Indwelling Catheters: Urethral and Supra-pubic

• Catheter change frequency in the community: IDC -every 4 weeks and SPC - every 4-6 weeks. For hospital settings, consult the hospital policy for frequency.
• Wash around the catheter site and groin twice a day. Use plain soap and water and remove any crusting from the meatus (this requires retraction of the foreskin if present), vulva and/or stoma site. This has been proven to reduce incidence of catheter associated urinary infections. Pat dry.
• Avoid kinking of the catheter tubing as this can damage the balloon mechanism. Use a securement device if needed.
• If the person is getting out of bed, ensure an appropriate drainage bag such as a leg bag is connected. This will help reduce pulling on the catheter when doing activity and can improve visualisation of the bag to know when to empty.
• Encourage consumption of 2-3 litres of water unless on fluid restrictions.
• Educate the person with the catheter to:
  • change clothing daily to reduce bacterial transfer to the catheter
  • avoid using scented soap or talcum powder around the catheter
  • never pull, remove, cut or put anything in the catheter.

• The first SPC change should be done at 6 weeks as this allows the stoma site to form. This will reduce complications with the first change such as premature closure of the site.
• SPC stoma site care prevents skin adhesions and erosion around the stoma:
  • Gently roll the catheter between the thumb and forefinger once a day (preferably after a shower)
  • Move the catheter in a cross (+) shape to allow the stoma to form
  • Form a small loop then secure the catheter to the abdomen with tape. This protects the stoma site from trauma caused by the catheter pulling.
• Manage over-granulated tissue around the stoma site early.

• Plug in the night drainage bag/bottle directly to the end of the leg bag. Open the leg bag valve so urine will drain from the leg bag into the night bag/bottle.
• Hang the drainage bag below the level of the bladder. Bags should be off the floor in a hospital environment to reduce transfer of bacteria to the system. The bottle can sit on the floor next to the bed in a home environment as it is the person's own flora and fauna.
• When changing the leg bag, check the hospital procedures before doing so. In the community the process is a clean procedure rather than a sterile technique and the connection can be cleaned with soap and water.

• Hand hygiene is the most important task to prevent catheter associated urinary infection. Wash hands before and after handling the catheter, bags and/or bottle.
• If able, encourage the person to drain their own urine bag. Don't let the tap and outlet touch any surface such as the toilet.
• Empty the leg bag when it is two thirds full to avoid pressure on the bladder.
• All disposable drainage bags (including leg and overnight bags) must be changed every 7 days (or as per manufacturer's recommendations). Dispose of emptied, used bags in the garbage.

• A larger drainage bag or 4L bottle is 'piggy backed' to the leg bag for night-time drainage.
• Clean the night bag/bottle daily. After emptying and disconnecting the night drainage bag/bottle, rinse the tubing and bag/bottle inside and out with tap water with the outlet clamp left open.
• A drainage bottle can be used for 6 months and the tubing changed every 3 months. It should be changed earlier if it is in poor condition, such as cloudy tubing or cracks.
• The bottle needs to be clean but not sterile. Clean as per the manufacturer's recommendations.

• Leave the leg bag connected to the catheter. Drain the bag prior to getting into the water to prevent the urine bag overfilling.
• Change the wet leg straps or the leg bag holder as soon as possible after exiting the water to avoid affecting the skin.

• Sexual activity may continue with a suprapubic catheter without any changes to the routine.
• If a male is participating in sexual activity with an indwelling urethral catheter, it is recommended to secure the catheter with tape to the erect penile shaft, apply a condom over the top of the catheter. This will prevent potential issues with developing a urinary infection and prevent trauma of meatus from the catheter movement.
• If a female is participating in sexual activity with an indwelling urethral catheter, to make sure the indwelling catheter is secured to the leg to prevent pulling on the catheter.

Check for the following:

• Is the tubing bent or kinked?
• Is the bag below bladder level?
• Is the bag over-full?
• Is the person dehydrated?
• Is the urine concentrated, cloudy or bloody? Screen for a urinary tract infection - Management of UTI
• Encourage the person to move around to help with movement of fluid.
• Is there oedema in the lower limbs? This could be assessed and managed ongoing with the treating doctor and a therapist trained in oedema management.

If there is still no drainage after following the checklist NOTIFY the nurse or doctor. If residing in the community, attend the local hospital or emergency department. If experiencing frequent blocking refer to Prevention of Catheter Blockages

Check for the following:

• Is the catheter draining? See above
• Is the urine concentrated, cloudy or bloody? Screen for a urinary tract infection - Management of UTI
• Has the catheter been in for more than 6 weeks?
• Check for constipation Bowel troubleshooting

If the bypassing and spasticity still occur after following the checklist NOTIFY the nurse or doctor.

• Always insert 50ml of water into the bladder prior to changing the SPC. Anecdotally it has been shown to assist in two ways:
  • To reduce bladder spasticity by making it easier to reinsert the catheter
  • Helps maintain the 'shape' of the bladder and assists with lining up the two stoma openings of the bladder and exterior site.
• If the catheter falls out or if it is difficult to reinsert, it is recommended that an indwelling urethral catheter is inserted (if able) to avoid over stretching the bladder.

• Check valve for damage
• Add 2-3ml of sterile water to inflation channel to dislodge debris
• Attach syringe to valve and leave in place for 20-40 minutes
• Squeeze visible tubing to dislodge any crystal formation in channel
• If the balloon still doesn't deflate, seek medical advice and/or present to the local hospital or emergency department.

• Make sure the catheter moves freely in the stoma site and there are no adhesions.
• Never force the removal of water from the balloon as this can increase the risk of catheter ridging. Ridging appears as raised or wrinkled areas over the balloon and is usually an issue with silicone catheters. A contributing factor is that silicone has no 'memory' and does not return to its original shape and this can create ridging issues. The correct method is to attach the syringe to the valve and allow the water to drain into the syringe on its own.
• If there is suspected crystal formation, add 2-3ml of sterile water to inflation channel to dislodge debris. Squeeze visible tubing to dislodge any crystal formation in the channel
• If still unsuccessful, instil 0.5-1ml of water into the balloon to remove any ridging in the catheter balloon. Some silicone catheters can be more prone to ridging than others. Try to remove the catheter with the water insitu.
• Place a hand around the stoma site for support and gently pull on the catheter to remove. If concerned about the amount of force required to remove the catheter, then present to the local hospital or emergency department.

• Sterile catheter pack
• Disposable underpad
• Sterile gloves
• Plastic apron
• Mask
• Protective eyewear
• Sodium chloride 0.9% pour bottle
• Aqueous chlorhexidine 0.1%
• Water soluble lubricant gel
• Indwelling urinary catheter
• 50ml catheter tipped syringe
• 10ml x 2 syringes
• 10ml ampoule of water for injection
• Urinary drainage bag
• Tape or other appropriate device for securing catheter
• Protective bed pad (Bluey)