11.2 Catheter Care and Drainage Bag Management (INACE Skill)

Catheter Care on the INACE Skills Evaluation

Emptying the urinary drainage bag and measuring output is one of the mandated performance skills you may be assigned during the INACE manual-skills portion. An indwelling urinary catheter (also called a Foley catheter) is a flexible tube held in the bladder by a small water-filled balloon; it drains urine continuously through tubing into a collection bag. CNAs do not insert, remove, or irrigate catheters — those are licensed-nurse tasks — but you are responsible for daily perineal/catheter hygiene, drainage-bag management, observation, and reporting.

Types of Urinary Catheters

The Five Core Catheter Rules

Memorize these — they translate directly into exam answer choices and skills-checklist steps:

1. Keep the closed system closed. Never disconnect the catheter from the drainage tubing; every break invites bacteria and UTI.
2. Bag below the bladder, always. Gravity drains urine; raising the bag above bladder level lets urine flow backward (reflux) into the bladder.
3. Bag off the floor. A bag touching the floor is contaminated.
4. Tubing free and secured. Anchor the tubing to the inner thigh with the leg strap or tape; keep it uncoiled, unkinked, and not trapped under the resident.
5. Daily hygiene. Provide perineal care and clean about 4 inches of catheter from the insertion site outward (away from the body) with soap and water during the bath.

Emptying the Drainage Bag — Step by Step (INACE Skill)

1. Wash hands; apply clean gloves; provide privacy.
2. Place a clean graduate (measuring container) on a paper towel under the drain spout.
3. Open the spout/clamp at the bottom of the bag.
4. Let urine drain fully into the graduate; do not let the spout tip touch the graduate, the floor, your gloves, or any surface.
5. Close and re-clamp the spout, then return it to its sleeve on the bag.
6. Measure at eye level on a flat surface for accuracy.
7. Note color, clarity, and odor.
8. Discard urine in the toilet, rinse the graduate, and store it per facility policy.
9. Remove gloves, wash hands, and record the amount on the I&O sheet.
10. Report any abnormal findings to the nurse.

Empty the bag when it is about two-thirds full or at least every 8 hours / once a shift; a bag allowed to overfill causes backflow and breaks the gravity drainage.

DO and DO NOT

Recognizing Problems — Report Immediately

Catheter-associated UTI (CAUTI) is the single most common health-care-associated infection tied to catheters, which is exactly why the closed-system and bag-position rules carry so much exam weight.

Worked Scenario: No Output During a Transfer

You are moving Mr. Davis to a wheelchair and notice the bag held no new urine in 4 hours. Correct sequence: keep the bag below bladder level, then first check for a kinked, coiled, or compressed tube and verify the bag is not clamped; if flow does not resume, report to the nurse immediately. Never disconnect or irrigate to "restart" it. During the transfer itself, secure the tubing, clamp briefly only if the bag must rise above the bladder, then lower it again at once and keep it clear of the wheelchair wheels and bed rails.

Daily Catheter Hygiene Procedure

During the bath or peri-care, hygiene around the catheter prevents CAUTI and is a checklist favorite:

1. Wash hands, apply gloves, provide privacy, and explain the procedure.
2. Expose only the perineal area; keep the rest of the resident covered for dignity.
3. For a female, separate the labia; for an uncircumcised male, retract the foreskin gently, then replace it afterward.
4. Using a clean washcloth with soap and warm water, clean the perineum first, then clean the catheter starting at the insertion site and moving outward about 4 inches — never wipe back toward the body.
5. Use a fresh section of cloth for each stroke so you never drag bacteria toward the urethra.
6. Rinse, pat dry, re-secure the tubing to the inner thigh, remove gloves, and wash hands.

External (Condom) Catheter Notes

Unlike a Foley, a condom catheter is non-invasive, so the CNA may apply it per facility training. Roll the sheath on, leaving about 1 inch of space between the tip of the penis and the end of the catheter, and secure it with the manufacturer's strip — never with regular adhesive tape, which does not stretch and can cut off circulation. Check the skin every shift for redness, swelling, or color change distal to the device, and remove and replace it daily. Because it is external, infection risk is lower than with an indwelling catheter, but skin breakdown from constriction is the main hazard to watch for and report.

Common traps: an indwelling catheter is held by a balloon, not by tape; the bag goes below the bladder even during sleep and transport; you clamp briefly only when the bag must temporarily rise; and any pink-to-brown urine, absence of output, fever, or leaking around the site is a report-to-nurse finding, not something to monitor silently.