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 (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?
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B
C
D