Urinary catheters are indispensable medical devices utilized to manage urinary elimination when individuals are unable to void naturally. While catheters serve a crucial purpose, their use is not without potential complications, most notably catheter-associated urinary tract infections (CAUTIs). For nurses, accurate diagnosis and meticulous catheter care are paramount to ensuring patient safety and comfort. This article delves into the essential aspects of Catheter Care Nursing Diagnosis, providing a comprehensive guide for healthcare professionals.
Understanding Urinary Catheters and the Need for Care
Urinary catheters are tubes inserted into the bladder to drain urine. They are used in a variety of clinical situations, including:
- Urinary retention: Inability to empty the bladder.
- Incontinence: When other management methods have failed and it is impacting quality of life or skin integrity.
- Monitoring urine output: In critically ill patients.
- Post-surgery: Especially after procedures involving the urinary tract or nearby organs.
- Managing bladder irrigation: To clear blood clots or debris.
There are primarily two main types of urinary catheters:
- Indwelling Catheters (Foley Catheters): These catheters remain in place for continuous drainage and are held in position by a balloon inflated in the bladder.
- Intermittent Catheters (Straight Catheters): These catheters are inserted temporarily to drain the bladder and then removed.
Both types of catheters require diligent care to prevent complications. Poor catheter care can lead to various problems, with CAUTIs being the most significant and frequent.
Common Nursing Diagnoses Related to Catheter Care
When caring for patients with urinary catheters, nurses must be vigilant in identifying potential or actual problems. Several nursing diagnoses are commonly associated with catheter care:
1. Risk for Infection (Specifically, CAUTI)
This is arguably the most critical nursing diagnosis related to catheter care. The presence of a foreign body like a catheter in the urinary tract inherently increases the risk of bacterial entry and subsequent infection.
Risk Factors:
- Prolonged catheterization
- Breaks in the closed drainage system
- Poor perineal hygiene
- Female anatomy
- Older age
- Compromised immune system
Nursing Interventions:
- Strict aseptic technique during insertion: Using sterile equipment and maintaining a sterile field.
- Maintaining a closed drainage system: Ensuring all connections are secure and unbroken.
- Proper catheter securement: Preventing catheter movement and urethral irritation.
- Routine perineal care: Cleaning the perineal area with soap and water at least daily and after each bowel movement.
- Avoiding routine catheter changes: Changing catheters only when clinically indicated, not routinely.
- Ensuring unobstructed urine flow: Preventing kinks and ensuring the drainage bag is below the level of the bladder.
2. Impaired Urinary Elimination
While catheters are used to manage urinary elimination, problems can still arise that fall under this nursing diagnosis in the context of catheterization.
Related Factors (in catheterized patients):
- Catheter blockage (kinking, sediment, clots)
- Bladder spasms
- Constipation (affecting catheter drainage)
- Improper catheter size
- Complications from underlying conditions
Signs and Symptoms (in catheterized patients):
- Decreased or absent urine output in the drainage bag
- Bladder distention despite catheterization
- Patient report of bladder fullness or discomfort
- Leakage around the catheter
- Pain or spasms
Nursing Interventions:
- Assess catheter patency: Check for kinks, sediment, or clots.
- Irrigate the catheter if ordered: Using sterile saline and following facility policy.
- Ensure proper catheter size and placement: Verify catheter size is appropriate and positioned correctly.
- Manage bladder spasms: Administer antispasmodics as prescribed.
- Address constipation: Implement bowel management strategies.
- Monitor intake and output: Track urine output and fluid balance.
3. Impaired Skin Integrity
Indwelling urinary catheters can pose a risk to skin integrity, both at the insertion site and in the perineal area.
Related Factors:
- Pressure from the catheter and drainage tubing
- Moisture from urine leakage
- Allergic reaction to catheter material
- Friction and irritation from catheter movement
- Improper catheter securement
Signs and Symptoms:
- Redness, irritation, or breakdown at the urethral meatus
- Skin rash or allergic reaction
- Perineal skin maceration or breakdown
- Pain or discomfort at the insertion site
Nursing Interventions:
- Proper catheter securement: Use appropriate securement devices to minimize catheter movement and pressure.
- Regular skin assessment: Assess the urethral meatus and perineal skin for signs of irritation or breakdown.
- Meticulous perineal hygiene: Keep the perineal area clean and dry.
- Barrier creams or skin protectants: Apply as needed to protect the skin from moisture and irritation.
- Consider alternative catheter materials: If allergic reactions are suspected.
4. Pain
Pain associated with urinary catheters can arise from various sources.
Related Factors:
- Catheter insertion trauma
- Bladder spasms
- Urethral irritation
- Infection
- Catheter blockage
Signs and Symptoms:
- Patient report of pain during or after catheter insertion
- Complaints of bladder spasms or cramping
- Pain at the urethral meatus
- Pain with urination (if able to void around the catheter)
Nursing Interventions:
- Ensure gentle catheter insertion: Use adequate lubrication and proper technique.
- Administer pain medication as prescribed: For bladder spasms or general pain.
- Assess for and manage infection: Promptly address any signs of UTI.
- Ensure catheter patency: Blocked catheters can cause pain and bladder distention.
- Provide comfort measures: Warm compresses to the abdomen or perineum may help with spasms.
