Catheter care in palliative care
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Urinary catheters are tubes that allow urine to pass from the bladder out of the body. They can help people with terminal illnesses who have problems passing urine, but there are risks of complications including infection and discomfort. It’s important to know how to look after catheters and how to reduce the risk of complications.
On this page:
How do catheters work?
Catheters work by allowing urine to drain from the bladder out of the body. The tubes are thin, flexible and hollow.
People may have a bag to collect the urine or they may have a valve on the catheter tube, which they open to pass urine into the toilet.
There are two main types of catheter – urethral and suprapubic. Which type someone has will depend on why they can’t pass urine in the usual way, why they need a catheter, how long they need it for and which type they would prefer.
Urethral catheters pass through the urethra into the bladder. They can be intermittent (temporary) or indwelling (in place for days or weeks). A suprapubic catheter is inserted into the bladder through a small cut in the person’s abdomen.
Different types of catheter
Intermittent urethral catheters (temporary)
People who use intermittent catheters usually insert the catheter themselves three to four times a day. A doctor or nurse will show them how to use the catheter and make sure they’re confident using it themselves.
When someone needs to empty their bladder, they pass a new intermittent catheter through the urethra into the bladder. Once the bladder is empty, they remove the catheter and throw it away.
The person should use a new catheter each time to reduce the risk of infection. They need to clean the area of skin around the entry point before inserting the catheter. Using lubricant makes it more comfortable to insert the catheter and reduces the risk of damage to the urethra.
Indwelling urethral catheters (in place for days or weeks)
These catheters pass through the urethra into the bladder. They are held in place by a small balloon, which is filled with sterile water.
A doctor, nurse or healthcare assistant with catheter training will insert an indwelling catheter, using aseptic technique to reduce the risk of infection. They will choose the most suitable type of catheter, taking into account the needs and wishes of the person having the catheter.
Suprapubic catheters
Suprapubic catheters are inserted by a doctor under general or local anaesthetic in hospital. A specialist nurse or district nurse can change the catheter in the community. They inserted into the bladder through a small cut in the person’s abdomen.
Suprapubic catheters aren’t suitable for everyone, but they may be used if urinary catheters aren’t effective or comfortable.
Why might someone have a catheter?
Someone may have a catheter if:
- they’re unable to pass urine (urinary retention)
- they have problems fully emptying their bladder
- the urethra is blocked
- urine leaks are causing skin problems
- urine leaks are causing distress
- they need help with continence problems and to prevent skin damage – only if other treatments have been tried first.
What are the risks of having a catheter?
There are several possible risks linked with having a catheter:
- They increase the risk of urinary tract infections (UTIs). Intermittent urethral catheters and suprapubic catheters have a lower risk of infection than indwelling urethral catheters.
- They can cause bladder spasms and urinary blockages.
- If someone is agitated or confused, they may try to remove the catheter themselves which can damage their skin and tissues and cause pain and bleeding.
- Some people may not be able to use intermittent catheters, for example if they have problems with their eyesight or with using their hands.
- Indwelling urinary catheters can be uncomfortable, causing some people to become distressed. If this happens, the catheter should be removed.
- Catheters can affect people’s body image, sex life and independence.
Contact the GP or district nurse if someone has any problems with their catheter.
Urinary tract infections (UTIs)
Inserting a catheter can introduce bacteria or other pathogens into urethra, bladder and kidneys. This is called a urinary tract infection (UTI).
Symptoms of a urinary tract infection may include:
- feeling unwell
- becoming agitated, confused or unusually tired
- a temperature of 38°c or higher, with or without uncontrollable shaking
- strong smelling, dark or cloudy urine
- blood in the urine
- new pain in the lower abdomen or back
- pain in the area where the catheter enters the body
- unusual discharge in the urine.
To minimise the risk of infection, catheters are inserted using aseptic technique. People will usually only have a catheter after other options have been tried, and they will have the catheter removed as soon as possible.
Bladder spasms
If the catheter irritates the bladder, the bladder can go into spasm. This can feel like stomach cramps and some urine may leak outside the catheter. If this happens, the person may need a smaller catheter size. Some people may benefit from medication, such as oxybutynin, to make the spasms less painful and less frequent.
Drainage problems and blockages
Some things can stop urine draining freely out of the catheter, such as:
- the position of the drainage bag – the bag should be below the level of the bladder
- urethral stricture (narrowing of the urethra) caused by inflammation or scar tissue
- bladder stones – these are more common in people with suprapubic catheters than with urinary catheters
- constipation putting pressure on the bladder – the GP or district nurse can suggest treatments for existing constipation.
Any blockages should be recorded in the person’s notes or catheter passport.
If someone has repeated blockages, they may need to have their catheter removed.
How are catheters managed?
The doctor, specialist nurse or district nurse will decide whether someone needs a catheter and how it should be managed, based on the person’s individual needs. They will only insert a catheter if there’s a medical reason and the benefits outweigh the risks.
