The bladder catheters either hang from the urinary opening or protrude through the abdomen from surgical placement. These pose a significant risk of infection because the tubes provide a conduit for skin surface bacteria and viruses to enter the bladder. There is also the possibility of injury because the catheters remain in the bladder with fluid-filled balloons attached to the indwelling tip. This type of injury was covered in the section about restraints. Nurses are educated to be aware of these latent problems and provide preventive measures that include using disinfectant solution for catheter care and taping the catheter to the leg to prevent accidental pulling.
||Problem Identification (Nursing Diagnosis)
|Follow-up and Outcome|
||Risk of urinary tract infection due to indwelling bladder catheter (Foley)
||No urinary tract infection
||Catheter care with antibacterial soap, water, and application of Betadine ointment at meatus every 8 hours
Urine clear and yellow, no sign of infection
||Risk of urinary tract injury due to presence of bladder catheter
||No urinary tract injury
||Keep catheter secured to inner thigh with tape. Teach patient that catheter can cause urge to urinate,and be a source of irritation. Remind patient periodically that the catheter is there.
Catheter intact. No sign of injury
Additionally, it is important to realize that the presence of a bladder catheter can be very irritating, causing the constant feeling of having to urinate. There is often a risk of critically ill patients becoming confused and yanking out the tube to get rid of the source of irritation. I have reviewed a number of cases resulting in major damage to the urinary tract requiring a permanent urine tube placed through the lower abdominal wall. To nurses and physicians, bladder catheters are commonplace. Thus you would increase your safety if you remind them of the measures to prevent injury. The best way to do this is to ask to see the nursing care plan. It should look something like the sample on the table above.
Asking nurses to show and go over their care plans with you as a patient or family member may throw them off balance and cause a negative response because they are not accustomed to client scrutiny. The best way to respond to such a reaction is to reassure the nurse, "I am not questioning your competence, but 1 am going to exercise my right to participate in my care (the care of my husband, wife, father, mother, sister, brother, child, etc.). Therefore, I must go over the nursing care plan for preventing the common complications of bladder catheters" (nurses commonly use the term Foley catheters).