Hi-R-Ed Online

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More Characteristics of Catheters

Valves:

Urine can be drained through “free drainage” or intermittent drainage through the use of a valve. The catheter valve fits into the end of a catheter and is a tap-like device that can be turned on or off allowing urine to be stored in the bladder and emptied into a toilet or bag. Long-term catheters often include the valve device which allows the bladder to intermittently fill to retain capacity and tone. The use of a valve can also reduce the risk for catheter infection and blockage by intermittently flushing the catheter by draining urine. A valve can be used with or without a leg bag and offers a way to be more discreet about long-term catheter maintenance. The valve should be changed every 5-7 days and can be changed when the leg bag is typically changed.

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photo courtesy of Byram Healthcare

Drainage Bags and Systems:

Drainage bags are categorized as leg bags or night bags. Leg bags are worn under clothing and must be kept below the level of the bladder to assure that the gravity system doesn’t lead to reflux. Night bags are connected to a leg bag for overnight drainage. Usage of a bag makes it a closed system to prevent bacterial contamination. The leg bag is only disconnected when it is replaced every five to seven days. The night bag can be drained through a tap and can be removed, washed with water, and allowed to dry.

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photos courtesy of Byram Healthcare

Devices to Secure Catheters:

Devices to Secure Fasteners: Catheter suspension and straps were developed in the 1960s to prevent complications associated with catheter movement. While adhesive tapes and Velcro strapping devices are sometimes used, these are not considered appropriate for securing urinary catheters. If not properly secured, catheters can cause urethra trauma, inflammation, irritation, pain, infection, dislodging of the catheter, and possible damage to the bladder neck or cleaving of penile or labial tissues. There are a number of devices to secure catheters under names such as securement, holder, fastener, and stabilization device. These vary in sizes and how they secure the catheter. Catheter securement devices may include a plastic clamp or a hook and loop section and can stay in place for up to seven days. Another type of device clamps the catheter in place and secures it to the skin with a soft silicone gel pad with an adhesive that allows it to be moved without using an alcohol pad to loosen it.

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photos courtesy of Byram Healthcare

Indications for Catheter Placement

Best practice guidelines provide us with some very specific indications for appropriate indwelling urinary catheter use--and they are listed on this slide. For those of you who have Foley catheters in your “house”, are they used for one of the indications listed below?

--Acute urinary retention.

--Bladder outlet obstruction.

--In critically ill patients they can be useful in getting accurate measurements of urinary output.

--Perioperative use with urological or surgeries near GU tract structures.

Catheters can also be useful for other reasons:

--Anticipated prolonged OR time, need to infuse large volumes and/or diuretics in OR, need for intraoperative monitoring of urinary output

--Sacral and/or perineal wounds in incontinent patient

--Prolonged state of immobility related to prolonged surgery or multiple traumas

--Comfort at end of life

--Catheters can be appropriate and useful when the anticipated time in the OR is expected to be prolonged, there is a need to infuse large volumes and/or diuretics in the OR, or there is a need for intraoperative monitoring of urinary output.

--If the incontinent patient has sacral and/or perineal wounds.

--If there is expected to be a prolonged state of immobility related to prolonged surgery, or multiple traumas.

--They can be used to provide comfort at end of life.

Diagnostic purposes may include the determination of conditions in the genitourinary tract and involve the need to collect an uncontaminated urine specimen, imaging of the urinary tract, or for monitoring output.

We should mention here that there are also contra-indications for urinary catheters. In women, urethral tearing (a traumatic injury to the lower urinary tract) is a contraindication for catheter use. It should be noted that suspected bladder injury is not a contraindication and catheters can provide drainage and contrast administration for cytoscopy.