Why are catheters used?

Catheters can be used for a number of different reasons, the reason for your catheter should have been explained to you on insertion. If it wasn’t, please clarify this with a health professional. Some of the reasons catheters are used are:

  • Before or after surgery
  • Due to an injury or dysfunction
  • Urinary retention/obstruction
  • As a last resort treatment for urinary incontinence due to skin breakdown

Despite catheter being a useful treatment, sometimes problems can occur. Therefore it is very important to care for you catheter properly to reduce the risk of any possible problems.

What is an indwelling urinary catheter?

An indwelling urinary catheter is a flexible, hollow tube used when people, for various reasons, cannot empty their bladder naturally. It is called an indwelling catheter as it is inserted into the bladder. The tube is inserted into the bladder through the urethra and allows urine to drain freely from the bladder. In women, the urethra can be located just above the vagina and in men it runs through the length of the penis. Once inside the bladder, a small balloon is inflated to ensure the catheter is kept in the right position.

In some cases it may be required to make an incision through the abdominal wall to insert a catheter into the bladder; this is known as a suprapubic catheter.

Caring for your indwelling catheter

Having a catheter increases your risk of getting a urine infection which can be serious and difficult to treat. Reducing the risk of infection can be achieved in the following ways.

Hand washing

It’s extremely important to wash your hands before and after touching your catheter or drainage.

Keeping clean

If possible, have a daily shower or bath. Do this with your leg bag or valve attached. Wash the area where the catheter enters your body with a mild soap and water at least daily and always after a bowel movement.

Urethral catheters

Men should ensure they wash under their foreskin, replacing afterwards, unless circumcised.

Women should always wash the genitals from front to back to ensure faeces is not transferred to the catheter. Avoid using talc or creams.

Suprapubic catheters

The area in which the catheter enters your body needs to be kept clean and observed for signs of infection, such as discharge or inflammation. If this happens then contact your district nursing service who will advise the best treatment.

Emptying your leg bag

Empty your leg bag into a clean toilet, jug or urinal when it is two thirds full. Do not let the bag get too full and heavy as it may pull which can cause pain, bladder spasms or even catheter displacement.

Further catheter care

What you eat and drink can help with management of your catheter:

  • Drink about 1.5 - 2 litres of fluid each day, unless clinically advised not to

  • Avoid caffeine and alcohol as they may irritate your bladder
  • Maintain a healthy bowel. Constipation can press on the bladder and stop drainage from the catheter. Ensuring a balanced diet with enough fibre can help maintain regular bowel movements

Urine drainage bags

The leg bag

The outside part of the catheter is connected to a drainage bag so the bladder can be kept empty. Another option is to have a valve attached which allows the bladder to fill as normal and can be drained by opening the valve. This should be done every three to four hours during the day, when you feel full, before opening your bowels and before going to bed. Leg bags and catheter valves last up to seven days before a new one should be attached.

Your leg bag should be positioned below the level of your bladder. To secure the leg bag, the tubing will need to be fixed to the thigh with a G-strap (or clinifix fixation device depending on medical history) and to the calf with the elasticated catheter straps. These straps should run underneath the tubing so they are not restricting the flow of the catheter.

The night drainage bag

During the night, a larger bag is attached directly to the leg bag to allow you to sleep through the night without emptying the bag.

  • To connect the night bag:
  • Remove the leg bag support straps
  • Empty the leg bag, then with the tap still open attach the night bag into the tubing below the tap
  • Place the night bag on the stand on the floor by the side of your bed

Disconnecting the night bag:

Turn off the tap at the bottom of the leg bag and disconnect the night bag from the tubing below the tap

Empty the night bag into the toilet and discard of the night bag. These are single use and should not be re-used

Possible problems with your catheter and what to do

Catheter not draining

If your catheter has not drained any urine for two to three hours, especially if you feel like your bladder is full, please check the following:

  • Make sure the tubing is not twisted, kinked or restricted by tight clothing
  • Check the catheter is below the level of the bladder
  • Empty the leg bag as the catheter will not drain if the bag is full
  • Ensure you have been drinking enough fluids 

If you have checked all the above and the catheter is still not draining, please contact your community nursing team immediately.

