- 15 April 2021
- 17 min read
Catheter Skills Training Video By A NurseSubscribe To Advice
- Laura Bosworth
- Mat Martin
- Richard Gill
- Aubrey Hollebon
- Chris Anderson
- Sarah Wakenge
- Amy Lyons
This skills based training video is about catheters. It explains the different types of catheter, how to keep them sterile, when we use them, catheter care, and ensuring dignity.
Disclaimer About This Training Video
This video will explain in detail what you can expect to do. It will also supplement any existing qualification and experience you have in this subject and procedures, refresh your memory and prepare you for a regulated training course. (Of course, it is not a substitute for a course.) You can also find regulated training courses on Nurses.co.uk. Our courses will build your CPD, provide you with a certificate, and enhance your CV when job hunting.
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What Is A Catheter?
Hi, and welcome back to the vlog. So this video is all about catheters and catheter care and why we need catheters and all that jazz. I had a lovely request for this video and actually I thought it was a really good idea because I don't do as many skills based kind of videos, and I think actually I should be doing more of those just to help you out maybe a little bit. So yes, today is all about catheters. Firstly, a catheter is a tube that goes into your bladder and this helps to drain any urine. And there will be a bag attached on the end to catch the urine. It's not just going to go everywhere on the floor. Honestly, it's in a bag, so it's a tube and a bag. Done.
Different Types Of Catheter
Now, there are a couple of types of different catheters. I'm going to use images because I'm at home. I have not got catheters lying around my house. I might have a speculum but not a catheter. So this bag here is your catheter. So this goes, as it says on the tin, it goes straight into the urethra, into the bladder and drains the urine directly from there.
And this is sometimes called a leg bag or night bag, or people have all these weird and wonderful names for it. But normally it hangs out and attaches to the leg. If someone is in bed, it should really be attached to a little stand or something so that it can drain properly and not get blocked. And this type of catheter can be inserted by nurses and doctors. I've inserted some female catheters. I haven't done a male catheter yet because you need the extra training, which I'm assuming they're doing at uni now, because I think the guidelines and everything have changed.
But when I trained, we weren't allowed to do male catheters just because of the anatomy and the danger of the prostate and all of that jazz. So we just had the female catheters to do just because the urethra's quite small and it's quite an easy-ish one to navigate and put in, but it was really, really simple ... I found it really, really simple. I'm saying it's really simple, but actually it's not really simple, but I found it for some reason, just really simple to do. I never had a problem. I think I was just lucky with the anatomy and physiology of the females I had. It was there. I could visualize it. It was straight in. When you insert a catheter, it is a septic technique because you don't want to insert any bacteria or anything into that area because they're going to end up with urine infections.
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Keeping It Sterile
They could end up with sepsis and all sorts. So really, really important that it's aseptic, you keep that sterile field as clean as possible, and you'll be okay. Now the tricky part, that was the easy part. You have the tube, you have the bag, but then there's the tap. Now, the tap is very different on every bag and I don't 100% know, not what the difference is, but why they choose certain types over other taps. I don't know. But you have the flip tap, which is just literally you flip it on, flip it off to get the urine out. There's other taps that you have to turn. There's another tap that you push across. So it's like a little bit, I'll put a picture here, but it's like a little bit that you push across so that when you push it across, the urine comes out.
And one of the biggest problems with these taps is sometimes people forget to close them. I've done it. Absolutely. I've forgotten to close it. You've got urine all over the floor and you're thinking nightmare, what a plonker. And next, you also have the night bags and day bags. So the day bags are a certain size, and then you have the night bags that are a bit bigger. Some people attach a bag onto a bag as well. I've seen that done before, but I'm not 100% sure about the guidelines around that, but I'm going to put some information below if you really want to look it up. Go for it, knock yourself out guys. And also there are two types of these catheters, if I make sense, I don't know, but one is called the intermittent catheter. So this is a catheter that a patient can actually change theirselves quite regularly throughout the day. So they do it themselves. They're trained to do that. And this is just inserted a few times a day that allows people to just drain it into the toilet still, if that makes sense. However, in my head I think this could have the potential to cause maybe some urinary tract infections because you're constantly changing it. There is that little bit more risk, maybe. I don't know, but it is a really good tool for those people that really need it. And then there is the indwelling urinary catheter, which is pretty much the first one that I spoke about. So it's inserted into the urethra and it's left. That is it. Insert it in, there's a little balloon that you pump up and it stays in until it's due to be changed or if it gets blocked or something happens, but that catheter will stay in.
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And it's just the bag bit that gets changed every so often. So leg bags on indwelling catheters should be changed every seven days and you should, normally it's really good practice to date and sign the back of it just in pen, just so that you know when it's last been changed and what time so that you know that in seven days time you change that leg back again. And this isn't the whole catheter. This is literally just the tubing in the leg bag on the end. Most indwelling catheters need to be changed every three months, sometimes before if there's any issues.