You should follow any local guidelines on managing catheters. Many areas use the national catheter passport. The passport allows healthcare staff and carers to record details of catheter care, making it easier to share information between care services. It also contains useful information for the person with the catheter.
The person having the catheter should be involved in any discussions with the healthcare team. They may have a preference for how they’d like to manage urinary problems or for which type of catheter to have.
Looking after the catheter
You should follow national and local guidelines on managing catheters. The guidelines cover how to:
- monitor for signs of infection and other complications
- empty the drainage bag
- connect a new drainage bag
- connect a night bag.
Ask your manager if there’s any training you can attend to learn these skills.
How can I reduce the risk of infection and other complications?
There are national guidelines for managing catheters which aim to reduce the risks of infection and other complications associated with catheters. Royal College of Nursing guidelines and NICE guidelines recommend the following:
- wash your hands before and after touching the catheter
- wear a new pair of non-sterile gloves
- secure the drainage bag so it doesn’t put tension on the catheter
- position the drainage bag below the level of the person’s bladder – make sure it doesn’t touch the floor
- check that the catheter tube doesn’t have any loops or kinks and isn’t restricted by tight clothing
- wash the skin where the catheter enters the body (meatus) daily with unperfumed soap and water – women with a urethral catheter should wipe front to back and men should clean under the foreskin
- support the person to wash daily, with their drainage bag or valve attached
- clean the catheter tube from the body towards the bag or valve
- make sure the catheter is kept clean when the person opens their bowels, especially if they have bowel incontinence
- avoid using talcum powder
- don’t disconnect the drainage bag unless you’re replacing it with a new one
- don’t wash out the catheter with bladder maintenance solutions – this can increase the risk of infection.
If you drain the catheter into a container, make sure the valve or tap doesn’t touch the container and use a new container for each person.
Men using a urinary catheter should regularly move the leg bag to a different position to avoid the catheter tube causing injury to the penis.
Follow local guidelines on preventing infection. Many healthcare teams in England follow the epic3 guidelines.
When should I ask for help?
Contact the district nurse or GP if:
- the catheter falls out
- the catheter stops draining
- urine is leaking around the catheter
- there’s blood around the catheter or in the urine
- there are signs of infection
- the person develops a swollen abdomen
- the person is constipated.
If there are signs of infection, the doctor or nurse will use the catheter’s sampling port to take a urine sample. They will send the sample to the pathology laboratory to test for infection. They may put in a new catheter, prescribe antibiotics and advise the person to drink more fluids. They will record the symptoms and any treatment in the person’s notes or catheter passport.
The GP or district nurse can tell you who will be responsible for changing the catheter equipment, if you’re not trained to do it. They may also give you details of any local guidelines for catheter care.
Sharing experiences and watching other health professionals can help you continue learning about catheter care.
Sepsis
If someone has an infection that isn’t treated, they are at risk of sepsis, which is life threatening. Sepsis develops when the immune system over reacts to an infection and starts to attack the body’s tissues and organs. Symptoms can be vague and hard to spot but may include:
- a high (above 38°c) or low (below 36°c) temperature
- fast breathing or breathlessness
- a fast heartbeat
- confusion or not making sense
- not needing to pass urine as much as usual
- extreme shivering or muscle pain.
Symptoms can also include some or all of the following changes to their skin:
Blue skin
On lighter skin tones this can be seen on the skin, lips or tongue. On darker skin tones, a blue tinge may be easier to see on the lips, tongue, gums, under the nails or around the eyes.
Paleness (pallor)
This is often more easily seen in people with lighter skin tones. People with darker skin tones may look greyish, and you might see pallor on their palms, lips, gums, tongue, or nail beds.
In all skin tones, you can see pallor by pulling down the lower eyelid. The inside of the eyelid is normally dark pink or red, but will be pale pink or white if they have pallor.
Mottled skin
People with lighter skin tones may have skin that looks blotchy (has different colour patches). Mottling is harder to see on darker skin tones – it might look darker than normal, purple or brownish in colour.
Call 999 if someone has any of these symptoms and you think they may have sepsis. They don’t need to have all of the symptoms listed above.
Useful resources
NHS Improvement: Urinary Catheter Tools
Health Protection Scotland: Urinary Catheter Care Passport and Guidance for Use
Public Health Wales: Patient Urinary Catheter Passport
Key points
- A catheter will only be inserted if there’s a medical need and other treatment options haven’t worked.
- Catheters can be intermittent (temporary) or indwelling (usually kept in place for a few days or weeks).
- Having a catheter increases someone’s risk of a urinary tract infection.
- There are things you can do to reduce someone’s risk of infection, such as practising good hygiene when you’re handling catheter equipment.
- Contact the GP or district nurse if someone has any problems with their catheter.
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Disclaimer
This information is not intended to replace any training, national or local guidelines, or advice from other health or social care professionals.
The Palliative Care Knowledge Zone is not intended for use by people living with a terminal illness or their family and friends, who should access our information for the public.
