Urinary catheter maintenance is the care of indwelling urethral or suprapubic urinary catheter systems.

National evidence-based guidelines provide recommendations for preventing infections associated with the insertion and maintenance of urinary catheters. The epic guidelines cover short-term indwelling urinary catheters in acute care, and the NICE guidelines cover long-term urinary catheters in primary and community care. A Scottish best practice statement on urinary catheterisation and catheter care is also available.

These guidelines state that maintaining a sterile, continuously closed urinary drainage system is central to preventing infection.

In summary, these guidelines make the following recommendations regarding urinary catheter maintenance:

• connect indwelling urethral catheters to a sterile, closed urinary drainage system, or catheter valve if appropriate
• ensure that the connection between the catheter and the urinary drainage bag is not broken, except for good clinical reasons (e.g. changing the bag in accordance with the manufacturer’s instructions)
• decontaminate hands and put on a pair of clean, non-sterile gloves before manipulating a catheter, and decontaminate hands after removing gloves
• obtain urine samples from a sampling port using an aseptic technique. Collect urine samples only for a valid reason (e.g. suspected infection), not routinely
• position urinary drainage bags below the level of the bladder on a stand that prevents contact with the floor
• empty the drainage bag frequently enough to maintain urine flow and prevent reflux. Use a separate clean container for each patient and avoid contact between the urinary drainage tap and the container
• change urinary bags when clinically indicated and according to the manufacturer’s instructions
• change catheters only when clinically necessary (remembering the use of long-term catheters where appropriate) or according to the manufacturer’s recommendations (not as part of routine practice)
• antibiotic prophylaxis should only be prescribed for catheterised patients who have a history of catheter-associated UTI following catheter change, and patients with a heart valve lesion, septal defect, patent ductus or prosthetic valve
• for patients with suprapubic catheters, treat insertion sites as surgical wounds until healed
• document all catheter care in the patient’s records
• regularly review the patient’s clinical need for continuing urinary catheterisation and remove the catheter as soon as possible.

Always follow the manufacturer’s instructions and adhere to local procedures and policies.

Use a sterile, closed urinary drainage system or catheter valve, if appropriate. Regularly review the patient’s clinical need for continuing urinary catheterisation and remove the catheter as soon as possible.

When emptying catheter bags, use a separate clean container for each patient and sterilise this after each use. Single-use plastic jugs, disposable paper-pulp jugs or urinals can be used. Emptying multiple catheter bags into a single container is unacceptable, as it greatly increases the risk of cross contamination.

Always follow the manufacturer’s instructions and adhere to local procedures and policies.

Catheter maintenance solutions are prescription only medication (POM) and should therefore be treated in the same way. They should be prescribed on an individual patient basis and are available in the Nurse Prescribing Formulary. The patient should always be informed about the treatment and should have given consent to receive the treatment.

There is no indication for prophylactic use of catheter maintenance solutions and the aim is to decrease and stop washouts as soon as possible. (see Bladder management)

Maintenance solutions include:

• normal saline
• solution G (3.23% citric acid, also known as Suby G)
• solution R (6% solution of citric acid)
• chlorhexidine 0.02%
• mandelic acid 1%.

Manufacturers recommend that their solutions are used in one or more of the following ways:

• daily washouts for heavily encrusted catheters, reduced to a weekly maintenance once an acute episode of blocking has subsided
• closed drainage system is changed after every treatment
• daily washouts should be used for a limited time no longer than 1 to 2 weeks
• weekly washouts should be co-ordinated with the changing of the drainage system
• where maintenance regimens don’t appear to be effective, their use should be reassessed and more frequent catheter changes considered.

Select personal protective equipment, such as aprons and gloves, following assessment of the level of risk associated with the catheter care procedure.

Refer to the Decontamination module for more information on decontamination of urine jugs and catheter stands, and disposal of urinary catheters and catheter bags.

Always follow the manufacturer’s instructions and adhere to local procedures and policies.

Effective hand decontamination is vital to control the spread of infections. Choose an appropriate method of hand decontamination for the procedure, according to your local policy. Refer to Hand Decontamination for further guidance.

The Department of Health has published the ‘essential steps to safe, clean care’. This is a delivery programme which aims to reduce healthcare associated infections, including MRSA. The ‘essential steps’ programme provides tools and guidance to support different organisations and settings, including residential and nursing homes, as they work towards reducing and eradicating healthcare associated infections. Click here for more information on the ‘essential steps’ programme.

As part of the ‘essential steps to safe, clean care’ programme, the Department of Health has launched a specific step relating to urinary catheter care. The aim of this document is to reduce the risk of infection associated with urinary catheters. Please click here for further information.

As part of the same series, the Department of Health has also launched a specific step relating to preventing the spread of infection. The aim of this document is to reduce the risk of microbial contamination in everyday practice and to ensure there is a managed environment that minimises the risk of infection to patients, clients, staff and visitor. Please click here for further information.