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6.6 Urinary Elimination and Catheter Care

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NCLEX-RN Registered Nurse

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1 Introduction

About the NCLEX-RN Exam Next Generation NCLEX (NGN) Clinical Judgment Measurement Model (NCJMM) How to Use This Course

2 Chapter 2: Management of Care

2.1 Legal Rights and Responsibilities 2.2 Advance Directives and Self-Determination 2.3 Informed Consent Protocols 2.4 Client Advocacy and Rights (HIPAA) 2.5 Assignment, Delegation, and Supervision 2.6 Five Rights of Delegation 2.7 Scope of Practice (RN vs LPN vs UAP) 2.8 Ethical Practice Principles

3 Chapter 3: Safety and Infection Prevention and Control

3.1 Standard Precautions and Hand Hygiene 3.2 Transmission-Based Precautions (Contact, Droplet, Airborne) 3.3 PPE Donning and Doffing Sequences 3.4 Fall Prevention and Restraints 3.5 Fire Safety (RACE/PASS) 3.6 Disaster Triage and Emergency Response

4 Chapter 4: Health Promotion and Maintenance

4.1 Growth and Development (Erikson/Piaget) 4.2 Developmental Stages: Infancy through Older Adult 4.3 Maternal and Newborn Care (Antepartum) 4.4 Intrapartum Care and Fetal Monitoring 4.5 Postpartum Care (BUBBLE-HE) 4.6 Health Screening Guidelines 4.7 Immunization Schedules

5 Chapter 5: Psychosocial Integrity

5.1 Therapeutic Communication Techniques 5.2 Non-Therapeutic Communication (What to Avoid) 5.3 Anxiety Disorders and Mental Health Concepts 5.4 Schizophrenia: Hallucinations and Delusions 5.5 Depression and Suicide Assessment 5.6 Substance Misuse and Withdrawal 5.7 Grief and End-of-Life Care

6 Chapter 6: Basic Care and Comfort

6.1 Mobility and Hazards of Immobility 6.2 Assistive Devices (Crutches, Canes, Walkers) 6.3 Nutrition and Diet Therapy 6.4 Enteral Nutrition (Tube Feeding) 6.5 Bowel Elimination and Ostomy Care 6.6 Urinary Elimination and Catheter Care

7 Chapter 7: Pharmacological and Parenteral Therapies

7.1 Medication Administration Rights 7.2 Medication Calculations 7.3 High-Alert Medications: Insulins 7.4 High-Alert Medications: Anticoagulants 7.5 High-Alert Medications: Opioids 7.6 High-Alert Medications: Digoxin and Electrolytes 7.7 IV Therapy and Complications 7.8 Blood Product Administration 7.9 Total Parenteral Nutrition (TPN)

8 Chapter 8: Reduction of Risk Potential

8.1 Laboratory Values: Hematology (CBC) 8.2 Laboratory Values: Metabolic Panel (BMP) 8.3 Laboratory Values: Coagulation Studies 8.4 Vital Signs and Trend Recognition 8.5 Perioperative Care (Pre-Op and Post-Op) 8.6 Nasogastric Tubes and Therapeutic Procedures

9 Chapter 9: Physiological Adaptation

9.1 Fluid Imbalances (Hypovolemia and Hypervolemia) 9.2 Arterial Blood Gases (ABGs) and Acid-Base Balance 9.3 Medical Emergencies: Stroke (CVA) 9.4 Medical Emergencies: Myocardial Infarction (MONA) 9.5 Diabetic Emergencies (Hypoglycemia and DKA) 9.6 Respiratory Conditions (COPD, Pneumonia) 9.7 Cardiac Conditions (Heart Failure) 9.8 Neurological Conditions (Seizures)

6.6 Urinary Elimination and Catheter Care

Key Takeaways Explain This Topic AI

Maintain strict sterile technique during urinary catheter insertion to prevent catheter-associated UTI (CAUTI)

Keep the drainage bag below the level of the bladder at all times to maintain gravity drainage and prevent backflow

Assess for bladder distention using a bladder scanner if the patient has not voided within 6-8 hours post-surgery or post-catheter removal

Daily catheter care includes cleansing the perineal area and meatus with soap and water—no routine antiseptic solutions needed

Evaluate the continued need for catheterization daily; remove as soon as medically possible to reduce CAUTI risk

Last updated: January 2026

Urinary elimination is essential for waste removal and fluid balance. The nurse must assess urinary patterns, recognize problems, manage urinary catheters safely, and prevent catheter-associated urinary tract infections (CAUTIs).

