What is a Catheter and When is it Used?

A catheter is a thin, flexible tube inserted into the body to allow fluids (like urine or blood) to drain or be introduced. In healthcare, urinary catheters are most common, used to drain urine from the bladder when a person cannot do so naturally. 

This can happen with conditions such as urinary retention, where the bladder does not fully empty due to nerve problems, an enlarged prostate, or following surgery. They are also used in cases of severe urinary incontinence, when other treatments to control bladder leakage are not effective.

Catheters are a frequently used urology product during and after surgery to keep the bladder empty, especially during long operations or recovery periods. They may also be necessary for individuals with spinal cord injuries or neurological disorders that interfere with bladder control. Other situations include urinary tract obstructions caused by kidney stones, blood clots, or tumors. In critical care settings, catheters are often placed so that healthcare providers can closely monitor urine output as part of patient management.

The two most common types of urinary catheters are intermittent catheters and indwelling catheters. Intermittent catheters, often called “in-and-out” catheters, are inserted only when needed to empty the bladder and then removed immediately afterward. Many people who use them, such as those with spinal cord injuries, may self-catheterise several times a day. Because they are not left in place, they generally carry a lower risk of infection compared to long-term use options.

Indwelling catheters, also known as Foley catheters, remain in place to provide continuous drainage. They are held in the bladder by a small balloon and can be connected to either a bedside collection bag or a discreet leg bag. These catheters are typically used when regular self-catheterisation is not practical, such as during extended recovery, in cases of severe illness, or for palliative care. However, because they stay inside the body, they are more likely to cause urinary tract infections (UTIs). 

The main distinction between the two is how long they remain in place. Intermittent catheters are temporary and removed immediately after the bladder is emptied, while indwelling catheters are designed to stay in for days or even weeks, providing continuous drainage.

Cleaning the Catheter and Surrounding Area

To prevent infections and maintain hygiene, a catheter and its surrounding area should be regularly cleaned.

Supplies Needed:

1. Gloves - Protects the opening from bacteria that may be found on the hands (if not washed properly)

2. Hand Towel - Used to gently wipe down the area after being washed. 

3. Gauze - Can be around the site for comfort when using an indwelling catheter.

4. Catheters (Intermittent & Indwelling) - Catheters need to be replaced periodically to avoid blockages and encrustation. 

5. Leg Strap or Securement Device -  allows your care recipient to move around more freely without having to worry about pulling at their catheter. 

6. A Clean Drainage Bag - If you are changing your drainage bag, a clean one is needed. 

Step-by-Step Catheter Care Process:

Catheter care involves maintaining hygiene, avoiding any complications that may arise, like blockages and preventing infection. There are few crucial steps in the catheter care process that need to be followed. 

1. Wash Your Hands Thoroughly

Using soap and warm water for at least 20 seconds before and after handling the catheter. Make sure you dry your hands with a clean towel. (Prevents transfer of bacteria to the urinary tract.)

2. Gather Your Supplies

Referencing the above guide, collect your supplies and keep them close by to help shorten the care process. 

3. Clean the Catheter Site

Put on clean gloves and gently wash around the urethral opening with mild soap and water, wiping front to back (for women) or away from the tip (for men). Clean 4–6 inches of the catheter tubing closest to the body and pat dry with a clean towel, making sure you avoid rubbing, which may irritate the skin.

4. Check the Securement

Ensure the catheter is anchored with a securement device or leg strap to prevent tugging. Confirm tubing has some slack and isn’t pulling on the urethra and adjust straps so they are snug but not so tight that they cut off circulation.

5. Position the Drainage Bag

It’s important to always keep the drainage bag below bladder level to prevent urine from flowing backward. You never want to place the bag on the floor and make sure tubing is not kinked or twisted. At night, hang the larger drainage bag on a stand or hook beside the bed.

