Indwelling catheter care and removal

What it is

Every day with a urinary catheter raises the risk of infection. Nursing care aims at three things: keeping the system closed and sterile inside, keeping urine flowing freely into the bag, and removing the catheter as early as possible. The 2009 CDC guideline recommends reviewing every day whether the catheter is still indicated, not changing the catheter or bag at fixed intervals, doing only routine meatal hygiene and not clamping the catheter before removal. After removal, the first void is watched.

Indications

• Daily maintenance of every indwelling urinary catheter while it is indicated.
• Emptying the bag regularly, before it overfills or before a transfer.
• Taking urine for testing from the sampling port, never from the bag.
• Removal once there is no indication; after surgery, ideally within 24 hours unless there is another reason to keep it.

Contraindications and precautions

• Do not clamp the catheter «to train the bladder» before removal: the CDC guideline considers it unnecessary.
• Do not change the catheter or bag at fixed intervals; change them for infection, obstruction or a broken closed system.
• Do not irrigate the bladder routinely; only when obstruction is expected (for example, bleeding after prostate surgery) and on order.
• Before removal, confirm the order and that it is not a catheter the surgeon asked not to touch.
• Use standard precautions (gloves and, if splashing is likely, a gown) whenever handling the catheter or bag.

Equipment

• Clean gloves, perineal care supplies and a towel or pad.
• A clean container used only for that patient to empty the bag, and a graduated measure for output.
• For removal: a needle-free syringe of suitable size to empty the balloon and a waste container.
• For specimens: alcohol or another disinfectant, a sterile syringe and a labelled sterile container.
• A thigh securement device.

Step by step (and why)

1. Hand hygiene and gloves before touching the catheter or bag — most infections enter through hands or the system.
2. Check the catheter is secured, without traction or kinks — traction injures the urethra and kinks trap urine.
3. Wash the meatus and catheter with soap and water, moving away from the meatus — routine hygiene is enough; antiseptics do not prevent infection.
4. Empty the bag into a clean container used only for that patient, spout touching nothing — it avoids splashing and contaminating the system.
5. Record urine volume and appearance and assess whether the catheter is still indicated — the daily review shortens catheter time.
6. To remove, empty the balloon completely with the syringe — removing it with the balloon full injures the urethra.
7. Withdraw the catheter gently as the patient breathes out, and stop if there is resistance — resistance suggests the balloon is still full.
8. Check the catheter came out whole, give perineal care and note the time — the removal time starts the clock for the first void.
9. Explain that the first void may burn a little and to call when they void — so the void is measured and retention is caught.

Complications

• Catheter-associated urinary tract infection: temperature of 38 °C or more, chills, confusion or lethargy, foul-smelling urine, suprapubic or flank pain.
• Blockage from clots, sediment or kinking, with bladder distension and pain.
• Urine leaking around the catheter or bladder spasms.
• Urinary retention after removal.
• Urethral injury from traction or from removing the catheter with the balloon inflated.

Next step: when to call for help

• Report signs of infection at once: fever, chills, new confusion or flank pain.
• If the catheter stops draining after you have checked for kinks and the bag position, report it before handling it further.
• If the patient has not voided 4 to 6 hours after removal or reports a full bladder, assess the residual per protocol (bladder scan) and report.
• Report resistance on removal that does not ease, a balloon that will not empty, or a catheter that came out incomplete.

Test yourself

Think of the answer, then tap the question to see it.

Add to my cards (4)

Connections

← All of nursing

Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Guideline for Prevention of Catheter-Associated Urinary Tract Infections (2009) (Centers for Disease Control and Prevention (CDC), HICPAC, 2009); Nursing Skills, 11.3: Preventing CAUTI (Open RN, Chippewa Valley Technical College (via LibreTexts), 2021); Nursing Skills, 11.6: Removing an Indwelling Urinary Catheter (Open RN, Chippewa Valley Technical College (via LibreTexts), 2021).

Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake

Send

Representative model, for educational purposes only.