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This urinary catheter care and removal guide provides a step-by-step approach to performing catheter care and removal in an OSCE setting.
General principles for catheter care
- Wash your hands and wear non-sterile gloves when attending to a catheter
- Meatal hygiene should be undertaken daily with water and soap. In men, the foreskin should be replaced following this
- Drainage bags should be emptied regularly to allow urine to drain and prevent reflux. They should be changed if they become discoloured, odorous or damaged, or after seven days of use
- Only use single-use items once
- Document catheter care accurately in patient notes
- To prevent catheter-associated complications, catheter needs should be routinely reviewed, and when no longer needed, they should be removed as soon as possible. Document the need for ongoing catheterisation where relevant1
Emptying the catheter bag
Indwelling catheters should be connected to a drainage bag as a closed, sterile system. To prevent the bag from overfilling, the drainage bag should be emptied in line with the rate of urinary production.1-3
Gather equipment
- Plastic apron
- Non-sterile gloves
- Plastic goggles
- A large jug or container
- Alcohol swab (2% chlorhexidine gluconate in 70% isopropyl)
Introduction
Wash your hands using alcohol gel. If your hands are visibly soiled, wash them with soap and water.
Don PPE including your gloves, apron, and goggles (if there is a splash risk).
Introduce yourself to the patient including your name and role.
Confirm the patient’s name and date of birth.
Briefly explain what the procedure will involve using patient-friendly language: “I need to drain the urine from your catheter bag. This should not cause you any discomfort.”
Gain consent to proceed.
The patient does not need to be in any particular position but should be comfortable.
Ask the patient if they have any pain before continuing with the clinical procedure.
Procedure
1. Free the catheter valve if tucked into a notch on the drainage bag.
2. Clean the catheter valve using an alcohol swab for 30 seconds and allow to dry for 30 seconds.
3. Note the volume of urine in the catheter bag and/or urometer. If a urometer is present, empty the hourly volume box content into the catheter bag by inverting the box.
4. Place a large jug or container below the valve.
5. Open the catheter valve and allow all the urine to drain into the jug or container, avoiding the valve touching the container.
6. Close the valve and clean it with an alcohol swab for 30 seconds and allow to dry for 30 seconds.
7. If present, reinsert the valve into the drainage bag notch to prevent the valve from touching the floor.
8. Reposition the catheter bag below the level of the bladder, and not touching the floor.
To complete the procedure…
Explain to the patient that the procedure is now complete and that they should seek review if the catheter becomes painful or if they begin to feel unwell.
Cover the jug or container, and dispose of urine in the dirty sluice or down a toilet.
Dispose of PPE appropriately and wash your hands.
Document the urine volume (i.e. on a fluid balance chart). If the urine has an unexpected colour, viscosity, odour, or blood, document the findings and if concerned, report this to a senior.
Removing a urinary catheter
Prompt catheter removal once indicated plays a key role in reducing catheter-associated urinary tract infections. Catheter removal is best planned for the morning as this allows time for assessment of the patient’s ability to pass urine.1-2, 4
Gather equipment
- Plastic apron
- Non-sterile gloves
- 10 mL syringe
- 10 mL 0.9% sodium chloride
- Catheter removal or basic procedure pack: including cotton wool balls, sterile gauze, and gallipot (a.k.a. a small pot)
Introduction
Confirm when the catheter was inserted from the clinical notes. Note the volume of sterile water used to inflate the catheter balloon. In most cases, this will be 10 mL, however, in 3-way catheters, volumes of up to 30 mL may have been used.
Wash your hands using alcohol gel. If your hands are visibly soiled, wash them with soap and water.
Don PPE including your gloves and apron.
Introduce yourself to the patient including your name and role.
Confirm the patient’s name and date of birth.
Briefly explain what the procedure will involve using patient-friendly language: “Today, I need to remove your catheter. This will involve me removing the water from the catheter balloon and then gently guiding the catheter out. This may feel strange but should not cause you any pain. Please let me know at any point if you do experience any pain or discomfort, and I will stop.”
Inform the patient of possible symptoms following removal: “You may experience discomfort following removal of the catheter, or increased urgency or frequency of urination. This is caused by irritation from the catheter. These should be temporary and settle on their own”.
