Catheter Care, Wound Observation & Special Procedures
Key Takeaways
- Indwelling urinary catheter care includes cleaning meatal area with soap and water, securing tubing to prevent traction, keeping drainage bag below bladder level, and never pulling or kinking tubing.
- CNAs observe and report wound changes—new redness, drainage, odor, increased size, or exposed tissue—but do not perform sterile dressing changes unless specifically trained and delegated.
- Closed urinary drainage systems should remain closed; CNAs do not routinely disconnect tubing; report breaks in closed system immediately.
- Special procedures within CNA scope include applying clean dressings per protocol, colostomy bag emptying when trained, and post-mortem care under supervision.
- Catheter care and perineal care appear on the NNAAP skills list; critical steps include warm water, front-to-back cleansing, and privacy.
Quick Answer: Provide catheter care with soap and water, keep drainage bag below bladder, secure tubing, observe wounds and report changes—do not perform sterile dressing changes or irrigate catheters unless specifically delegated.
Indwelling Urinary Catheter Care
Catheters increase infection risk (CAUTI). CNAs maintain hygiene and drainage function.
| Principle | Application |
|---|---|
| Closed system | Do not disconnect routinely |
| Bag position | Below bladder; not on floor |
| No kinks | Tubing straight for flow |
| Secure tubing | Prevents urethral traction |
| Meatal cleaning | Soap and water; front-to-back on female |
Catheter Care Steps
- Explain; privacy; wash hands; gloves
- Position resident for exposure of meatus
- Clean around catheter at meatus with warm soapy water; rinse if policy
- Pat dry gently
- Check tubing secure; bag below bladder
- Empty bag measuring output if ordered; close port
- Remove gloves; hand hygiene; document
Never pull catheter or apply force.
Drainage Bag Emptying
- Clean drainage port with alcohol wipe per policy
- Drain into graduate without touching port to container
- Measure; record; close clamp
- Hand hygiene after
Night vs Day Bag Management
Some residents use a large night bag for uninterrupted sleep. Per policy, connect/disconnect only with nurse direction. Keep night bag below bladder level on bed frame—not on floor.
Wound Observation (Not Sterile Treatment)
CNAs are eyes at the bedside:
| Report Immediately | Examples |
|---|---|
| New open area | Skin breakdown |
| Increased drainage | Purulent, bloody |
| Odor | Foul smell |
| Redness spreading | Cellulitis signs |
| Sutures open | Dehiscence |
Sterile dressing changes are nursing unless you have specific competency documentation.
Pressure Injury Staging (Awareness)
| Stage | Description |
|---|---|
| 1 | Non-blanchable redness intact skin |
| 2 | Partial thickness loss |
| 3 | Full thickness |
| 4 | Tissue/bone exposed |
Do not stage officially unless trained—describe what you see objectively.
Wound Description Language
Report location, size estimate, color, drainage type/amount, odor, and pain. Example: "2 cm open area on left heel, pink wound bed, small serous drainage, no odor, resident reports pain 4/10."
Ostomy Awareness
When delegated, empty colostomy bag at 1/3–1/2 full; wipe outlet; check peristomal skin; report redness or leakage. Ileostomy output is liquid—different appliance care.
Post-Mortem Care
After death pronounced:
- Provide privacy and dignity
- Close eyes gently; clean body per policy
- Remove tubes per nursing direction
- Position limbs; identify belongings
- Emotional support for family
Prometric Skills Link
Perineal care and catheter care share principles: warm water, front-to-back on females, gloves, privacy, hand hygiene.
Suprapubic Catheter Awareness
Some residents have suprapubic catheters (surgically placed through abdomen). Cleaning around insertion site and securing tubing follow similar principles—never tug tubing; report redness or drainage at site.
Worked Scenario
Catheter tubing caught on bedrail when resident turns. First action?
Free tubing safely without pulling catheter; secure to leg/bed per policy; check for pain or bleeding; report traction injury signs.
Exam Traps
- Bag above bladder level
- Disconnecting drainage bag without order
- Applying antibiotic ointment inside wound without order
- Ignoring small stage 1 redness ("just a little pink")
- Irrigating Foley catheter without specific delegation
CAUTI Prevention in New York Facilities
Catheter-associated urinary tract infections (CAUTI) are tracked in NY nursing home quality data. CNA catheter care directly affects infection rates.
Daily Catheter Inspection Checklist
| Check | Action if Abnormal |
|---|---|
| Urine color/odor | Report cloudy, foul, or bloody urine |
| Tubing kinked | Straighten; ensure bag below bladder |
| Tension on meatus | Reposition securement; report pain |
| Bag volume | Empty before overfull; measure if ordered |
| Peristomal skin | Report redness at insertion site |
Closed Drainage System Rules
Do not disconnect the catheter from the drainage bag without a nurse order. Breaking the closed system introduces bacteria. If accidental disconnection occurs, report immediately—do not reconnect on your own.
Wound VAC and Advanced Dressings
Some residents have negative-pressure wound therapy or complex dressings. CNAs observe dressing integrity, report alarms or leakage, and do not change these devices unless specifically trained and delegated.
Hemovac and Jackson-Pratt Drains
When residents have surgical drains, CNAs may empty and measure output only when delegated. Record amount, color, and consistency. Report sudden increases or cessation of output.
Post-Mortem Care and NY Regulations
After physician pronounces death, CNAs provide post-mortem care per facility policy and resident/family cultural wishes. Tag belongings, maintain dignity, and allow family time. Emotional self-care after post-mortem care is part of professional practice.
Leg Bag vs Night Bag
Leg bags allow ambulation during day; switch to larger night bag for sleep per orders. Tubing length must prevent traction on catheter. Report urine color change after procedures or if output suddenly stops—possible obstruction.
Staging vs Describing Wounds
On exams, choose objective description over guessing stage if uncertain. "Red area 3 cm on sacrum, non-blanchable, skin intact" is safer than mislabeling Stage 2 when skin is intact.
Documenting Catheter Output
Record time, volume, and appearance when emptying bags on I&O. Sudden decrease to zero output may indicate kink, obstruction, or dehydration—report before next round. Never irrigate catheter unless specifically delegated with orders.
NY Exam Review Takeaway
Master the NYSDOH/Prometric decision rules for this topic: stay in scope, protect dignity, use standard precautions, and report changes to the licensed nurse before finishing non-urgent tasks. Practice until safe steps are automatic on skills day and written traps feel predictable.
When caring for a resident with an indwelling urinary catheter, the drainage bag should be kept:
A nurse aide notices purulent drainage and odor from a surgical wound. The appropriate action is:
During perineal or catheter care on a female resident, cleansing should be performed:
The nurse aide may empty a urinary drainage bag when: