If the tubing becomes disconnected, clean the ends with an alcohol-soaked pad and reconnect it immediately. Then call your doctor or nurse, because the catheter may need to be changed.

  7. 7.

    Do Not—irrigate the catheter, unless told to do so by your doctor and unless you have been shown the correct way to do it. If it becomes clogged and stops draining, call your doctor or nurse.

  8. 8.

    Do Not—be alarmed if the catheter sometimes leaks. This is normal and is caused by bladder spasms. It is only a problem if no urine is draining.

Call Your Doctor or Nurse if:

  • The urine has a strong smell, becomes cloudy or dark, or turns red.

  • You have chills, a fever above 100ºF, lower back pain, weakness, and/or leakage around the catheter.

  • There is swelling at the place where the catheter is inserted.

  • There is an increased amount of sediment in the drainage tube or bag.

  • The catheter is not draining any urine (first make sure the catheter or tubing is not blocked or kinked).

  • The catheter falls out. If you have an SP catheter and it falls out, you must call your doctor or nurse right away so it can be replaced.

© 2010 revs 2017 by Diane K. Newman

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Newman, D.K., Cumbee, R.P., Rovner, E.S. (2018). Indwelling (Transurethral and Suprapubic) Catheters. In: Clinical Application of Urologic Catheters, Devices and Products. Springer, Cham. https://doi.org/10.1007/978-3-319-14821-2_1

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