Assessment for Catheter Care Nursing Diagnoses
A comprehensive assessment is crucial for identifying and addressing catheter-related issues. Key assessment components include:
-
Patient History:
- Reason for catheterization
- Duration of catheter use
- Previous history of UTIs or catheter-related complications
- Underlying medical conditions
-
Physical Assessment:
- Urine: Color, odor, clarity, presence of sediment or clots.
- Catheter Insertion Site: Redness, swelling, drainage, pain, skin integrity.
- Abdomen: Bladder distention, tenderness.
- Vital Signs: Temperature, heart rate, blood pressure (especially if infection is suspected).
- Patient’s Report: Pain, discomfort, urgency, frequency, bladder spasms, changes in urine output.
-
Catheter Function Assessment:
- Drainage: Assess the amount, rate, and consistency of urine drainage.
- Patency: Check for kinks, obstructions, or sediment.
- Securement: Verify proper catheter securement to prevent movement and trauma.
-
Review of Medical Record:
- Medications (especially diuretics, anticholinergics, antibiotics)
- Laboratory results (urinalysis, urine culture if indicated)
- Urology consult notes if applicable
Nursing Interventions: Best Practices in Catheter Care
Effective catheter care involves a multifaceted approach focused on prevention, early detection, and prompt intervention. Key nursing interventions include:
- Adherence to Aseptic Technique: Crucial during catheter insertion and any manipulation of the drainage system.
- Maintaining a Closed Drainage System: Avoid disconnecting the catheter and drainage tubing unless absolutely necessary (e.g., catheter change).
- Proper Catheter Securement: Use appropriate securement devices to minimize urethral trauma and prevent accidental dislodgement.
- Routine Perineal Hygiene: Cleanse the perineal area daily and after each bowel movement with soap and water. Avoid harsh antiseptic solutions unless specifically ordered.
- Encouraging Fluid Intake (if not contraindicated): Adequate hydration helps to flush the bladder and reduce the risk of infection and sediment buildup.
- Avoiding Routine Catheter Changes: Change catheters only when clinically indicated, such as blockage, damage, or infection, rather than on a fixed schedule.
- Prompt Removal of Catheters When No Longer Necessary: Regularly assess the need for continued catheterization and remove the catheter as soon as clinically appropriate.
- Patient Education: Educate patients and caregivers on proper catheter care techniques, signs and symptoms of complications, and when to seek medical attention. For patients performing self-catheterization, ensure thorough teaching and competency demonstration.
Catheter Care Plan Example: Risk for Infection related to Indwelling Urinary Catheter
Nursing Diagnosis: Risk for Infection related to indwelling urinary catheter.
Expected Outcomes:
- Patient will remain free from signs and symptoms of urinary tract infection throughout catheter use.
- Patient (or caregiver) will demonstrate proper catheter care techniques.
Assessment:
- Assess risk factors for CAUTI: Prolonged catheterization, breaks in closed system, poor hygiene, etc.
- Monitor vital signs: Temperature, heart rate, blood pressure, respiratory rate.
- Observe urine: Color, odor, clarity.
- Assess catheter insertion site: Redness, drainage, pain.
- Evaluate patient’s (or caregiver’s) understanding of catheter care.
Interventions:
- Maintain sterile technique during catheter insertion and manipulation.
- Ensure closed urinary drainage system is intact.
- Secure catheter appropriately to prevent movement.
- Provide perineal care with soap and water daily and PRN.
- Encourage fluid intake (if not contraindicated) to 1500-2000 mL per day.
- Avoid routine catheter changes; change only when clinically indicated.
- Educate patient (or caregiver) on:
- Hand hygiene before and after catheter care.
- Proper perineal cleaning technique.
- Signs and symptoms of UTI to report.
- Importance of maintaining a closed drainage system.
- Monitor for signs and symptoms of UTI: Fever, chills, dysuria, cloudy urine, foul-smelling urine, flank pain.
- Report any signs of infection to the physician promptly.
Conclusion
Catheter care nursing diagnosis is an essential aspect of patient care for individuals requiring urinary catheters. By understanding the potential complications, particularly CAUTIs, and implementing evidence-based nursing interventions, nurses play a pivotal role in preventing infections, maintaining patient comfort, and promoting optimal urinary health. A proactive and diligent approach to catheter care, grounded in accurate nursing diagnosis, is fundamental to ensuring positive patient outcomes.
References
- Gould, C. V., Umscheid, C. A., Agarwal, R. K., Kuntz, G., Pegues, D. A., & Healthcare Infection Control Practices Advisory Committee. (2009). Guideline for prevention of catheter-associated urinary tract infections 2009. Infection Control & Hospital Epidemiology, 30(S3), S1-S116.
- Hinkle, J.L., & Cheever, K.H. (2018). Brunner & Suddarth’s textbook of medical-surgical nursing (14th ed.). Wolters Kluwer.
- NANDA International, Inc. (2018). Nursing diagnoses: Definitions and classification 2018-2020. Thieme.
- ренью, К. (2023, March 29). Urinary Catheter Care: Types, Management & Potential Problems. Nurse.org. https://nurse.org/education/urinary-catheter-care-management-potential-problems/
- Siddiqui, N. Y., & Ashraf, M. A. (2013). Catheter-associated urinary tract infections. Sultan Qaboos University Medical Journal, 13(3), 359–366.
