Part 4 in this series discusses how to remove urinary and suprapubic catheters
Yates, A. (2008) Urinary catheters Part 4 - Removing an indwelling urinary catheter. Nursing Times; 104: 42, 26-27.
Ann Yates, BN, DipN, FETC, RGN, is director of continence services, Cardiff and Vale NHS Trust.
When an indwelling urinary catheter is inserted into a patient’s bladder, it is important to plan to remove it as soon as possible in order to prevent any complications. These include urinary infections, encrustation and/or damage to the bladder neck.
You need to understand the reason for removal of the catheter and whether this is a permanent removal, a planned catheter change or unplanned change due to problems encountered (Skills for Health/RCN, 2008). The site of insertion of the catheter - urethral or suprapubic - must be taken into account before removal.
The removal of a urinary catheter should be a simple, uncomplicated procedure but nevertheless has recognised competencies (Skills for Health/RCN, 2008). These include legislation, policy and good practice, anatomy and physiology, care of the individual, carrying out the procedure, materials and equipment required, drugs and medication, and infection control relating to catheter care.
Routine urethral removal
- Gain consent from the patient and make sure they understand the procedure. Explain any potential symptoms they may experience following removal such as urgency, frequency and or discomfort.
- Check the patient’s records to see how much water was inflated into the balloon and scheduled removal date for planned removals.
- Gather relevant equipment required for catheter removal including the appropriate syringe (normally 10ml syringe for routine catheters), gloves, cleaning solution (this is usually normal saline - see local policy), catheter specimen pot plus another syringe if a sample is required.
- Screen area to maintain privacy. Protect bedlinen using protective covering. Ask the patient to lie in a supine position, preserving dignity (Royal Marsden, 2008).
- Wash hands and put on gloves (Fig 1). Place a container between patient’s legs to receive the used catheter and to catch any urine spillage.
- If necessary, clean around the meatus and catheter using appropriate solution (usually normal saline - see local policy), always swabbing away from the urethral opening. Release any leg support system for easier removal of catheter. Change gloves and attach syringe to catheter valve to deflate balloon (Fig 2). Do not pull on syringe but allow the solution to come back naturally - follow the manufacturer’s instructions.
- Ask patient to relax and to breathe in and out. As the patient exhales, gently remove catheter. Male patients should be warned of potential discomfort as the deflated balloon passes through the prostatic urethra (Fig 3). Inspect the removed catheter for any signs of encrustation, especially if a new catheter is to be inserted.
- Clean the meatus and make the patient comfortable. Remove gloves and dispose of equipment appropriately (Fig 4).
- Wash hands. Document the date and time of catheter removal. Record urine output until frequency and voided volumes are satisfactory. Encourage the patient to drink plenty of fluids. Inform patient and/or observe for any signs of voiding difficulties.
- Follow the first five steps for urethral catheter removal. Place a container between patient’s legs to receive used catheter and to catch any urinary spillage.
- If necessary, clean around the catheter site using the appropriate solution (see local policy). Release any abdominal and/or leg support system for easier catheter removal. Change gloves. Attach the syringe to catheter valve to deflate the balloon (Fig 5). Do not pull on syringe but allow the solution to come back naturally - follow the manufacturer’s instructions. Ask the patient to relax and to breathe in and out. As the patient exhales, gently remove the catheter (Fig 6).
- If the catheter is being removed so it can be changed, observe the catheter for any signs of encrustation, the lie of the catheter, the angle of insertion and how much of the catheter was inserted. This information will prove a useful guide for the insertion of the new catheter.
Dealing with difficulties
All Foley catheters require that the balloon should be deflated by removal of the solution with a syringe before removing the catheter. If the balloon will not deflate, a number of simple techniques can be tried before referral to the care of a urologist:
- Try a different syringe;
- Leave the syringe attached to the inflation valve, with the plunger removed, for 20 minutes;
- ‘Milk’ the catheter along its length to help unblock any debris or obstructions;
- Insert a few millilitres (ml) of sterile water which may help to clear any blockage;
- Attach a 25 gauge (orange) needle into the inflation chamber just above the cuff and draw back; this will bypass a faulty valve (ACA, 2008).
Do not attempt to burst the balloon by overinflation as this could break it into fragments within the bladder. Never cut the inflation arm or catheter. The balloon may not deflate and, if there is any traction on the catheter, it could retract into the bladder.
This procedure should be undertaken only after approved training, supervised practice and competency assessment, and carried out in accordance with local policies and protocols.
Association for Continence Advice (2008) Notes on Good Practice. www.notesongoodpractice.co.uk
The Royal Marsden (2008) Royal Marsden Hospital of Manual of Clinical Nursing Procedures. Oxford: Royal Marsden Hospital/Wiley Blackwell.
Skills for Health/RCN (2008) Continence Care. www.skillsforhealth.org.uk