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This article provides an overview of when and how to use a catheter valve

This article, the fifth in a six-part series on urinary catheters, provides an overview of when and how to use a catheter valve for bladder drainage.

Citation: Yates A (2017) Urinary catheters 5: teaching patients how to use a catheter valve. Nursing Times [online]; 113: 5, 25-27.

Author: Ann Yates is director of continence services, Cardiff and Vale University Health Board.

Urinary catheterisation is associated with a number of complications including catheter-associated urinary tract infection (CAUTI), tissue damage, and bypassing and blockage. The risk of complications means catheters should only be used after considering other continence management options, and should be removed as soon as clinically appropriate (Loveday et al, 2014).

During the insertion procedure, tissue trauma and poor aseptic technique can lead to CAUTI; this risk continues as long as the catheter is in place. Appropriate catheter drainage and support devices, along with hand hygiene and associated infection prevention strategies, can reduce this risk.

Catheterisation can have a profound effect on patients’ lifestyle and sexual relationships (Prinjha and Chapple, 2013; Royal College of Nursing, 2012). It is vital that they are involved in the selection of drainage devices such as catheter bags and catheter valves, and that their ability to manage these independently is assessed.

The traditional method of free drainage into a urine drainage bag can cause problems for some patients (Van den Eijkel and Griffiths, 2006). As the bag fills, it becomes heavy and uncomfortable, which can be socially restricting and cause anxiety and embarrassment. This method can also result in the loss of normal bladder function as continuous urine drainage means the detrusor muscle of the bladder wall is not able to stretch and relax in response to bladder filling and emptying (Fig 1).

Catheter valves have been available for many years and are a popular alternative to the more customary urine drainage bag. These tap-like devices fit into the end of a urethral or suprapubic catheter, allowing urine to be stored in the bladder and then emptied into a toilet or receptacle at regular intervals during the day. They can help maintain bladder function, capacity and tone by allowing the filling and emptying of the bladder, mimicking normal function.

Catheter valves are particularly useful for people who:

The advantages of catheter valves are listed in Box 1.

Box 1. Benefits of catheter valves

A full patient assessment is required before using a valve as some patients may not be suitable (Fig 2a). Cautions that should be considered are outlined in Box 2. Poor manual dexterity is often cited as a problem that may prevent a patient from using a catheter valve. However, it could be argued that patients with catheters need to be able to manipulate the valve on a drainage bag, which involves a similar technique to using a catheter valve; the critical issue is how much help they require to do this.

Box 2. Cautions when considering a valve

Valves may not be suitable for certain groups of patients, including those with:

Valves should not be used after prostate or bladder surgery as pressure caused by a distended bladder may lead to bladder perforation (Dougherty and Lister, 2015). An indwelling urinary catheter is usually required for a short post-operative period and free drainage is the preferred method.

A patient may have access to help so they can empty a drainage bag twice a day, but catheter valves need to be released every 3-4 hours, and help may not be readily available so frequently. It is essential that valves are released that often to ensure the bladder does not become over-distended with urine as this can cause pain and discomfort as well as bypassing, when urine leaks around the catheter. Allowing regular over-distension of the bladder to occur can also have a detrimental effect on renal function.

A number of different types of catheter valves are available on prescription in England and Wales; however, some characteristics are common to all of the various types. They are:

Valves attach to the indwelling catheter via either a smooth (Fig 2b) or ridged (Fig 2c) connector; there are three main types of tap: lever, twist and bayonet (Fig 2d).

Most valves have a soft connector at the end to allow for easy attachment of the drainage bag. Patients may choose to attach their valve to an overnight drainage bag to allow free drainage of urine while they sleep; some attach a leg bag when it is inconvenient to release their valve, for example, if making a long train journey or taking a flight.

Selecting the right device for the individual patient will optimise patient care. It is important that health professionals consider the characteristics not only of the individual patient but also of the individual valve, and that patients have an opportunity to try out different devices and find the one that suits them. How to use the valve should be clearly explained and demonstrated, and information with text and pictures should be supplied.

Valves should fit securely without excessive effort and should not become loose. Some are easier to open than others; this may be an important issue if the patient has poor dexterity (Fig 2e). The valve should resist accidental opening, and should be leak free and discreet.

In hospitals, catheter valves should be connected by staff using an aseptic technique. They should be changed when clinically indicated or in line with the manufacturers’ guidelines – which usually states every 5-7 days.

Patients changing their own catheter valve should use a clean technique and be taught to:

A securing device, such as a leg strap, can be used to support the catheter and valve (Health Talks, 2015); this will help reduce movement of the catheter which can lead to trauma and CAUTI.

When carers change patients’ catheter valves they should use a clean technique and put on gloves after washing their hands but before handling the catheter valve; they should then follow steps 3-5 of the procedure that has been outlined above.

The nurse should document in the patient’s notes:

If patients need a drainage bag for part of the day or night, they (or their carer) can attach it to the end of the catheter valve by pushing the connector of the bag into the inlet of the valve. They should:

Leg bags that are used during the day should be secured onto the leg (Fig 2f). Overnight, a night drainage bag should be attached to a catheter stand. The stand should be positioned below the level of the bladder to allow free drainage and prevent reflux of urine into the bladder, which increases the risk of infection. Bags should be used and disposed of according to manufacturers’ instructions, and replaced with a new bag every time the drainage system is broken (see part 3 of this series).

Professionals and patients must understand the device being used and how to obtain adequate supplies. Patients need the telephone number of an appropriate health professional who they can contact with any questions or concerns.

Tagged with: Newly qualified nurses: practical procedures

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Megan Ford reports on a Nursing Times roundtable event discussing the recruitment and retention of overseas nurses during a global shortage