Leakage around the catheter

This is called bypassing. This may be caused by a blockage or as a result of a spasm. Ensure the tubing is not restricted in anyway and that the leg bag has been emptied. If it continues to bypass please contact you community nurse team.

Catheter falling out

If your catheter gets pulled out or falls out please contact your community nurses as soon as possible.

If you have been advised that your catheter is not for community change, you must attend A&E for further intervention as your community nurses will be unable to change the catheter.

Bladder spasms

These usually stop within a few days and are nothing to worry about. If it persists please speak to your community nurse for advice.

Blood or debris in the urine

Debris causing cloudy urine is common and the longer the catheter has been in place the more common it becomes. This debris can sometimes block the catheter, if this happens please contact your community nursing team. If you see blood coming through your catheter this could be an indication of infection and needs further investigation. Please contact your community nurses for further advice.

Urine infection

You will always have bacteria in your urine if you have catheter in place for more than a few days. This does not mean you have a urine infection. Indications of a possible urine infection are:

  • Urine has a strong, foul odour
  • A fever
  • New pain in the tummy or back
  • Agitation or new confusion

Pain around the area where the catheter is inserted If you are experiencing any of the above, please contact you community nurse.

If indicated, a urine sample will be taken. You may be prescribed antibiotics and your catheter should be changed.

SEPSIS

Sepsis is a reaction to severe infection and can involve many different parts of the body. The germs causing the infection can be bacteria, viruses or fungi. People with indwelling catheters have a higher risk of SEPSIS. Symptoms and signs of sepsis in adults include:

  • Suddenly becoming confused, drowsy, or unconscious
  • Slurred speech
  • Severe breathlessness
  • Feeling cold or clammy, or having pale or mottled skin
  • Fast breathing
  • A fast heartbeat
  • Extreme shivering
  • Severe muscle pain
  • Feeling extremely unwell - including the feeling like you’re going to die • Not passing urine for an entire day
  • Low oxygen levels (as measured with a pulse oximeter)

If you are experiencing any of the above, call 999 immediately

Changing your catheter

In most cases this will be carried out by your community nursing team unless advised otherwise. Depending on the type of catheter, your catheter will be changed every four weeks for short term catheters or every 12 weeks for long term catheters, unless otherwise specified.

Sexual intercourse

It is possible to have sexual intercourse with a catheter inserted but you should remember to wash your hands before and after touching your catheter and empty your leg bag.

Advice for men:

  • Once erect fold back the catheter along the length of the penis, leaving a loop. This will stop the catheter pulling
  • Apply a condom to help secure the catheter
  • If you need lubricant use a water-based gel

Advice for women:

  • Secure or tape your catheter out the way
  • After intercourse clean your genital area thoroughly with warm water and unperfumed soap

Obtaining supplies

You should be discharged home with a small amount of catheter supplies. Following your initial referral to the community nurses your GP will be contacted with a list of the supplies you require.

Once this has been done you will be able to order supplies for your catheter directly through your GP on a repeat prescription.

You will need to ensure you have an adequate supply of:

  • Catheters
  • Leg and night bags
  • Optilube—used to insert the catheter
  • G-straps and leg straps to secure your catheter

Patient Advice and Liaison Service (PALS)

If you have some concerns, questions or need advice on our services, you can contact the Patient Advice and Liaison Service (PALS) on 0800 234 6088 or email PALS@lscft.nhs.uk

Need mental health support?

Need urgent help? For 24/7 mental health support call 111 and select the mental health option If you have a hearing problem or need advice in another language, visit NHS 111 website.

Text support can be reached by messaging Shout, which is a free, confidential and 24/7 texting service. Simply text ‘Shout’ to 85258. Further support is available through Kooth offering self-help resources, online messaging and support for young people aged 11 to 25. 

Additionally, the Hub of Hope provides a directory of mental health support and services across the UK.

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