Your father is coming home from the hospital tomorrow with a catheter. The nurse showed you how to empty the bag once, quickly, at the end of her shift. Now you're wondering how to clean it, what's normal, and what to do at 2 a.m. if it stops draining.
Here's a practical guide to catheter care at home.
Why a parent may have a catheter
An indwelling catheter is a tube inside the bladder that drains urine into a bag outside the body1. Common reasons include urinary incontinence, urinary retention (not being able to urinate), surgery that made a catheter necessary, or other health problems1. Some older adults need one for a few days or weeks after surgery; others use one long term, for example with an enlarged prostate, nerve damage, or wounds that need to stay dry.
Ask the doctor why the catheter is needed and how long it should stay. Catheters left in longer than necessary raise the risk of infection, so it's fair to ask at each visit whether it can come out. If incontinence is the reason, other options may exist; see incontinence in the elderly.
Daily skin care
Make catheter and skin care part of the daily routine1. Supplies include two clean washcloths, two clean towels, mild soap, warm water and a clean container or sink1. Once a day, or more often if needed, wash hands well, then gently wash all around where the catheter goes in with a soapy washcloth; for women, wipe front to back, and for men, from the tip of the penis downward1. Rinse, then wash the upper legs and buttocks, rinse and pat dry1.
Don't use creams, powders or sprays near the area1. Older skin is fragile, so be gentle and watch for redness or sores. See skin tears in the elderly and bed sores in the elderly.
Cleaning the catheter tube
Twice a day, clean the catheter itself to keep germs away1. Wash hands, use fresh warm water and the second soapy washcloth, gently hold the catheter, and wash starting at the end near the body, moving slowly down the tube away from the body1. Never clean from the bottom of the catheter toward the body1. Dry the tubing with the second clean towel1.
The catheter is attached to the inner thigh with a fastening device, which keeps it from pulling1. Check that it's secure, and move its position slightly from time to time so the skin underneath doesn't get sore. A catheter that's pulled or tugged can cause pain, bleeding or damage.
Leg bags and night bags
Many people use two bags: a small leg bag during the day and a larger bedside bag overnight1. The leg bag straps to the thigh with Velcro or elastic and can be hidden under clothing2. Always keep the bag lower than the bladder so urine doesn't flow back2. Try not to disconnect the catheter from the bag more than necessary, since keeping it connected works better1.
Empty the bag into the toilet at least two or three times a day, or when it's a third to half full2. Wash hands, keep the bag below the hip, open the spout over the toilet without letting it touch the rim, clean the spout with rubbing alcohol on a cotton ball or gauze, close it tightly, and wash hands again2. Never put the bag on the floor2. At night, hang the bedside bag on the bed frame below mattress level.
Changing and cleaning bags
Change the bag once or twice a month, or sooner if it smells bad or looks dirty2. When switching bags, don't let the tube end or bag opening touch anything, and clean both with rubbing alcohol2. Clean the bedside bag each morning and the leg bag each night before switching2. Soak the used bag for 20 minutes in a solution of 2 parts white vinegar to 3 parts water, or about 1 tablespoon of bleach in half a cup of water, then hang to dry with the spout down2.
The catheter itself is usually changed by a nurse or doctor on a schedule. Ask how often and who will do it.
Keeping urine flowing
Check the catheter and bag throughout the day1. Look for kinks and move the tubing if it isn't draining1. Encourage plenty of water during the day to keep urine flowing, unless the doctor has limited fluids1. Constipation can press on the catheter and block drainage, so watch bowel habits; see constipation in the elderly. Avoid physical activity for a week or two after the catheter is placed1.
If the bag hasn't filled in a few hours, check for kinks, make sure the bag is below the bladder, and that your parent isn't lying on the tube. If it still isn't draining, or your parent has lower belly pain or fullness, call the doctor or home health nurse right away.
Infection: the biggest risk
A urinary tract infection is the most common problem for people with an indwelling catheter1. Call the provider for signs such as pain in the sides or lower back; urine that smells bad, is cloudy or changes color; fever or chills; burning or pain in the bladder or pelvis; discharge around the catheter; or not feeling like oneself, with tiredness, achiness and trouble focusing1.
In older adults, a UTI may show up mainly as sudden confusion, agitation, falls or weakness, with few urinary symptoms. Don't dismiss a sudden change in thinking. Untreated infections can spread to the bloodstream. See UTIs in the elderly, delirium and sepsis in the elderly.
Other reasons to call
Also contact the provider if the bag fills up quickly with more urine than usual, urine leaks around the catheter, there's blood in the urine, the catheter seems blocked, there's grit or stones in the urine, or there's pain near the catheter1. Call too if you're unsure how to attach, clean or empty the bag, if the bag fills too fast or not at all, or if there's a skin rash or sores2. Keep the home health or urology phone number, including after-hours, on the fridge.
Getting hands-on help
You don't have to learn everything from a rushed hospital lesson. Before discharge, ask the nurse to watch you do each step, and ask for written instructions and supplies to start. If your parent qualifies, Medicare home health care can send a nurse to teach catheter care and change the catheter; see does Medicare pay for home health care and hospital discharge planning.
Medicare Part B covers some prosthetic devices and supplies, including urological supplies, for people who qualify3. Ask the doctor to order supplies from a Medicare-enrolled supplier.
Comfort and dignity
Many older adults feel embarrassed about a catheter. Let your parent do as much as they safely can, and offer privacy. A leg bag under loose pants helps them move around and stay social. A son caring for his mother, or a daughter for her father, may both feel more comfortable with a nurse or aide handling intimate care; that's a reasonable choice. See companion care and caregiver burnout.
Catheters and dementia
People living with dementia may pull at the catheter because they don't understand why it's there, which can cause injury. Secure the tubing well, route it under clothing, and offer something for restless hands. Ask the doctor whether the catheter is truly needed, and whether alternatives such as a scheduled toileting routine could work. Check for UTI signs closely, since your parent may not be able to describe symptoms.
Other kinds of catheters
An indwelling (Foley) catheter isn't the only option. With intermittent catheterization, a thin tube is inserted to drain the bladder several times a day and then removed, which lowers infection risk for some people but takes steady hands or a trained helper. External catheters fit over the penis like a sheath, or sit against the body for women, and drain into a bag without entering the bladder; they can work for incontinence when the bladder empties on its own. A suprapubic catheter goes into the bladder through the belly and may be more comfortable long term. Ask the urologist which fits your parent's condition, abilities and skin.
Bathing, clothing and getting out
Ask the doctor or nurse whether your parent can shower with the catheter in place; many people can, with the bag kept below the bladder and the tubing secured. Loose pants, skirts or dresses make a leg bag easier to wear and hide2. When going out, bring a spare leg bag, alcohol pads and a change of clothes. Plan bag emptying around outings and car rides, and keep the bag below the bladder when sitting in the car.
Supplies to keep on hand
Keep a small stock: spare leg and night bags, catheter securement devices, alcohol pads or rubbing alcohol and gauze, mild soap, washcloths and towels, gloves for helpers, white vinegar for cleaning bags, and a written list of the catheter size and type. Reorder before you run low, especially before weekends and holidays.
An example
When Marcus's father came home with a catheter after prostate surgery, a home health nurse visited the next day. She watched Marcus clean the tube, showed him how to switch to the night bag, and left a checklist. Marcus set a routine: skin care after breakfast, tube cleaning morning and evening, emptying the leg bag at lunch and dinner. When his father became suddenly confused one afternoon, Marcus called the nurse, who arranged a urine test; it was an infection, treated early. This is an illustration.