Explain the need for a chaperone: “One of the other staff members will be present throughout the procedure, acting as a chaperone, would that be ok?”
Gain consent to proceed with urinary catheter removal.
Explain to the patient that they’ll need to remove their underwear and lie on the clinical examination couch, covering themselves with the sheet provided. Provide the patient with privacy to undress and check it is ok to re-enter the room before doing so.
Ask the patient if they have any pain before continuing with the clinical procedure.
Equipment preparation
1. Clean the top of a procedure trolley using a disinfectant wipe.
2. Check the expiry date on the 0.9% sodium chloride and sterile equipment.
3. Set up the sterile field by first removing the outer packaging from the procedure pack and then opening the pack from the corners without touching the inner surface of the field.
4. Using an aseptic non-touch technique (ANTT), place the 10 mL syringe onto the field.
5. Pour the 0.9% sodium chloride solution over the cotton balls/sterile gauze, which should already be located within the gallipot of the procedure pack.
Procedure
1. Remove any catheter leg straps or adhesive stickers so that the catheter is freely mobile.
2. Use the syringe to deflate the catheter balloon and remove all of the sterile water.
3. Ask the patient to take a deep breath. On exhalation, apply gentle continuous traction to remove the catheter. This should happen with very little resistance.
4. Clean the urethral meatus and surrounding area with sterile cotton balls/gauze soaked in 0.9% sodium chloride.
- In males, support the penis with your non-dominant hand. With your dominant hand, clean the glans, moving gradually away from the urethral meatus. Ensure that the foreskin has been replaced to anatomical position if it has been retracted.
- In females, part the labia with your non-dominant hand and with your dominant hand, wipe in a front to back direction.
5. Dispose of the catheter and your equipment in a clinical waste bin.
6. Provide the patient with privacy to get dressed.
To complete the procedure…
Explain to the patient that the procedure is now complete and that they should seek review if they experience any pain or if they begin to feel unwell.
Dispose of PPE appropriately and wash your hands.
Advise the patient to drink 2-3 litres of fluid over the course of the day and undertake gentle exercise.
Advise the patient to inform nursing staff when they next need to pass urine so that the volume of urine can be measured.
Document the details of the procedure in the patient’s notes:
- Your personal details including your name, job role and registration number
- The date and time the procedure was performed
- Confirmation that verbal consent was obtained
- The details of the chaperone who was present including their name and job role
- The volume of water removed from the catheter balloon (e.g. 10 mL). It is good practice to verbalise the volume removed to an examiner
- Any complications experienced during the procedure
- The residual volume of urine in the catheter bag
Trial without catheter
Catheter removal in patients post-operatively, after acute urinary retention, or with chronic retention necessitates a ‘trial without catheter’ or TWOC. This establishes that they can void normally. Types of TWOC include:
- Early morning: with a same-day review
- Daytime extended overnight: a next-day review
- Nighttime: for patients with nocturnal polyuria
Patients are routinely monitored following catheter removal to ensure they can safely void urine without a catheter. The urine volume passed by the patient on the second void should be measured and recorded.
A TWOC should be abandoned and the patient re-catheterised if they experience concerning pain or bleeding or they withdraw consent. Patients may also fail their TWOC if they are not able to pass urine or if they have a large residual volume on a bladder ultrasound scan.4 Local guidelines vary, however, if a patient voids >200 mL and the post-void residual is <150 mL, they are likely to have passed their TWOC.
Reviewer
Hannah Ames
RN and Independent NMC OSCE Trainer
Editor
Dr Jamie Scriven
References
- Royal College of Nursing. Catheter Care: RCN Guidance for Health Care Professionals. 2021. Available from: [LINK].
- NICE. Infection prevention and control: Quality statement 4: Urinary catheters. 2014. Available from: [LINK].
- The Royal Marsden NHS Trust. Urinary catheter bag: emptying. In: The Royal Marsden Manual of Clinical and Cancer Nursing Procedures. Tenth ed. Available from: [LINK].
- The Royal Marsden NHS Trust. Urinary catheter removal. In: The Royal Marsden Manual of Clinical and Cancer Nursing Procedures. Tenth ed. Available from: [LINK].
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