Caring for my urinary catheter (North Central London Integrated Care System)

To be completed by your nurse or healthcare professional:

Having a catheter in place increases the risk of developing a urinary tract infection (UTI) which can seriously affect your general health and wellbeing.

Good management of your catheter may improve your quality of life. Follow the guidelines in this booklet to reduce the risk of developing a UTI.

Catheters are only inserted if there is a medical need and must not be inserted at the request of a patient/family member alone.

A catheter is a thin, hollow, flexible tube inserted into your bladder to drain urine. You will have a drainage bag attached to your leg or around your waist, or a catheter valve with, or without, a leg bag. There are two types of catheter: urethral and supra-pubic.

You may need a catheter for many reasons, including:

• to let urine drain if there is a blockage in your urethra (the tube that carries urine out of the body).
• to allow you to urinate if you have bladder weakness or nerve damage that affects your ability to pass urine.
• to drain your bladder before, during and/or after some types of surgery.
• for your comfort.

A urinary catheter is only put in when absolutely necessary as it increases the risk of developing a urinary tract infection (UTI) which can be serious or even life threatening.

The information in this booklet will help you avoid a UTI.

If you need more help caring for your catheter, need more supplies, or have any health concerns, please contact your community nurse.

The catheter is put into your urethra, the tube that carries urine from the bladder to the outside of the body (the opening is at the tip of your penis orjust above your vagina).The catheter tip is put into your bladder, and a small balloon near the end is inflated with sterile water to hold it in place.

The catheter is put in via a small cut made in the stomach. This is done in hospital by a doctor, during a short operation using either local or general anaesthetic.

• Wash your hands with soap and water, using the method shown below, before and after touching your catheter.
• If possible, have a daily shower (preferably) or bath. Do this with your leg bag or valve attached.
• Wash the skin in the area where the catheter enters the body with unperfumed or mild soap and water at least daily and after using the toilet if possible. Use a clean flannel or cloth kept for this purpose only.
• Wash the catheter tubing holding it away from the body.
• Avoid using talcum powder.

If you have a urethral catheter

• Men should be careful to wash under their foreskin, replacing it afterwards, unless they have been circumcised.
• Women should always wash their genitals from front to back, to avoid transferring faeces from the anus to the catheter.

If you have a suprapubic catheter

• Some people may experience a slight discharge from around
• the catheter site. If this happens then contact your nurse who
• will tell you the best way to treat it.
• Avoid pulling or restricting your catheter by wearing loose, comfortable clothing. Tight clothing can cut off the flow of urine and may cause skin irritation.

It’s important to wash your hands before and after touching the catheter or drainage bag / catheter valve.

Adapted from the World Health Organisation “Clean hands protect against infection”.

A catheter securement device should be used to stop your catheter tube moving around. Your healthcare professional will advise you when and how to use this.

Your catheter bag should always be below your bladder unless you are using a belly bag. The leg bag is attached to your calf or thigh by a pair of straps, a sleeve, fixation device or a special holster. How you wear the bag depends on what feels comfortable for you.

The choice and size of the bag and the length of tubing depend on where you want to wear it and how much urine you pass. When wearing trousers, a long tube bag may be more convenient as it is possible to roll up the bottom of the trouser leg and access the tap at the base of the bag for emptying urine. Short tube leg bags can be worn on thethigh and are more discreet under skirts, shorts and dresses.

Men should try to change the position of the leg bag frequently to avoid damage to the penis from the catheter rubbing in one position.

• Wash your hands before and after touching your catheter.
• Empty the leg bag when it is 2/3 full, into the toilet or a dedicated container for transport to the toilet.
• To help prevent infection, only disconnect the leg bag when replacing it with a new one.

Most leg bags are changed on a weekly basis; it is best to change your leg bag on the same day of the week. Empty the attached leg bag before changing to your new one.

• Wash your hands (see section above) before and after.
• Open the new leg bag, but don’t remove the protective cap.
• Remove the attached leg bag carefully. Don’t pull or use excessive force.
• Point the end of the catheter upwards as you detach the leg bag to prevent leakage. Dispose of the old leg bag into a plastic bag (follow your local council’s policy for disposal).
• Carefully remove the protective cap from the new leg bag. Do not touch the nozzle once you have removed the cap.
• Gently insert the new leg bag connector to the catheter. Take care not to touch the plastic nozzle.

