Safe catheter care starts with a daily question
“Does this patient still need the catheter?” A practical nursing guide to preventing CAUTI and supporting comfortable, dignified care.
A urinary catheter can be essential, but it should never become an invisible part of a patient’s admission. When staff become used to seeing the bag beside the bed, the original reason for insertion can be forgotten. Good catheter care includes reviewing that reason, protecting the drainage system and responding to the patient’s concerns.
This article covers adult indwelling urinary-catheter care for nursing education. Insertion, replacement and removal require appropriate competence and your facility’s authorisation or protocol.
1. Know the device and the problem
An indwelling urethral catheter remains in the bladder and drains into a collection system. Intermittent catheterisation empties the bladder and then the catheter is removed. A suprapubic catheter enters the bladder through the lower abdomen; an external device collects urine without an indwelling urethral tube. These are different approaches, and the team chooses according to the patient’s needs.
Catheter-associated urinary tract infection (CAUTI) is symptomatic infection associated with a urinary catheter. Prolonged use is an important risk factor. Teach patients to ask why the device is needed, avoid pulling or twisting the tubing and report discomfort. CDC CAUTI overview.
2. Check the indication at handover
Appropriate reasons include acute urinary retention, selected surgery or accurate urine-output measurement in a critically ill patient. Incontinence alone does not justify an indwelling catheter. Review the need each day and pursue removal under an authorised pathway when the indication has ended.
3. Protect the drainage system
Use hand hygiene before and after catheter care. Acute-care insertion requires trained staff, aseptic technique and sterile equipment. During maintenance, keep the system closed, secure the catheter, keep tubing free of kinks and position the bag below the bladder and off the floor. Empty it into a clean patient-specific container without letting the outlet touch the container.
For a prescribed urine culture, use the disinfected sampling port and aseptic technique rather than urine from the bag. Routine preventive antibiotics, antiseptic bladder washes and unnecessary disconnection are not part of standard prevention. Follow clinical indications and device instructions for replacement rather than inventing a ward-wide fixed interval. CDC prevention recommendations.
4. Assess the person as well as the bag
Ask about pain and discomfort, observe the drainage and consider the patient’s overall condition. A bag with little urine requires assessment: check the external tubing and bag position, review the recorded output and fluid plan, and seek clinical review for persistent poor drainage or concerning symptoms. Do not assume that every reduction is a simple blockage or that every patient needs extra fluid.
Severe bladder spasms, leakage with suspected blockage, visible blood, fever or feeling shivery need prompt clinical advice. Routine hygiene with mild soap and water, handwashing and avoiding kinked tubing support care. Fluid advice must respect any prescribed restriction. NHS catheter-care advice.
5. A positive culture does not tell the whole story
Catheters can become colonised by microorganisms. Bacteria in urine without attributable symptoms are not the same as symptomatic CAUTI. In most patients, asymptomatic bacteriuria does not require antibiotics; exceptions include pregnancy and certain invasive urological procedures, which need clinician-led assessment.
Urine-culture stewardship means collecting specimens for appropriate clinical reasons and handling them correctly. Unnecessary antibiotic treatment can cause adverse drug effects, promote resistant organisms and increase the risk of Clostridioides difficile infection. Interpret results alongside symptoms and the clinical assessment. CDC culture-stewardship guidance.
6. Make discharge teaching practical
Do not finish teaching with “Do you understand?” Ask the patient or carer to explain how they will position the bag, when they will seek help and whom they will contact. Demonstration and teach-back show whether the advice is usable at home. Check language needs, privacy, confidence and whether the patient can obtain the required supplies.
Give a written plan stating the responsible service, review arrangements and what to do if the catheter stops draining or falls out. Avoid assuming that a relative will provide care: ask the patient who they want involved and confirm that the person is willing and able to help.
Teach-back questions you can use
- “Where will you keep the bag when you sit or lie down?”
- “What would make you contact the care team?”
- “Can you show me how you will avoid pulling on the tube?”
- “Who will review the catheter, and how can you contact them?”
7. Write a handover that supports decisions
Document the indication, relevant assessment, output over a stated period, problems identified, action taken and the review or removal plan. If an issue was escalated, record who was contacted and the agreed response. Keep observations factual; do not write “CAUTI” as a confirmed diagnosis solely because urine looks different.
A useful final question before leaving the bedside is: “Is there anything about this catheter that is making you uncomfortable or worried?” Patients may reveal pulling, embarrassment or confusion that has not appeared on the chart.
Sources: CDC CAUTI basics, prevention recommendations and urine-culture stewardship; NHS living with a catheter, linked above. This learning guide supports, but does not replace, current local protocols and individual clinical assessment.