6. Empty the Drainage Bag

To empty the drainage bag, start by washing your hands and wearing gloves. Open the spout at the bottom of the bag over a toilet or clean container, not let the spout touch any surfaces. Once emptied, close the spout securely and wash hands again after disposal.

7. Monitor for Issues

Understand when to seek medical advice as a caregiver, watch out for these signs: 

• Fever, chills, or confusion (possible infection)
  

• Cloudy, foul-smelling, or bloody urine
  

• Redness, swelling, or pain around the catheter site
  

• Leakage around the catheter
  

• No urine draining for several hours

Securing the Catheter

Securing Methods

Catheter security is essential to prevent accidental dislodgement, infection, and discomfort. The most common securing methods include:

• Adhesive Anchoring Devices: Specially designed securement devices that attach to the skin and hold the catheter tubing in place. These are often more comfortable and reliable than standard medical tape.
  

• Leg Straps: Adjustable elastic or fabric straps that gently hold the catheter tubing against the thigh, preventing pulling when the patient moves.
  

• Medical Tape: While sometimes used, plain tape is less secure and can irritate the skin if used long-term.
  
  

Best Practices for Securing

• Positioning: Ensure the catheter tubing is looped loosely to prevent tugging, and place the drainage bag below bladder level to encourage proper flow.
  

• Skin Protection: Clean the skin thoroughly before applying securement devices, and check for redness or irritation during daily care.
  

• Device Choice: Use purpose-built securement devices (rather than tape) whenever possible, as they provide better stability and reduce infection risks.
  

• Routine Checks: Inspect securement every shift (for professional caregivers) or at least daily (for family caregivers) to ensure the device is still firmly in place.
  

• Patient Comfort: Always ensure the securement method does not cause pulling, pressure, or pain, especially for elderly or bed-bound patients.
  
  

Common Mistakes to Avoid

• Using Only Tape: Relying on adhesive tape alone can cause skin breakdown, especially in elderly patients with fragile skin.
  

• Ignoring Tubing Loops: Failing to leave slack in the tubing increases the risk of accidental removal or bladder trauma.
  

• Placing Drainage Bags Incorrectly: Hanging the bag above bladder level can cause urine to flow backward, increasing infection risk.
  

• Not Replacing Devices Regularly: Securement devices and straps should be replaced according to manufacturer instructions, usually every 7 days or sooner if soiled.
  

• Over-tightening Straps: Leg straps should be snug but not so tight that they restrict circulation.

Troubleshooting Common Catheter Issues

1. No Urine Flow

If no urine is draining into the collection bag, first check for simple causes. Make sure the drainage bag is positioned below bladder level, as urine relies on gravity to flow. Inspect the tubing for kinks, twists or blockages and gently straighten it out. If your care recipient has not had much to drink, low urine flow may simply be due to reduced fluid intake. However, if the bladder feels full, the person appears uncomfortable, or there has been no urine for several hours, seek medical help urgently. A blocked catheter can quickly cause bladder damage or infection if not resolved.

2. Leakage Around the Catheter

Sometimes urine leaks around the catheter instead of flowing into the drainage bag. This is known as bypassing. Common reasons include blockage inside the tubing, bladder spasms, or a catheter that is the wrong size. Start by checking the tubing for bends or kinks. If leaking continues, do not attempt to replace the catheter yourself unless trained. Contact a nurse or doctor, as ongoing leakage increases the risk of skin irritation and infection.

3. Signs of Infection

Catheter-associated urinary tract infections (CAUTIs) are a frequent complication. Watch for warning signs such as fever, chills, cloudy or strong-smelling urine, and pain, swelling or redness around the catheter site. In older people, sudden confusion or agitation may also signal infection. If any of these symptoms appear, seek medical attention promptly. Good prevention includes washing hands before and after handling the catheter, daily cleansing of the insertion site, and keeping the drainage bag below the bladder.

