Urinary catheters 5 - Catheter drainage and support systems
This article discusses the use and care of catheter equipment
(2008) Urinary catheters 5 - Catheter drainage and support systems. Nursing Times; 104: 43, 22-33.Yates, A.
Ann Yates, BN, DipN, FETC, RGN, is director of continence services, Cardiff and Vale NHS Trust.
It is important that patients are instructed in how to use and care for their catheters and how to obtain further supplies of equipment.
There are many types of drainage systems. Choices to be made include bag capacity, fabric or non-fabric backed, tube length, tap design, mobility and fixation aids.
The capacity of drainage leg bags are: 350ml, a small capacity bag; 500ml, the most common choice for daily use; and 750ml (Fig 1).
The patient should choose where they prefer to wear their leg bag - thigh or calf - which determines the length of the inlet tube. Bags are fitted with short tubes, long tubes and direct inlets (Fig 2). The leg bag should always be positioned below the bladder to maintain urine flow.
Leg bags connected to the catheter in a ‘closed system’ should be changed every 5-7 days in line with manufacturer’s recommendations (Department of Health, 2007). If a bag becomes disconnected from the catheter, a new bag should be attached.
Patients normally require a 2L drainage bag that is connected to the leg bag at night. The outlet tap on the leg bag is left open so that the urine collects in the larger bag. This maintains a link system that helps reduce infection (Pratt et al, 2001).
A large capacity bag should be supported on a stand or support hanger (Fig 3), not put on the floor. Large capacity bags can also be connected directly to a catheter in a closed system and can be used post-operatively, if patients are confined to bed or if the use of a leg bag is not appropriate.
Outlet taps and bag emptying
To empty the drainage bag, the patient must have the dexterity to operate the mechanism at the outlet. There are a number of tap options, the most common being the lever tap and the push-across type (Fig 4).
The bag should be emptied regularly before it becomes too full and causes reflux or damage to the urethra. This is normally when it is about two-thirds full. It is not advisable to open the tap to empty the bag more often as this can promote infections.
Patients who can empty their bag should wash their hands, open the tap, empty the bag into the toilet or other suitable receptacle, close the tap and wipe the bottom of the tap dry to prevent urine drips. They should finish by washing their hands. If the patient cannot perform the task, their carer should wash their hands and wear non-sterile gloves to carry out the procedure.
In an acute or institutional setting, the procedure is as follows:
Explain the procedure and gain consent;
Wash hands and wear disposable gloves;
Clean the outlet port according to local policy and allow to dry;
Empty the drainage bag into a clean, dry appropriate container. Ensure that the outlet tap does not touch the side of the container (Fig 5);
Once urine has ceased draining, close and clean the outlet tap;
Cover the container and dispose of contents in sluice or toilet;
Remove and dispose of gloves.
If required record the amount collected in patient’s notes.
It is important that the catheter and bag are well supported to prevent damage to the urethra and bladder neck. There are a range of devices that help to prevent traction of the catheter. Leg bags are routinely supplied with a pair of latex-free leg straps; one fits the top of the bag and one the bottom.
An alternative is a sleeve that completely encases the leg bag. The sleeve has a small opening for the tap so it is easy to access and empty. This method helps to distribute the weight of the bag more evenly, so it is useful for patients who have frail skin or if the straps dig or rub into the skin.
There is a range of devices to help stabilise the catheter, preventing tension or pulling on the catheter on movement and acting as a shock absorber. These minimise the risks of urethral pain, trauma and leaking. They are available on prescription (Fig 6).
Everyday patient advice
Patients should always wash their hands before and after handling their catheter. Daily routine bathing or showering will maintain meatal hygiene (Pratt et al, 2007).
Fluid and diet advice should include: how much fluid to drink, any caffeine restriction, any patient-specific health needs and the importance of diet in avoiding constipation.
Patients need to be advised not to kink or clamp the catheter tubing, to empty the drainage system regularly, keep a closed system of drainage and always attach the catheter to the chosen drainage system.
Patients should know the type of equipment they are using, how to dispose of it and how to order more. Most importantly, they must know when they need specialist or medical advice (in cases of urinary tract infection, bleeding, pain or bypassing) and who to contact (RCN, 2008).
This procedure should be undertaken only after approved training, supervised practice and competency assessment, and carried out in accordance with local policies and protocols.
Department of Health (2007) Drug Tariff.London: HMSO.
Pratt, R.J. et al (2007) National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. (EPIC2). Journal of Hospital Infection; 65S: S1-S64.
Pratt, R.J. et al (2001) The Epic project: developing national evidence-based guidelines for preventing healthcare-associated infections. Journal of Hospital Infection; 47: S3-S82.
RCN (2008) Catheter Care: RCN Guidance for Nursing. London: RCN.