Catheter Care for Home Health Aides and New CNAs

What the work looks like

Catheter care is one of the most common tasks a home health aide (HHA) or certified nursing assistant (CNA) does in long-term care, home health, and hospital med-surg. You do not insert catheters (that is an LPN, RN, or physician task in most states), but you clean them, empty and measure drainage bags, reposition them to prevent pulling, document output, and observe for infection signs.

Three types you will see:

• Indwelling (Foley) catheter: balloon-tip catheter that stays in the bladder, connected to a drainage bag. Changed every 30 days typically.
• Straight (intermittent) catheter: inserted, drained, removed. Not a CNA task.
• Condom (external) catheter for male patients: a sheath that rolls over the penis and connects to a leg bag. Changed daily.

Job titles: CNA, Home Health Aide (HHA), Personal Care Aide (PCA), Patient Care Technician (PCT). Pay $15 to $22 per hour; hospital pay is usually higher than long-term care.

Safety and tools

Catheter-associated urinary tract infections (CAUTI) are the number-one preventable hospital-acquired infection. The rules exist to stop bacteria traveling up the catheter into the bladder.

Every shift:

• Perform perineal care with soap and water (or a no-rinse perineal cleanser) at least daily and after every bowel movement. Wipe from meatus outward, not back toward the meatus.
• Keep the drainage bag BELOW the level of the bladder at all times. A bag raised above causes urine reflux and infection.
• Do not disconnect the catheter from the bag unless absolutely necessary. If you do, wipe both connection points with alcohol first.
• Empty the drainage bag when it is 2/3 full. Use a separate graduated container for each patient (not the same jug).
• Secure the catheter to the patient's thigh with a StatLock or tape strap to prevent pulling on the urethra.
• Wash hands before and after. Wear gloves.

Red flags to report to the nurse immediately: cloudy or bloody urine, a sudden decrease in output (less than 30 mL per hour for adults), foul smell, patient complaint of bladder pain or burning, leakage around the insertion site (may mean catheter is blocked).

Tools: gloves, perineal cleanser or soap-and-water setup, washcloths, graduated measuring container, StatLock or catheter securement device, documentation paper or EMR tablet.

Your first exercise

Practice (on yourself, clothed, no actual catheter) the positioning. Identify where the drainage bag should hang relative to the bladder. Identify where the catheter tubing should be secured to prevent pulling (inner thigh for female patients, abdomen for male patients to reduce friction). Describe out loud the five signs of possible infection (cloudy, bloody, low output, foul smell, pain). If you can list the five, you are ready for a real first day.

Where to go next

Build on Catheter Care with CNA Fundamentals (Introduction to CNA Skills), Infection Control, Wound Care (Introduction to Wound Care), Diabetes Management (Introduction to Diabetes Management), Pediatric Home Care (Introduction to Pediatric Home Care), and Medication Administration. Safety: Bloodborne Pathogens, HIPAA/PHI, Workplace Safety.