Catheterisation of patients is carried out mostly for the following reasons in terminal care:

• To relieve retention of urine
• A comatose patient
• To manage incontinence when no other means is practical

An indwelling urethral catheter is a foreign object to the body and therefor is may be associated with problems. Catheter care is aimed at optimizing patient comfort as well as limiting the complications of catherization.

General Care

Fluid intake

An adequate fluid intake ensures a large volume of dilute urine.

This will limit gravel formation and will flush out bacteria.

This fluid intake should be at least 2 -3 litres per day; however, this is not always possible if the patient is very ill.

Acid urine

Maintaining the normal acidity of the urine may help to prevent urinary tract infections

Diet can help to keep the urine acid

Meat, fish poultry, eggs, cereals and citrus fruits acidify the urine.

Catheter and genital care

1) Ensure free drainage of urine by avoiding twisting/kinking of the catheter or drainage bag tube.

2) Fix the catheter to the upper thigh minimize irritation and trauma. Avoid fixing the catheter to the patients clothing or bed linen.

3) The urine bag must always be lower than the pelvis of the patient to ensure adequate drainage by way of gravity. Should it be necessary to raise the drainage bag, i.e. with a bed-ridden patient who must be turned onto the other side be sure to clamp the tube before. The bag. Keep the tube clamped until the drainage bag is below the level of the bladder on the other side. Check that the flow of the urine is no longer obstructed.

4) Take extra care when moving or ambulating a patient to prevent pulling on the catheter. Disconnect the drainage bag and tubing from the bed frame before helping a patient out of bed. When possible, attached a leg bag to allow your patient greater mobility.

5) Peri-anal –genital care should be done twice daily if possible.
This reduces the incidence of infections. Secretions accumulate at the urethral orifice and allow bacteria to ascend to the bladder. The basic care is thorough washing with soap and water. For uncircumcised male patient, the foreskin must be gently pulled back to clean well under it.
Roll patient over and wash and dry the anal area (using the SAGE HEALTH SOLUTIONS bed companion)

6) Make sure your hands are washed prior to changing the drainage bag
The clean bag is attached to the catheter
Keep the drainage bag off the floor by hanging it on the stand or securing it to the bed frame
Ensure that there are no loops in the tubing which hang below its entry into the changing bag

7) Empty the drainage bag at regular intervals so that it doesn’t
Overfill and cause urine back up in tubing.

8) Empty the bag you have removed
Rinse the bag by pouring water into the open outlet tap
Insert 5 ml Jik (household bleach) into the outlet with a 5ml
Syringe add water and wash bag out. Rinse and hang to dry.
Complications of a urethral catheter, which must be reported to your Community sister.

1 Infection of Bladder
Signs and symptoms
Pain (lower abdomen)
Urine appears murky or sludgy
Mucus in the urine
Blood in the urine
Urine has offensive ‘fishy smell’
Patient may feel hot, have a raised temperature or be confused

2 Blockage of the catheter by blood, mucus or sediment, therefore no urine draining into bag

3 By passing or urine around catheter due to blockage of catheter or bladder spasm

4 Catheter falls out or is pulled out completely followed by some bleeding

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