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This article describes how to safely remove the indwelling urinary catheter and ensure good care of the patient before, during and after the operation

This article is the last part of our six-part series on urinary catheters. It discusses how to remove an indwelling urinary catheter, as well as patient care before, during, and after surgery.

Citation: Yates A (2017) Urinary Catheter 6: Remove the indwelling urinary catheter. Nursing time [online]; 113: 6, 33-35.

Author: Ann Yates is the Director of Incontinence Services for Cardiff and Vale University Health Committee.

Catheterization is associated with many complications, including catheter-related urinary tract infection (CAUTI), tissue damage, and bypass and obstruction. The risk of complications means that the catheter can only be used after consideration of other incontinence management options and should be removed as soon as clinically appropriate (Loveday et al., 2014).

It is important to understand the reason for the removal and whether the catheter was permanently removed or was removed in a planned or unplanned change due to a problem encountered by the patient (such as a blocked catheter). The procedure differs depending on whether the insertion site is the urethra or suprapubic bone.

Removal of the urinary catheter should be a simple and uncomplicated process, but with recognized capabilities. The nurse who removes the catheter must pay attention to:

The Foley catheter has an inflatable balloon that holds the catheter in the bladder. The catheter has two channels-one for urination and the other for inflating and deflating the balloon.

The balloon is inflated with sterile water/or liquid in a syringe provided by the manufacturer. A syringe connected to a valve on the catheter is usually used to insert and remove water.

The size of the balloons varies, but adults usually need 5-10 ml balloons. Always check the manufacturer's instructions. Balloons cannot be overinflated because they will burst and leave debris in the bladder (Dougherty and Lister, 2015).

Patients may feel anxious about the pain and discomfort during the operation and urination afterwards. Especially those who have failed previous trials without a catheter may worry about independent urination. Some people may also worry about bladder control and urinary incontinence. If the catheter has been placed for a long time, these concerns may be exacerbated.

The nurse needs to discuss the surgical procedure and possible complications after the catheter is removed with the patient (Royal College of Nursing, 2012). They should also make sure that patients know who to contact if they encounter problems. Box 2 lists possible complications after the catheter is removed.

Box 2. Complications after catheter removal

Urinary retention (inability to urinate)-symptoms include:

If retention is suspected, it is important to perform an ultrasound of the bladder (Yates, 2016) and reintubate the patient if necessary.

Dysurea (pain when urinating)-tingling and burning may occur when urinating; symptoms can last for several days. It is important that the patient drinks 2-3 liters of fluid every day to dilute the urine.

Frequent urination (need to urinate more often than usual) and urgency (sudden and strong urge to urinate)-these symptoms will appear immediately after the catheter is removed. It is important that the patient can go to the toilet or obtain appropriate aids (such as a urinal) and be able to seek help when needed. Symptoms usually subside within a few days, but if symptoms persist or are accompanied by signs of urinary tract infection or urinary retention, further testing is required.

Patients with frequent urination and/or urgency may be reluctant to drink water, but should be informed that concentrated urine can irritate the bladder and cause unnecessary contractions/spasms. Drinking liquids, especially water, dilutes urine, so the bladder becomes less irritable and can tolerate holding back for longer.

Hematuria (hematuria)-This may occur after the catheter is removed, but if it persists or worsens, the patient should report it to a health professional for further evaluation.

Incontinence-patients may experience incontinence problems immediately after the catheter is removed; these may take a few days or longer to resolve, depending on how long the catheter is in place. Patients may need to temporarily use management aids such as absorbent pads to help them stay dry; however, this should not be seen as a long-term solution.

If symptoms persist, the patient should be evaluated and referred for expert support. If the catheter has been in place for a long time, the patient may need instructions for bladder retraining.

The catheter is usually removed in the early morning. This means that any problem, such as urinary retention, usually occurs during the day and can be dealt with by appropriate health professionals (Dougherty and Lister, 2015).

Source: Catherine Hollick, Peter Lamb

All Foley catheters have a balloon and must be deflated before removing the catheter. If the balloon does not deflate, some simple techniques can be tried before being referred to a urologist. These include:

This procedure can only be carried out after approved training, supervisory practices and competency assessments, and in accordance with local policies and agreements.

Tagged as: Newly Qualified Nurse: Utility

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