Catheter Bag Position

[Johnnyspud]

Tried searching for my answer, but couldn't find it.

I'm a CNA student completing my clinicals. We've been kicking this around in class. At one facility, the patients have leg bags for their catheters. These are not switched to bedside bags at night. When the patient is in bed, the drain bag either remains on their leg or is placed on the mattress (not hung off the bedside). Our instructor suggests this is poor practice and puts the patient at risk for improper drainage (and UTI's) as the bag is nearly level with the patient's bladder.

I asked the nurse at the facility why they didn't place the drain bag lower, especially at night. She said I had a good question and she didn't know the answer. That's the way we do it here.

Any thoughts?

[Be_Moore]

Often leg bags do not have as long of tubing connecting the catheter to the bag and to hook it to the side of a bed may cause tugging/pulling...wouldn't you hate to roll over in the middle of the night and feel a really nice tug? Could be the answer. If the tubing is sufficiently long that you can hang it on the side of the bed without a likely pulling situation, it should be.

[CathyLew]

most of the catheters we use have one way flow valves. The urine can not flow back to the bladder, even if the bag is raised above the bladder level...but if the bag is so gravety can have the urine flow....it doesn't flow. why don't they switch to a gravety bag at night? do they take the patients to empty the leg bags durring the night? Or do they just let them get full? (I know I have to get up at least once a night to pee.... and I can't imagine those leg bags holding much more than a bladder would.)

I wouldn't leave a leg bad on at night.

On the other hand, any time you disconnect and reconnect a catheter, it creates a chance for contamination. So switching bags can also add to the UTI picture. I have seen people disconect a leg bag, and put it in a bed pain in the patients bathroom...and then hook that same bag up in the morning! yikes! you need to use some common sence!

[Duranie]

Actually, you may not have to disconnect the legbag at all. If it is not the hard plastic, twist-to-open type, you can use a connector and tubing to attach it "in-line" to the night receptacle (bag or bottle, as the case may be) thus preserving the integrity of the system. I think it's COLOPLAST that recommends this method with their legbags.

I used this technique with my own urostomy for nearly 1 year. The bonus was being able to use a shorter length of extension tubing to reach the legbag, and being able to secure the various tubes exiting my body extremely well (with duoderm and tape) to avoid any inadvertant tugging or pulling. FWIW, personally, I preferred the bottle for overnight drainage.

I am now "tube-free", lol :yeah:Yay!!!

[BriWisco]

Everyone knows that the drainage bag should be in a position that is below the bladder. To me, this sounds like a case of laziness.

[pshs_2000]

check out this link from guidelines.gov. this site provides all kinds of evidence based recommendations for clinical practice. http://www.guidelines.gov/summary/summary.aspx?doc_id=12923&nbr=006637&string=catheter

ensure appropriate management of indwelling catheters

19. properly secure indwelling catheters after insertion to prevent movement and urethral traction. a-iii

20. maintain a sterile, continuously closed drainage system. a-i

21. disconnection of the catheter and drainage tube is prohibited unless the catheter must be irrigated. a-i

22. replace the collecting system using aseptic technique and after disinfecting the catheter-tubing junction when breaks in aseptic technique, disconnection, or leakage occur. b-iii

23. for examination of fresh urine, collect a small sample by aspirating urine from the sampling port with a sterile needle and syringe after cleansing the port with disinfectant transport urine specimens for culture promptly to the laboratory. a-iii

24. obtain larger volumes of urine for special analyses aseptically from the drainage bag. a-iii

25. maintain unobstructed urine flow. a-ii

26. empty the collecting bag regularly using a separate collecting container for each patient. avoid touching the draining spigot to the collecting container. a-ii

27. keep the collecting bag below the level of the bladder at all times. a-iii

28. cleaning of the meatal area with antiseptic solutions is unnecessary. routine hygiene is appropriate. a-i

29. to minimize cross-infection, avoid placing infected and uninfected patients with indwelling catheters in the same room or in adjacent beds. c-iii

a-iii means "evidence from opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees." and "good evidence to support a recommendation for use."

here's a link to some of their references: http://www.guidelines.gov/summary/select_ref.aspx?doc_id=12923

hope this helps!

[MichelleB34]

The bag should always be below the bladder. To eliminate the issue of tugging at our hospital we have a strap that we are supposed to use to secure the catheter to the leg. Also we are encouraged along with the doctors to eliminate the use of catheters whenever possible. I am not sure if it is a New York state mandate or a federal mandate but the hospital will no longer be reimbursed for UTI's that are related to foley catheters. In fact even prior to the mandate one of our orthopedic surgeons rarely if ever let his patients have foley catheters even for elderly patients with ORIF of the hip. It took a little getting used to but there were hardly ever any issues r/t the lack of a catheter. We would bladder scan the patients every 6 hours and if greater than 250 or 300 we would straight cath them.