9.4 Elimination, Catheter Care & Bedpan

Elimination Care on the Wisconsin CNA Exam

Elimination assistance is intimate, infection-sensitive, and heavily skills-tested. Wisconsin Headmaster tasks include Bedpan (Modified) + Hand Washing, Female Catheter Care + Hand Washing, and Isolation Gown/Gloves; Empty Urinary Bag; Measure/Record Output; Doff + Hand Washing. Knowledge questions cover normal vs abnormal urine, privacy, catheter safety, and when to report.

Residents may feel embarrassed asking for a bedpan. Answer call lights quickly for toileting needs—delayed response is a common contributor to falls and incontinence episodes. Offer help proactively for residents who cannot request assistance clearly.

Normal Elimination Observations

CNAs do not diagnose, but they collect objective data:

Blood in urine (hematuria), pain with urination, fever with urinary symptoms, and catheter bypassing (leaking around the tube) are classic report-now findings.

Bedpan (Modified) with Hand Washing

The modified bedpan skill tests whether you can help a resident use a bedpan safely while protecting privacy and finishing with proper hand washing.

Teaching Sequence

1. Knock, introduce, explain, and provide privacy (curtain/door).
2. Wash hands; gather bedpan, protective pad, toilet paper, wipes, gloves as required.
3. Lower the head of the bed as needed for placement; help the resident flex knees and lift hips (or log-roll if that is the safe method for that person).
4. Place the bedpan correctly (standard or fracture pan orientation per type); avoid skin trauma.
5. Cover the resident; raise the head of the bed if allowed for a more natural voiding position.
6. Place toilet paper and call light within reach; leave only if safe and instruct the resident to call when finished—follow handbook timing/rules for remaining vs stepping away.
7. When finished, remove the bedpan carefully to avoid spills; assist with peri cleaning front to back if the resident cannot; remove gloves; help with hand hygiene for the resident.
8. Empty contents into toilet (observe characteristics), rinse bedpan per procedure, remove PPE, wash hands as required by the skill.
9. Leave the resident clean, dry, covered, comfortable, with call light in reach; report observations.

Dignity and Comfort Tips

• Warm a metal bedpan with warm water if facility practice allows (dry it before placement).
• Never leave a resident on a bedpan longer than necessary—pressure injury risk and pain increase.
• Do not place the call light out of reach “so they won’t bother you.”
• Talk the resident through each step; keep your voice private and calm.

Fracture pans are thinner and often used after hip surgery or when lifting is limited; the thin end usually slides under the buttocks with the handle toward the feet—confirm the exact orientation taught in your program and handbook.

Indwelling Urinary Catheters: CNA Role

An indwelling (Foley) catheter drains urine continuously into a closed bag. CNAs do not insert or remove catheters in standard CNA scope; they provide catheter care, position tubing safely, empty bags, and observe.

Safety Rules for Tubing and Bags

• Keep the drainage bag below bladder level at all times so urine does not flow backward.
• Do not let the bag touch the floor.
• Avoid kinks and dependent loops of tubing that trap urine.
• Secure tubing per facility method so the catheter is not pulled when the resident moves.
• Maintain a closed system—do not disconnect tubing from the bag to “drain faster.”
• When moving the resident, move the bag carefully; never raise the bag above the bladder.

Female Catheter Care with Hand Washing

Wisconsin’s Female Catheter Care + Hand Washing skill focuses on cleaning the meatus and catheter to reduce infection risk without causing trauma.

Core Technique Principles

1. Provide privacy; explain; position safely; wash hands; apply gloves.
2. Use clean water/soap or facility cleanser as directed; check water temperature if a basin is used.
3. Hold the catheter near the meatus to prevent accidental tugging/traction while cleaning.
4. Clean the meatus area and catheter, wiping away from the meatus (down the catheter) so organisms are not pushed into the urethra.
5. Use a clean portion of the cloth for each stroke; avoid harsh scrubbing of delicate tissue.
6. Rinse if required; pat dry—moisture under the catheter site promotes skin breakdown and bacterial growth.
7. Ensure tubing remains patent and bag position correct after care.
8. Remove gloves and perform hand washing as scored on the WI skill.
9. Leave the resident comfortable and covered; report drainage, odor, redness, or resident pain.

Catheter-associated urinary tract infection (CAUTI) prevention is a facility priority. Your careful peri/catheter care and bag handling are frontline defenses.

Emptying the Urinary Drainage Bag; Measure and Record

Emptying is often paired with isolation PPE skills on the WI exam. Teaching principles:

Measure Like It Matters

1. Gather a clean graduate (measuring container), gloves, and alcohol wipe if policy requires cleaning the drain port.
2. Place the graduate on a barrier on the floor or low surface—do not contaminate the drain tip by letting it touch the graduate rim or floor.
3. Open the drain, empty completely, close the clamp/port securely.
4. Wipe the port if required; keep the system closed.
5. Read the amount at eye level in mL; record on the facility form with time and resident identifiers as directed.
6. Empty the graduate into the toilet; clean equipment; remove PPE and wash hands per the skill sequence.
7. Report unusual color, cloudiness, blood, or unexpectedly low/high volumes.

Accuracy matters for fluid balance decisions. Estimate is not acceptable when a graduate is available and measurement is ordered.

Isolation Context (Awareness)

When the skill combines isolation gown/gloves with bag emptying, remember donning order, keeping clean vs dirty technique while measuring, then doffing and hand washing without contaminating yourself or the environment. (PPE sequence detail is reinforced in the Infection Control chapter; apply those habits here.)

Privacy, Dignity, and Communication

Elimination care fails ethically when staff:

• Leave doors open or discuss bowel/bladder status loudly in hallways
• Show disgust through facial expression or comments
• Rush so fast the resident cannot relax enough to void
• Shame incontinence (“You had an accident again?”)

Instead, use neutral language (“I’ll help you with the bedpan”), clean promptly after incontinence, and protect odor control with proper bagging of waste—not with scolding. Incontinence is a clinical issue, not a character flaw.

Common Complications to Report

• No urine in the bag for a prolonged period when continuous drainage is expected (possible obstruction, kink, or oliguria)
• Bladder distention, restlessness, or leaking around the catheter
• Bloody urine, sediment blocking the tubing, or foul cloudy urine
• Pain at the urethra, bleeding at the meatus, or new confusion (infection clue in older adults)
• Resident pulling at the catheter (safety risk—report for nursing interventions)

Skills Exam Mindset for Elimination Tasks

Evaluators watch for:

• Privacy curtain before exposure
• Gentle placement and removal of the bedpan
• Cleaning direction and catheter stabilization during catheter care
• Drain tip not contaminated during bag emptying
• Correct measurement and recording when required
• Complete hand washing when the skill includes it—do not skip fingers, nails, or required timing

If you drop a clean item on the floor, replace it; do not “save time” with contaminated supplies. Infection control points often decide pass vs fail on these tasks.

Connecting Elimination to the Whole Resident

Poor intake reduces urine output; immobility and pain meds slow bowels; antibiotics may cause diarrhea. Your elimination observations complete the picture started in nutrition and mobility chapters. Chart facts, report changes, and protect dignity every time you answer a toileting call light.

Master bedpan assistance, catheter care directionality, closed-system bag emptying, and reportable urine changes—and you will handle both the knowledge items and some of the most frequently assigned Wisconsin skills with confidence.