Inform the patient and relatives about simple tips that can prevent complications: for example hygiene, fluid intake and checking that the catheter or the bag tube isn’t folded.
Hygiene is important to avoid complications such as infections, therefore daily cleaning of the genital area with a mild soap should be performed. For men who have foreskin, be sure to bring the foreskin back to avoid paraphimosis (stasis with painful swelling).
The part of the catheter closest to the urethral opening should also be cleaned regularly, to avoid irritations caused by the secretions that are commonly formed. This is also a common spot for bacteria to colonize.
Both the patient and the healthcare personnel should wash their hands before and after any contact with the catheter or other devices for example valve or urine bag.
Use of urinary bag
A drainable urine bag is recommended. Most manufacturers recommend to changing the bag once a week, and not to part the catheter from the bag during the week of treatment to avoid unnecessary exposure to bacteria. During the night the drainable urine bag can be connected to a larger bag.
Use of catheter valve
Most manufacturers recommend to changing the catheter valve once a week, and not to part the catheter from the valve during the week of treatment to avoid unnecessary exposure to bacteria. The catheter valve can be connected to a urine bag when needed.
By adjusting fluid intake, factors like urine color and texture, concrements or smell may be addressed. A common recommendation is to add one glass of fluid to every meal, if the medical condition allows it.
Citric acid might dissolve encrustations on the catheter. For this purpose 50-100 millilitres of sterile solution with citric acid are instilled by the catheter to an empty bladder for 5-10 minutes. Some manufacturers also mix in a small amount of magnesium oxide. Rinses normally are performed once or twice a week.
Bladder washout is not a routine procedure but decided on an individual basis. Bladder washout can be recommended in cases of bleeding after some urological surgical procedures, and to battle severe encrustation or avoid cloudy urine. The procedure should not hurt!
|1||Carefully inject 10-20 ml of prescribed fluid (normally sterile saline) and make sure it can easily be injected and flows out freely again.|
|2||Fill the bladder with 50-100 ml of fluid.|
|3||Aspirate approximately 50 %.|
|4||Repeat this procedure until the liquid is clear.|
Urine culture should not be routinely performed and dipsticks are not useful during catheter treatment. If the patient is systemically unwell or not responding to treatment, urine culture is the first choice for urine analysis.
If feasible, the urine should be kept in the bladder for a couple of hours before collecting a sample by either removing the current catheter or using a catheter clamp or valve. The urine shall then be collected using an aseptic technique, either by using a new catheter or through a sampling port of the urinary bag.
Remember that asymptomatic bacteriuria should not be treated routinely. There are exceptions, for example during pregnancy.
Source: All material has been written and reviewed by Märta Lauritzen, registered nurse and urotherapist and Helena Thulin, registered nurse and PhD, Karolinska University Hospital, Stockholm.