Indwelling Urinary Catheter Management and Care

Exam Tip: Common Misconceptions In clinical practice and on exams, remember that daily irrigation with sterile saline or changing the catheter tubing every 24 hours are not standard recommended practices for infection prevention. In fact, unnecessary irrigation can increase the risk of introducing bacteria.

System Maintenance and Proper Positioning

To ensure the catheter functions correctly and to prevent complications like reflux, the physical setup of the drainage system must be managed carefully.

Gravity Drainage and Bag Positioning

The urinary drainage bag must always remain below the level of the bladder. If the bag is raised above the bladder, urine can flow backward (reflux) into the bladder, significantly increasing the risk of infection and bladder spasms.

Managing Obstructions

Nurses must regularly inspect the catheter tubing for kinks or obstructions. A sudden stop in urine output or a patient reporting a burning sensation during drainage may indicate a blockage.

If a blockage is suspected, the nurse's initial action should be to:

1. Assess the tubing for kinks or loops.
2. Ensure the drainage bag is positioned correctly below the bladder level.

Assessment: Recognizing Cues of Complications

Effective management requires the nurse to "recognize cues"—identifying subtle changes in the patient that signal a problem is developing.

Urinary Retention

Urinary retention occurs when the bladder cannot empty effectively. Even with a catheter in place, mechanical obstructions (like a kinked tube) can lead to retention. Key cues include:

• Decreased urine output.
• The patient reporting a "full" feeling in the bladder.
• Dull, lower-abdominal pressure.

Urinary Tract Infection (UTI)

While CAUTI is a specific type of infection, general signs of a urinary tract infection should be monitored closely. Clinical indicators include:

• Fever.
• Flank pain.
• Cloudy or malodorous urine.

Safe Removal of Indwelling Catheters

When a physician orders the removal of a Foley catheter, the nurse must perform the procedure safely to prevent urethral trauma. The most critical step in this process is to deflate the balloon completely before attempting to withdraw the catheter. Failure to ensure the balloon is fully deflated can cause significant injury to the urethra.

Note: This article focuses on urinary catheter management. For information regarding medication administration, such as calculating IV dosages or documenting in the MAR, please refer to the Medication Administration study module.