4. Discomfort or Pain

Catheter discomfort may be caused by tugging, poor securement or irritation. Ensure the catheter is held in place with a leg strap or securement device, leaving enough slack for gentle movement. Avoid over-tightening straps, which may restrict circulation. If discomfort continues or worsens, particularly during urination or when the catheter is moved, consult a healthcare professional. Ongoing pain may suggest infection, irritation or incorrect placement.

Additional Tips for Home Carers

As a home carer, small daily habits can make a big difference in preventing complications and ensuring comfort. Encouraging the person in your care to stay well-hydrated, if not otherwise restricted by their doctor, helps maintain urine flow and reduces the risk of infection. Incorporating catheter cleaning into the individual’s normal hygiene routine can make the process feel more natural and less intrusive. At night, always switch to a larger drainage bag to avoid overfilling, as this allows for uninterrupted rest and safer overnight drainage.

Clothing also plays an important role in comfort and catheter management. Loose-fitting garments can prevent unnecessary pulling or pressure on the tubing, while making movement easier. Finally, it is important to provide emotional support. Many people with catheters feel a loss of dignity or independence, so handling the process gently and respectfully can make a meaningful difference to their wellbeing.

When to Seek Professional Help

While carers can manage much of the day-to-day care, it is vital to know when to seek professional support. Medical help should be sought urgently if no urine drains for several hours despite a full bladder, as this may signal a blockage. Persistent leakage around the catheter, or blood in the urine beyond small traces, also requires attention. Warning signs of infection include fever, chills, new confusion (especially in elderly patients) or cloudy, foul-smelling urine.

Pain is another important indicator. If there is severe or worsening pain around the insertion site, or if the catheter has been accidentally removed or dislodged, do not attempt to fix the problem yourself unless you are trained to do so. Instead, contact a nurse or doctor immediately. Recognising these red flags and acting quickly is essential for preventing serious complications and ensuring the safety of the person you care for.

Final Thoughts

Caring for someone with a catheter at home can feel overwhelming at first, but with consistent hygiene, securement, and observation, it becomes part of a routine. The key principles are cleanliness, correct positioning, and careful monitoring.

As a carer, your role is vital not only in preventing complications but also in supporting the comfort and dignity of the person in your care. When in doubt, always seek professional guidance, your vigilance can make all the difference in their health and wellbeing.

Sources

• Centers for Disease Control and Prevention (CDC). Guidelines for Prevention of Catheter-Associated Urinary Tract Infections (2009).

• Agency for Healthcare Research and Quality (AHRQ). Preventing CAUTI in Hospitals Toolkit.
  

• Royal College of Nursing (RCN). Catheter Care: RCN Guidance for Nurses (2019).
  

• Wound, Ostomy and Continence Nurses Society (WOCN). Indwelling Urinary Catheter Securement Guidelines.
  

• National Health Service (NHS UK). Living with a Urinary Catheter (2021).

• Centers for Disease Control and Prevention (CDC). Guidelines for Prevention of Catheter-Associated Urinary Tract Infections (2009).
  

• Agency for Healthcare Research and Quality (AHRQ). Preventing CAUTI in Hospitals Toolkit.
  
  Royal College of Nursing (RCN). Catheter Care: RCN Guidance for Nurses (2019).
  

• Wound, Ostomy and Continence Nurses Society (WOCN). Indwelling Urinary Catheter Securement Guidelines.
  

• StatLock® Manufacturer Information (Bard/BD).

• Australian Government, Department of Health and Aged Care. Urinary Catheters – Patient Information (2021).
  

• Australian Commission on Safety and Quality in Health Care. Healthcare-Associated Infection: Urinary Catheter Use (2020).
  

• Royal College of Nursing (UK). Catheter Care Guidance for Nurses (2019).
  

• Wound, Ostomy and Continence Nurses Society (WOCN). Indwelling Urinary Catheter Securement Guidelines.

• National Health Service (NHS UK). Living with a Urinary Catheter (2021).