  • Normal Urinary Function
  • Normal Urinary Output
  • Parameter Normal Range
  • Daily output 1,500-2,000 mL (average)
  • Minimum output 30 mL/hour (0.5 mL/kg/hr)
  • Voiding frequency 6-8 times per day
  • Nocturia 0-1 times per night
  • Characteristics of Normal Urine
  • Characteristic Normal Abnormal
  • Color Pale yellow to amber Dark amber (concentrated), red/pink (blood), orange (medications)
  • Clarity Clear Cloudy (infection, sediment)
  • Odor Mild, ammonia-like Foul (infection), sweet/fruity (diabetes)
  • Specific gravity 1.005-1.030 <1.005 (overhydration), >1.030 (dehydration)
  • Urinary Retention

Urinary retention is the inability to empty the bladder completely.

Causes

  • Category Examples
  • Obstruction Enlarged prostate (BPH), urethral stricture
  • Neurological Spinal cord injury, stroke, MS, diabetic neuropathy
  • Medications Anticholinergics, opioids, anesthesia
  • Post-operative Anesthesia effects, pain, immobility
  • Psychological Inability to void in public, anxiety
  • Assessment
  • Bladder distention: Palpable above symphysis pubis
  • Suprapubic discomfort
  • Frequent voiding of small amounts (overflow incontinence)
  • Bladder scanner: Non-invasive measurement of bladder volume
  • Post-void residual (PVR): Volume remaining after voiding
  • Normal: <50 mL
  • Abnormal: >100-150 mL may indicate retention
  • Nursing Interventions

Non-invasive measures first:

  • Provide privacy
  • Run water, pour warm water over perineum
  • Position comfortably (sitting for women, standing for men if able)
  • Allow adequate time

Bladder scanning: Assess volume non-invasively

Intermittent catheterization: If non-invasive measures fail and bladder is distended

  • Indwelling catheter: Only if necessary and for shortest duration possible
  • Urinary Incontinence

Urinary incontinence is the involuntary loss of urine.

Types of Incontinence

  • Type Description Causes
  • Stress Leakage with coughing, sneezing, laughing Weak pelvic floor muscles, childbirth
  • Urge Sudden, intense urge followed by involuntary loss Overactive bladder, UTI, neurological conditions
  • Overflow Continuous dribbling from overfull bladder Obstruction, neurogenic bladder
  • Functional Normal bladder function but unable to reach toilet Cognitive impairment, mobility limitations
  • Mixed Combination of types Multiple factors
  • Nursing Interventions
  • Intervention Rationale
  • Bladder training Scheduled voiding to increase capacity
  • Pelvic floor exercises (Kegels) Strengthen sphincter muscles
  • Prompted voiding Remind cognitively impaired patients
  • Toileting schedule Prevent accidents, especially before bed
  • Fluid management Adequate intake, limit before bed
  • Skin protection Barrier creams, incontinence products
  • Urinary Catheterization
  • Indications for Indwelling Catheter

Catheters should only be used for appropriate indications:

  • Acute urinary retention or obstruction
  • Accurate urine output monitoring in critically ill patients
  • Perioperative use for selected surgeries
  • Healing of open sacral or perineal wounds with incontinence
  • Prolonged immobilization (unstable spine, pelvic fractures)
  • End-of-life comfort care
  • Catheter Insertion: Sterile Technique

CRITICAL: Maintaining sterile technique during insertion prevents CAUTI.