The next type of catheter is the suprapubic catheter. I'm going to put an image here, again. So this catheter is actually a surgical procedure and they have to cut a little hole into your lower abdomen and then they thread the tube through there into the bladder and then you have the bag on the end to release the urine. And the suprapubic catheter can be done under general anesthetic and epidural or even local anesthetic. And the suprapubic catheter is used if the urethra is completely blocked so they can't use that end, or if they're unable to use an intermittent catheter. Also, these have a bag as well so these can either have a bag and it sits on the side of your body or the patient's body, or it can be connected with a little valve so then you just go into the toilet, empty it and then go back to your seat or whatever you're doing. And this catheter is usually changed every four to 12 weeks.
And another type that you may not have heard of is called a urostomy bag. So this is a bit like a stoma bag. If you've ever seen a stoma bag, it literally sits on the abdomen like a bag. I'm going to put picture here again. And this is done after you've had surgery to remove your bladder for whatever reason and they replace it with this bag. So you'll have this, it'll look like a hole going in through the abdomen and the bag is attached to this directly to the whole. There's no big, long tube or anything. It's literally just attached to the hole and that's where the urine comes out of.
If you want to know a little bit more about urostomy bags or stoma bags, please go and follow my amazing, amazing friend, Rachel. I'm going to put her blog below because she's got both a stoma and urostomy and she writes amazing blogs to make more awareness around it. She's done loads of photo shoots and stuff with them. And she's amazing. The strength this girl has is incredible. She's one of the most inspiring people that I know. And I know a few inspiring people, but she's up there. She is up there because she is amazing. So please go check out her blog. She's really, really informative. And if you're on Twitter or Instagram, she is also on those places, links below guys, go and give her a follow.
And last but not least is the male catheter sheath or the male sheath catheter, sometimes it's called a sheath. It might be called something completely different where you are. I'm going to put an image up so I'm going to warn you now, there is a bit of a graphic image coming up of the male anatomy. Don't be alarmed, but if you don't want to see it, maybe skip, I don't know, however many minutes. I'll put it here how long you should skip after the video's done. But here it is. And this is a little bit like a condom. So it will be ... the ones that I've seen in the hospitals is like a little plastic rubbery bit that goes over the penis and then there's a tube with a bag on it. So it literally like a temporary thing. So you put it on, they sleep with it, they use it in the day, whatever and then it gets disposed of, and they have a new one the next day. They do come in different sizes. So make sure you've got the right size for your patients.
When Do We Use Catheters?
Catheters are used if anyone has real difficulty in urinating. It can also be used before or after surgery as well to help perform certain tests for example, but more specific reasons the catheter might be used could be things such as, if you have some sort of bladder obstruction or urethra obstruction. If you have any form of bladder damage or maybe nerve damage that affects your ability to go to the toilet. Some pregnant people, during childbirth, if they have an epidural, because obviously everything's numb from the waist down so they haven't got control over their bladder. So that might need it. This is also common in surgery as well. So any type of surgery, if you've had an epidural where you can't control it, they might insert a catheter. Some people also have it to insert things like chemotherapy directly into the bladder. So if a patient has cancer of the bladder, they might have this type of bag as well just to deliver any form of medication directly to the bladder and as a massive, massive, massive, very, very last resort for somebody that has complete urinary incontinence, and it will be as a very last resort just because of the risk of infections. And we don't usually just insert a catheter for fun if someone's incontinent. So you have to do everything you can first and then if it's that severe, they might think about putting a urinary catheter in.
So how to look after a catheter. So as I said, the bags will be changed regularly just to keep it clean and sterile as possible to prevent those UTIs from coming in. Also, you would empty it as least as possible, really because you don't want to keep opening that valve because you're going to be allowing bacteria to travel up into the bag and through the urethra and all that jazz. So you're trying to minimize that risk of infection, so you shouldn't really be opening and closing that valve all day, every day, you should just be doing it like when the bag's getting full, then empty it all at once and then allow it to fill again.
So if your patient is able bodied and they can wash themselves properly, then you should be training your patient to clean around the tubing that goes into the urethra because they have to keep that clean just to prevent again, any infections from going up there. So keeping it clean, sometimes you can get like a little bit of discharge around the tubing. It can get a little bit mucky. So it's really important that that bit is cleaned daily. And if they can't do it, then please make sure that you do it. If you're washing and helping your patient to wash and dress and they can't do that, then please help your patient to do that and make sure that that's clean and dried properly.
