Urinary catheter care

This procedure describes the care required in the management of indwelling urinary catheters. Catheter care should be provided after assessment and then in accordance with patient needs, which may be daily or more frequently. The Royal College of Nursing (RCN, 2021) identify that, alongside catheter insertion, health care professions should also be proficient in:

• obtaining catheter specimens of urine
• changing drainage systems
• emptying catheter bag and catheter valves
• metal cleaning
• catheter bag positioning and support

Effective catheter care serves to keep the patient clean and comfortable as well as helping prevent catheter associated urinary tract infections (National Institute for Health and Care Excellence, 2014), and other complication such as urethral trauma. To avoid complications associated with urinary catheters, they should only be used when necessary and be removed when no longer required as well as adhering to best available evidence regarding their use (Gould, 2015).

Prior to undertaking any catheter related activity the nurse must consider:

• the necessity of the procedure
• their competence to provide the care
• gaining consent
• privacy and dignity
• preventing the introduction of infection or other complications
• the use of personal protective equipment
• effective hand hygiene both before and after the procedure

The requirements for equipment will depend on the procedure being undertaken as well as local policy, but will include:

• personal protective equipment
• a clean receptacle for urine drainage
• a drainage bag
• disposable washing clothes for cleaning
• soap and warm water
• towels
• tissue/isopropyl soaked swab for cleaning valve after use (according to local policy)
• a bag for waste

Only nurses or care staff who are trained and educated in catheter care should undertake this. The RCN (2021) considers it good practice to refresh the skills required at least every 5 years. The person undertaking the procedure should explain what they are planning to do to the patient and seek their consent. Nurses should ensure the maintenance of the person's privacy and dignity. All procedures, including any new untoward observations, such as signs of infection, should be recorded and reported immediately.

Staff undertaking any aspect of catheter care should undertake hand hygiene both before and after the procedure and wear appropriate personal protective equipment, which usually involves a disposable apron and non-sterile gloves. In some instances, for example where a patient may be agitated or confused, goggles may be indicated. All items used during any procedure should be disposed of according to local policy.

The main risks associated with catheter use relate to mechanical trauma and infection (Dellimore et al, 2013). The risks of both complications can be moderated by strict attention to hygiene and general catheter care practices.

Undetected and untreated urinary catheter associated urinary tract infections can give rise to septicaemia which may be fatal (Feneley et al, 2015). Removing catheters which are no longer clinically indicated removes these risks. Intermittent catheterisation and intermittent self-catheterisation may also help in reducing the risk of complications from catheterisation.

Nursing and Midwifery Council: standards of proficiency for registered nurses

Part 1: Procedures for assessing people’s needs for person-centred care

2.9 collect and observe sputum, urine, stool and vomit specimens, undertaking routine analysis and interpreting findings

Part 2: Procedures for the planning, provision and management of person-centred nursing care

9.6 use evidence-based hand hygiene techniques

Collie M, Hunter DJ. Assisting patients with their elimination needs. In: Delves-Yates C (ed). Essentials of nursing practice. London: Sage; 2022

Dellimore KH, Helyer AR, Franklin SE. A scoping review of important urinary catheter induced complications. J Mater Sci: Mater Med. 2013;24:1825-1835. https://doi.org/10.1007/s10856-013-4953-y

Feneley RC, Hopley IB, Wells PN. Urinary catheters: history, current status, adverse events and research agenda. J Med Eng Technol. 2015;39(8):459-470. https://doi.org/10.3109/03091902.2015.1085600

Gould D. Preventing catheter-associated urinary tract infection. Nursing Standard. 2015;30(10):50-59. https://doi.org/10.7748/ns.30.10.50.s48

National Institute for Health and Care Excellence.  Infection prevention and control. 2014. https://www.nice.org.uk/Guidance/QS61 (accessed 6 February 2024)

Royal College of Nursing. Catheter care: RCN guidance for health care professionals. 2021. https://www.rcn.org.uk/professional-development/publications/catheter-care-guidance-for-health-care-professionals-uk-pub-009-915 (accessed 6 February 2024)