Key Steps:

  • Perform hand hygiene, don sterile gloves
  • Prepare sterile field
  • Clean meatus with antiseptic solution
  • Insert lubricated catheter using sterile technique
  • Advance until urine flows, then advance 2-3 more inches (adults)
  • Inflate balloon with sterile water per manufacturer guidelines
  • Gently pull back to seat balloon at bladder neck
  • Secure catheter to thigh (women) or upper thigh/lower abdomen (men)
  • Hang drainage bag below bladder level
  • Female vs. Male Catheterization
  • Aspect Female Male
  • Anatomy Short urethra (3-4 cm) Long urethra (15-20 cm)
  • Insertion depth 5-7.5 cm (2-3 inches) 17-22.5 cm (7-9 inches)
  • Common difficulty Locating meatus Navigating prostatic curve
  • Position Dorsal recumbent, knees bent Supine, legs slightly apart
  • CAUTI Prevention Bundle

Catheter-Associated Urinary Tract Infection (CAUTI) is one of the most common healthcare-associated infections. Prevention focuses on reducing catheter use and proper maintenance.

CAUTI Prevention Strategies

  • Strategy Implementation
  • Avoid unnecessary catheters Use only for appropriate indications
  • Remove catheters promptly Evaluate continued need daily
  • Use sterile technique for insertion Strict aseptic technique
  • Maintain closed drainage system Never disconnect tubing
  • Keep bag below bladder level Prevents reflux of urine
  • Daily meatal care Soap and water cleansing
  • Secure catheter Prevents traction and urethral trauma
  • Empty bag regularly When 2/3 full, use clean technique
  • Daily Catheter Care
  • Perform perineal hygiene with soap and water
  • Cleanse around meatus (front to back in females)
  • Check that catheter is secured and not pulling
  • Ensure drainage tubing is not kinked
  • Empty drainage bag when 2/3 full

Evaluate daily: Does the patient still need the catheter?

  • Signs of CAUTI
  • Fever
  • Suprapubic tenderness
  • Flank pain
  • Cloudy, foul-smelling urine
  • New confusion (in elderly)
  • Hematuria

Note: Do NOT collect urine cultures routinely. Culture only if symptomatic.

  • Bladder Irrigation
  • Indications
  • Post-urological surgery (TURP)
  • Blood clots in bladder
  • Bladder instillations (medications)
  • Types
  • Type Description
  • Continuous bladder irrigation (CBI) Constant flow of irrigating solution; 3-way catheter required
  • Intermittent irrigation Periodic instillation and drainage
  • Nursing Considerations
  • Use sterile normal saline (or prescribed solution)
  • Monitor for clots, obstruction
  • Calculate true urine output: Output - Irrigant infused = Urine output
  • Watch for signs of bladder distention if outflow blocked
  • Urine Output Monitoring
  • Critical Findings
  • Finding Indicates Action
  • <30 mL/hour Decreased renal perfusion, dehydration Assess fluid status, notify provider
  • <0.5 mL/kg/hour Oliguria—possible renal failure Urgent evaluation
  • No output Anuria—possible obstruction or renal failure Emergency—check catheter patency, notify provider
  • Sudden increase Diuretic effect, post-obstruction Monitor for fluid/electrolyte shifts
  • On the Exam

NCLEX tests:

  • CAUTI prevention: Sterile insertion, keep bag below bladder, daily need assessment
  • Signs of retention: Distended bladder, small frequent voids, bladder scanner
  • Catheter care: Soap and water (not antiseptic solutions), keep system closed
  • Urine output: Normal >30 mL/hr, oliguria is <0.5 mL/kg/hr
  • Key Takeaways
  • Sterile technique for catheter insertion prevents CAUTI
  • Keep drainage bag below bladder level at all times
  • Assess for retention with bladder scanner if no void in 6-8 hours
  • Daily meatal care with soap and water—no routine antiseptics
  • Remove catheters as soon as no longer needed
  • Normal output: >30 mL/hour; oliguria: <0.5 mL/kg/hour