Dignity With A Catheter
This is a big one because I've seen this so many times and I just think, "Why? Why have you done that? Why?" When patients have a catheter and the tube in is very, very long and they need to go to the toilet, for example, because their bowels were okay, so they need to go to the toilet or they need to go into the shower room for whatever reason, or they're walking down the corridor and they've got a zimmer frame or a walking frame, whatever you want to call it and people come along and they take their patient and they put the catheter over the frame. I'm just like, "Where is that person's dignity? Everyone in that building can see that this person's got a catheter." They can see whatever the color their urine is, it's just not very dignified. And it used to infuriate me. And I used to be like, "No, why have you done that?" So please, please, please, if you're walking your patient around, just put it in a discreet place. Some patients don't mind. They're just like, "Yeah, whatever." But if that was me, I would not want my urine bag hanging over my frame for all to see whilst I'm walking. That's not dignified to me.
So please think about that when you're out there. Look after your patients, maintain their dignity, put the bag onto the leg, make sure it's covered up. Make sure they've got a blanket if they're sitting in the chair so that it's not on show. Make sure it's sort of hiding under away, I used to always tuck the bag away if they were sitting in hospital chairs, I would put the bag on a stand around the side if they didn't have straps to their legs or if it was too long, for example. But there's little things you can do, like get a shorter tubing, get some leg straps, strap it to their legs so that it's not on show all the time. Just please think about dignity. Thank you.
Rejection And Bladder Spasms
So your patient may have bladder spasms. They might have stomach cramps because obviously you're putting something into the bladder and your automatic reaction, your body is going to do this because it's trying to expel it back out because it's not normally there. But it should settle and if this is ongoing problems that they're having, they can be prescribed some medication to relieve those symptoms and those spasms just to give them a bit of a break. Catheters can leak as well. So if it's leaked, the first thing you want to do is maybe do flush it out to make sure it's not blocked. If it's blocked, then the whole catheter might have to be changed, like the tubing, the urethra, everything.
Sometimes catheters can be pulled out. I've seen this. We had one dementia patient who pulled their catheter out, the bag inflated and all, and it caused a little bit of trauma and there was a little bit of blood and things. It wasn't very nice to be honest, but it can happen. People can get it caught on things. And as they're walking, it can just pull out. It is a possibility. And that can't be very nice for any patient. If you see blood in the catheter bags, so it will be red in color and there's no explanation for it and you're thinking, "Oh God, this person has got hematosed blood." Then you need to contact the doctor and get them to check everything out. Maybe take a urine sample from the catheter as well... Oh actually, urine samples from catheters, I will cover that.
Other problems like I've already spoke about, urinary retract infections. UTIs are common if someone has a catheter. So just keeping an eye on that and making sure that there's no urinary problems. Which leads me perfectly on to getting your urine sample to test for a urine infection. So in the catheter at the top where the tube connects, normally nine times out of 10, there is a little section, I'm going to put a picture here. There's a little section that you can put a needle into. It'll be a little plastic piece and it'll have a rubber bit, a little rubber bit and you get a syringe and you get your needle, doesn't matter really. I used a green needle, I think it was a green needle. It's been that long since I've done this guy. Get your syringe, 10 mil syringe, 20 mil syringe, enough to fill up your urine pot, put that needle into it and then you draw back and you get the urine out of it. And then you can put it into your urine pot and send off. You should label it clearly as well on the forms and the pot that it's from a catheter because that bit at the top in the tube is the most sterile part. That's going to be fresher than the stuff that's sitting at the bottom of the catheter. So if you're opening the tap to get some urine, like I did at the start, no one had told me how to get a urine sample from a catheter. So I was opening the tap, getting it and that was it, until someone said, "Whoa, hang on. You shouldn't be doing that." And I was like, "No one's ever told me this. I just assumed that's what you do." Until I discovered the little bit, that you get a syringe, it's steroid, job done. But obviously this is just for more the indwelling catheters.
If someone has a suprapubic catheter or if they have the catheter sheath over the top, or if they have the urostomy bag, then the way that you take your urine sample is going to be different because they might not have that little bit that you can take a sample from. You might just have to do it from the tap or the valve, but as long as you've got the urine sample, then hopefully that should be okay. But that's the only way to do it on some bags, unfortunately. But if you can take it from a more better way, like the little adjustment on the indwelling ones, then do that.
So I think that is it. It very much depends on your patient what's happening to them, if they're having surgery, if they've got a condition, things like that, to what types of bags they will have. So just find out what your patient is having and why just to get a little bit of background information and then you can adjust what you do to the catheter, if that makes sense. So you know when to change it, you know when to change the bag, you know how often to do it and all that jazz. I think that covered most of catheters and I've already covered how to do the fluid balance charts. And I hope that helped you in some way. So thanks everyone for watching. Until next time, I'll see you later.