11.2 Catheter Care and Drainage Bag Management (INACE Skill)
Key Takeaways
- Drainage bag must always be below bladder level but never on the floor
- NEVER disconnect the catheter from the drainage tubing — maintain the closed system
- Empty the bag when 2/3 full or at least every 8 hours using sterile technique
- Do not let the spout tip touch the graduate, your hands, or any surface when emptying
- Report cloudy urine, foul odor, blood, no output, or leaking immediately
- Secure tubing to the inner thigh to prevent pulling; check for kinks regularly
Last updated: March 2026
Catheter Care and Drainage Bag Management (INACE Skill)
Catheter care (emptying the drainage bag) is one of the 21 mandated INACE performance skills. An indwelling urinary catheter (also called a Foley catheter) is a tube inserted into the bladder to drain urine continuously into a collection bag. While CNAs do not insert or remove catheters, you are responsible for daily catheter care and drainage bag management.
Types of Urinary Catheters
| Type | Description | CNA Role |
|---|---|---|
| Indwelling (Foley) | Stays in the bladder continuously; held by a balloon | Daily catheter care; empty drainage bag |
| External (Condom) | Fits over the penis externally; for male incontinence | Apply per training; empty drainage bag |
| Intermittent (Straight) | Inserted and removed for single drainage | Nurse performs; CNA may assist |
Indwelling Catheter Care Principles
| Principle | Details |
|---|---|
| Closed system | NEVER disconnect the catheter from the drainage tubing |
| Below bladder | The drainage bag must ALWAYS be below the level of the bladder |
| Off the floor | The bag must never touch the floor (contamination risk) |
| Secured tubing | Tape or secure the tubing to the inner thigh to prevent pulling |
| Free-flowing | Ensure the tubing is not kinked, coiled, or under the resident |
| Daily catheter care | Clean the area where the catheter enters the body daily |
| Handwashing | Wash hands before and after any catheter care |
Emptying the Drainage Bag (INACE Skill)
- Wash hands and apply gloves
- Place the graduate (measuring container) under the drainage bag spout
- Open the spout/clamp at the bottom of the drainage bag
- Allow urine to drain completely into the graduate — do not touch the tip of the spout to the graduate or any surface
- Close the spout securely
- Measure the output at eye level using the markings on the graduate
- Record the amount on the I&O sheet
- Note the color, clarity, and odor of the urine
- Empty the graduate into the toilet
- Rinse the graduate with cold water
- Remove gloves and wash hands
- Report abnormal findings to the nurse
Critical Catheter Care Rules
| DO | DO NOT |
|---|---|
| Keep the bag below the bladder level at all times | Let the bag rest on the floor |
| Secure the tubing to prevent pulling | Disconnect the catheter from the tubing |
| Provide daily perineal care around the catheter insertion site | Pull or tug on the catheter |
| Empty the bag when it is 2/3 full or at least every 8 hours | Allow the bag to become completely full (causes backflow) |
| Report any changes in urine color, amount, or odor | Raise the bag above the bladder during transfers (clamp if needed briefly) |
| Observe for signs of infection | Irrigate the catheter (nurse responsibility) |
Signs of Catheter-Related Problems — Report Immediately
| Problem | Signs |
|---|---|
| Urinary tract infection | Cloudy urine, foul odor, fever, pain, blood in urine |
| Obstruction | No urine output, distended bladder, resident complaints of pressure |
| Leaking | Urine leaking around the catheter insertion site |
| Displacement | Catheter pulled out partially or completely |
| Skin irritation | Redness, swelling, or breakdown at the insertion site |
| Blood in urine (hematuria) | Pink, red, or brown urine in the drainage bag |
Catheter Care During Transfers
When transferring a catheterized resident:
- Secure the tubing so it does not pull during the transfer
- Keep the bag below the bladder level throughout
- If the bag must be temporarily elevated (e.g., getting into a wheelchair), clamp the tubing briefly
- Reposition the bag below bladder level immediately after the transfer
- Ensure tubing is not caught in wheelchair wheels or bed rails
Test Your Knowledge
Where must the catheter drainage bag be positioned at all times?
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Test Your Knowledge
When emptying a catheter drainage bag, what should you be careful NOT to do?
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B
C
D
Test Your Knowledge
You notice that a catheterized resident has not produced any urine output in the last 4 hours. What should you do?
A
B
C
D