Living with a urinary catheter

Drainage bags

An indwelling catheter, such as a Foley catheter, is used to collect urine. It can be attached to a urine collection bag or to a catheter valve that can be opened and closed. Free drainage means that urine drains out from the catheter all the time into a drainage bag. A catheter valve is a tap-like device that fits into the end of a urethral or suprapubic catheter, which allows  urine to be stored in the bladder and emptied straight into the toilet or bag. The tap can be switched on to stop drainage or off to drain urine from the bladder thus allowing the bladder to fill and empty as normally as possible (see ‘Catheter valves’). Most people who have a long-term catheter now use a catheter valve (with or without a bag) because it is generally felt that the bladder should not be kept empty at all times as it reduces bladder capacity and tone. The catheter valve at the end of the catheter acts in a similar way to the tap at the bottom of the leg bag which is used to empty the leg bag when it’s full. Here, people talk about their experiences of drainage bags.
 
There are two kinds of bags: a leg bag for day time use and a night bag, usually larger, for use in bed. A leg bag is attached directly to the catheter tube. It collects all the urine produced during the day and becomes heavier as it fills. It shouldn’t be allowed to become too full as this carries the risk of pulling out the catheter.
There are many types of drainage systems, varying in terms of bag size/capacity, fabric or non-fabric backed, tube length, tap design, mobility and fixation aids.
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The people we interviewed had various reasons for using free drainage. Some, who’d had a spinal cord injury, had poor use of the hands so opening a catheter valve or tap could be difficult. A carer emptied the leg bag for some people.
A few people had at first used a valve but went onto free drainage as they became weaker. Sara said it became easier not to use a valve as her hands weakened. Stuart found a valve hard to use from the start – his level of paralysis made it impossible.
How someone wears the leg bag depends on how they feel comfortable: it can be attached to the thigh or calf with a pair of leg bag straps or worn inside a special leg bag holder against the leg. Leg bags are routinely supplied with a pair of latex-free leg straps; one fits the top of the bag and one the bottom. An alternative is a sleeve that completely encases the leg bag. The sleeve has a small opening for the tap so is easy to access and empty. This method helps to distribute the weight of the bag more evenly, so it is useful for people with frail skin or if the straps dig or rub into the skin. The catheter and bag must be well supported to prevent damage to the urethra and bladder neck. Bags are fitted with short tubes, long tubes and direct inlets. The leg bag should always be positioned below the bladder to maintain urine flow, though some people we spoke to wore their bag at their waist. Frances, for example, had tried various ways of wearing her bag. Although wearing it by her waist was not recommended by her doctor, she said she’d had no problems at all this way.
Some people disliked having ‘a bag of urine strapped to the leg’. A few wished they could empty the leg bag themselves instead of relying on a carer. To empty the drainage bag, the person must have the dexterity to open the tap at the bottom. There are a number of tap options, the most common being the lever tap and the push-across type. The bag should be emptied regularly before it becomes too full and causes reflux or damages the urethra. This is normally when it is about two-thirds full. It is best not to open the tap to empty the bag more often as this can promote infections. Leg bags connected to the catheter form a ‘closed system’, which prevents bacteria getting into the system and reduces the risk of infection. The leg bag should only be disconnected from the catheter when the bag needs replacing. It should be changed every 5-7 days in line with manufacturer’s recommendations. If a bag becomes disconnected from the catheter, a new bag should be attached. Some continence advisors suggest washing the bag with soap and water and re-using it. Other health professionals disagree with this and advise using a new bag every week.
People who can empty their bag should wash their hands, open the tap, empty the bag into the toilet or other suitable receptacle, close the tap and wipe the bottom of the tap dry to prevent urine drips. They should finish by washing their hands. If someone can’t perform this task, their carer should wash their hands and wear non-sterile gloves for the procedure.
The night bag, often a 2 litre drainage bag, is connected directly to the leg bag without disconnecting the leg bag. To connect the night drainage bag:
  • remove the leg bag support
  • wash hands carefully
  • empty the leg bag and, with the tap still open, push the end of the night bag into the small piece of tubing at the end of the tap to form a direct route for urine to collect in the night bag
  • attach the night bag to its stand; this stays on the floor by the side of the bed. In the morning, turn off the tap on the leg bag
  • disconnect the night bag, empty the urine into the toilet and rinse the night bag through with warm water. It is then ready to be used again the next night
Ian, who was partially paralysed, used a night bag all the time – it had more space so was more convenient for him and his carer. A few people kept their night bag in a bucket by their bed. Annie had found it hard to sleep with a night bag at first but soon got used to it, making sure she didn’t roll on it or that the tube didn’t kink. A few people, like Stewart, used a catheter valve during the day and a night bag when in bed.
Some people had had problems with a leg or night bag, including the catheter tube disconnecting from the bag, causing leaking or flooding. This prompted a few people to use a catheter valve instead (see ‘Catheter valves’).
John Y didn’t realise he could use a leg bag as well as a valve and wished he’d been told more about this. Others would have liked to know more about the different types of bags and valves and about looking after the bag.
Some people were using a catheter valve most of the time but on certain occasions, such as travelling or playing sports, they used a leg bag. Before going out, most people made sure they had an empty leg bag and spare catheter equipment with them or in the car (see ‘Going out locally’ and ‘Travelling long distance’). They knew when their bag was full as it would feel heavier, or they would feel it and notice it getting full. Some people with a spinal cord injury said that a headache sometimes alerted them to a full leg bag. Emlyn, who had a catheter inserted when he had surgery for prostate cancer, said a burning feeling in his penis told him his bag was full. Most people emptied their bag regularly throughout the day and changed it once a week. Michelle was an exception: she changed hers every day.

Last reviewed June 2015.

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