AbstractThis article, the third in a six-part series on urinary catheters, provides an overview of drainage devices and catheter support systems. It also explains the procedure for emptying a catheter bag.
Citation: Yates A (2017) Urinary catheters 3: catheter drainage and support systems. Nursing Times [online]; 113: 3, 41-43.Author: Ann Yates is director of continence services, Cardiff and Vale University Health Board.
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IntroductionUrinary catheterization is associated with a number of complications including catheter-associated urinary tract infection (CAUTI), tissue damage, bypassing, and blockage. The risk of complications means catheters should only be used after considering other continence management options and should be removed as soon as clinically appropriate (Loveday et al, 2014). During the insertion procedure tissue trauma and poor aseptic technique can lead to CAUTI; this risk continues for as long as the catheter is in place. Risk factors for CAUTI are outlined in Box 1. Appropriate catheter drainage and support devices, as well as hand hygiene and associated infection prevention strategies, can reduce the risk of CAUTI.
Box 1. CAUTI risk factorsThe risk of catheter-associated urinary tract infection (CAUTI) is increased when:
- The connection between the drainage device and catheter is broken
- The drainage device’s tap becomes contaminated when the bag is being emptied or comes into contact with the floor
- Reflux of urine from the bag into the bladder occurs because the bag is full or positioned above the level of the bladder
- There is poor hand hygiene before the catheter is handled by the patient or carer
- Patients have poor oral intake and/or level of personal hygiene while caring for their catheter
- The catheter is inadequately secured, causing trauma to the urethra and bladder neck
Selecting a drainage systemThe selection of an appropriate drainage device depends on:
- The reason for, and likely duration of, catheterization;
- Patient preference;
- Infection prevention issues (Dougherty and Lister, 2015).
- Two-liter bags – used for non-ambulatory patients and overnight drainage;
- Leg bags – can be worn under clothes, thereby encouraging mobility and rehabilitation as patients do not have to carry a bag attached to a catheter stand. Leg bags can also have a positive effect on patients’ dignity as they are not visible to others (Dougherty and Lister, 2015);
- Durometer bags – used to closely monitor urinary output.
Box 2. Principles for managing drainage devices
- Catheters must be attached to an appropriate drainage device or catheter valve (see part 5 on catheter valves to be published in the May issue)
- The connection between the catheter and urinary drainage system must not be broken unless clinically indicated (Loveday et al, 2014)
- Catheter bags should be changed according to clinical need – for example, if the bag is discolored, contains sediment, smells offensive, or is damaged (Royal College of Nursing, 2012), urinary drain bag or as instructed by manufacturers (Loveday et al, 2014), which is usually every seven days (RCN, 2012)
- Catheter specimens of urine should be obtained from a sampling port on the catheter drainage device according to local policy
- Bags should be positioned below the level of the bladder (Loveday et al, 2014); many are fitted with an anti-reflux valve
- Urinary drainage bags should not be allowed to fill beyond three-quarters (Loveday et al, 2014)
- When a 2L drainage bag is used, it should be attached to an appropriate stand, and contact with the floor should be avoided (Loveday et al, 2014)
- A separate clean container should be used to empty bags, avoiding contact between tap and container (Loveday et al, 2014)
- Antiseptic or antimicrobial solutions should not be added to urinary drainage bags (Loveday et al, 2014)
- Catheters must be well supported to reduce traction-related problems such as bypassing of urine, and discomfort and soreness around the catheter
- 350ml – a small capacity bag;
- 500ml – the most common choice for daily use;
- Direct inlet – attaches directly to the catheter;
- Short tube;
- Long tube.
- urinary drain bag