If you have a valve attached to your catheter instead of, or as well as, a leg bag you should open the valve to empty your bladder:

• every three to four hours during the day.
• when you feel your bladder is full.
• before opening your bowels.

A valve may not be recommended for certain conditions. You will be advised by your healthcare professional. To help prevent infection, only disconnect the valve weekly when replacing it with a new sterile one (washing your hands before and after). Attaching a night bag to a valve is optional but advisable.

Night bags allow free drainage of urine when you are in bed.

• Attach a night bag to the leg bag or valve.
• Open the tap from your leg bag.
• In the morning close the leg bag or valve.
• Remove the night bag and empty the urine into the toilet.
• Dispose of the empty night bag into a plastic bag (follow your local council’s policy for disposal).

It is possible to have sex. A suprapubic catheter may make it easier; ask your healthcare professional for more information.

Before intercourse wash your hands before and after touching your catheter and empty your bag. If during intercourse you experience any pain or discomfort, you should stop. Talk to a healthcare professional about any concerns you have.

Advice for men

• Once erect, fold back your 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 a lubricant, use a water-based gel.

Advice for women

• Secure or tape your catheter out of the way.
• After intercourse, clean your genital area thoroughly with warm water and unperfumed soap.
• If you need a lubricant use a water-based gel.

Maintaining a healthy bladder and bowel is very important. A full, constipated bowel can press on the bladder and stop the catheter from draining freely.

• Drink at least 1.5 to 2 litres (about 6 mugs or 8 cups) of fluid in 24 hours unless your healthcare professional advises you not to do so. This will keep you hydrated and will help soften your stools and aid easier bowel movements.
• Limit alcohol and caffeine intake as they may irritate your bladder. There is caffeine in tea, coffee, cola, other fizzy drinks and drinking chocolate.
• Fibre can improve constipation. Try to eat five portions of fruit and vegetables every day.
• Do not strain to open your bowels. If you do, speak to a health care professional for advice.
• The colour of your urine may vary, as some foods and medications can cause discoloration.

Darker urine may suggest dehydration. If your urine gets darker then drinking more fluids can help prevent infection.

Aim for light coloured urine.

If you are worried about your urine, or that your catheter is leaking/not draining, check the following:

• Are your food and fluid intake adequate? (See section above)
• Are you constipated? If you are already following the tips in the section above, seek medical advice.
• Is the drainage bag below the level of the bladder, particularly when sitting in a low or reclining chair?
• Is the tubing twisted or restricted by tight clothing?
• Is the tubing extended or pulled tight towards the bag?
• Is the catheter tube connected to the drainage bag correctly?
• Are the leg straps stopping urine flowing into the bag?
• Is the bag too full? If in doubt, empty the bag.
• Change your position and walk around if you are able to.
• If your catheter is leaking but still draining some urine, this may be due to bladder spasms where the bladder contracts because of irritation from the catheter. These can sometimes be treated with medication. Speak to your health care professional.

• You have lower stomach or back pain.
• You feel warm, flushed or shivery, as you may have a urinary tract infection (UTI).
• Your catheter is draining little/no urine despite an adequate fluid intake and you have followed the advice in the troubleshooting guide.
• Your urine has a strong smell, is dark in colour or becomes thick and/or cloudy and this does not improve if you drink more fluid (if able/advised). Your stomach is swollen and there is no other obvious cause.
• There is bright red blood in your urine.
• The catheter entry site becomes red and sore.
• You have bleeding into, or around, the catheter.
• You have enough urine leaking around the catheter to make your clothing wet and you have already followed the self-help measures in the section above.
• Your catheter falls out.

Having a catheter in your urinary tract significantly increases your chances of getting a UTI, which is why it is so important to care for it by following the advice in this passport.

Signs and symptoms of a UTI

• Feeling unwell.
• Fever with, or without, uncontrollable shaking.
• New pain in your lower tummy or back.
• Becoming agitated or newly confused.
• Pain in the area around where the catheter enters the skin.
• Pus-like discharge in the urine.
• Unusual tiredness.

How is a UTI treated?

• A urine sample should be taken from your catheter sampling port and sent to microbiology for testing.
• You may be started on an antibiotic.
• Your catheter should be changed.
• You should make sure you are drinking plenty of fluids.

Proper use of antibiotics

• Make sure you follow the instructions given with the antibiotic and finish the whole course.
• Use antibiotics only when you really need them. This will reduce the risk of the bacteria which cause a UTI becoming resistant to the antibiotics and we can rely on them to work when we really need them.