Catheter Care for CNAs: Step-by-Step Guide and Exam Tips

An indwelling urinary catheter, often called a Foley catheter, is a flexible tube that is inserted through the urethra into the bladder to drain urine continuously into a collection bag. The word "indwelling" simply means it stays in place rather than being inserted and removed each time the resident needs to urinate. Residents with indwelling catheters cannot control when they urinate because the catheter drains the bladder constantly. The drainage bag fills over time and must be monitored and emptied regularly.

Catheter care is the routine cleaning procedure that keeps the catheter and the surrounding skin free from bacteria buildup. It is an official NNAAP skills exam skill. The examiner evaluates whether you understand the positioning rules for the drainage bag, the correct cleaning direction, and the importance of keeping the tubing free from kinks. These are not arbitrary checkboxes. Each one directly prevents a specific type of harm.

Why This Skill Matters on the CNA Exam

Catheter-associated urinary tract infections, called CAUTIs, are one of the most common healthcare-acquired infections in the United States. They are also largely preventable. The bacteria that cause CAUTIs typically travel along the outside surface of the catheter tube from the perineal skin up into the bladder, or they enter the system if the closed catheter drainage system is disrupted. Every step in catheter care is designed to interrupt one of these pathways.

The drainage bag positioning rule is absolute: the bag must always be below the level of the bladder. The bladder is inside the lower abdomen, and the drainage bag hangs from the bed frame or the resident's leg. Gravity is what moves urine from the bladder, through the catheter tubing, and into the bag. If the bag is raised above the bladder, even briefly, urine flows backward from the bag into the bladder. That backflow carries bacteria directly into the sterile bladder environment and is a major cause of infection.

The catheter tube must also be secured to the inner thigh to prevent traction on the urethral opening. If the tube is not secured and the resident moves, turns, or rolls, the tube can pull on the urethral meatus (the opening where the catheter enters the body). This pulling causes tissue injury, pain, and creates an entry point for bacteria. A properly secured catheter has a small amount of slack between the insertion point and the securing strap so that movement does not transmit tension directly to the urethra.

What You Need

• Washcloth or gauze pads
• Mild soap or facility-approved cleanser (follow your facility's protocol, some use soap and water, some use a specific antiseptic wipe)
• Basin with warm water
• Catheter leg strap or tape for securing the tube
• Disposable gloves
• Waterproof pad (sometimes called a Chux or underpaid) to protect the bed linen

Step-by-Step: Indwelling Urinary Catheter Care

1. Wash your hands. Perform hand hygiene before gathering supplies or entering the room.
2. Gather supplies. Collect all needed items before starting. You will need washcloths or gauze, cleanser, a basin with warm water, a waterproof pad, and gloves.
3. Identify the resident. Check the name band when you enter the room.
4. Explain the procedure. Tell the resident you are going to clean around the catheter. Many residents feel self-conscious about having a catheter. A calm, matter-of-fact explanation reduces anxiety.
5. Provide privacy. Close the door and draw the curtain completely around the bed.
6. Apply gloves. Put on disposable gloves before any contact with the catheter, perineal area, or drainage system.
7. Position the resident and protect the bed. Help the resident into a supine position (lying on their back). Place a waterproof pad under the hips to protect the linen during care.
8. Inspect the drainage bag and tubing first. Before cleaning anything, perform a visual check of the entire catheter system:
   • Is the drainage bag below the level of the bladder? Look at the bag's position relative to the mattress and the resident's abdomen. The bag should hang below the mattress or on a leg strap below the bladder.
   • Is the bag touching the floor? If so, reposition it, the floor is one of the most contaminated surfaces in any care setting.
   • Is there free drainage? Trace the tubing from the insertion site to the bag. Look for any kinks, loops, or areas where the resident is lying on the tubing. A compressed tube stops urine from draining and allows it to pool, which increases infection risk.
   • Is the catheter secured to the inner thigh? Check the securing strap or tape and reapply if it has come loose.
9. Observe the urine. Look at the urine in the drainage bag and the tubing. Normal urine is pale yellow to medium yellow and clear. Document and report to the nurse if you notice: dark amber color (may indicate dehydration or concentrated urine), cloudy or hazy appearance (may indicate infection), pink or red color (may indicate blood), unusual or foul odor, sediment or particles, or a significant decrease in output compared to previous observations.
10. Perform perineal care. Clean the perineal area before cleaning the catheter tubing. For female residents, clean from the urethral area toward the anus, using a clean section of cloth per stroke. For male residents, clean from the urethral meatus outward using a circular motion. The catheter cleaning step comes after perineal care, not before, cleaning the perineum first reduces the bacteria count in the area before you handle the catheter tubing directly. See the Perineal Care lesson for detailed technique.
11. Clean the catheter tubing. Using a clean washcloth or gauze dampened with soap and water (or the facility-approved cleanser), hold the catheter gently and clean the tube starting at the urethral insertion site and moving outward along the tube for at least 4 inches. The direction of cleaning is critical: always clean away from the body, not toward it. Cleaning toward the urethra pushes bacteria from the outer portion of the tube back toward the insertion site. Use a single stroke per section of cloth, fold the cloth to expose a clean area, and continue until 4 inches of tubing have been cleaned. Do not disconnect the catheter from the drainage tubing during this process.
12. Confirm catheter securing and drainage bag position. After cleaning, confirm that the catheter is secured to the inner thigh with a small amount of slack. Confirm the drainage bag is hanging below the bladder, the tubing is free of kinks and loops, and the bag is not touching the floor.
13. Remove the waterproof pad and reposition the resident. Remove the Chux from under the resident's hips, fold it inward, and discard it. Help the resident back to their preferred position and ensure they are comfortable. Lower the bed to the safe height and place the call light within reach.
14. Remove gloves and wash hands. Remove gloves, dispose of them, and perform hand hygiene.
15. Document and report. Record that catheter care was performed, note the time, and document urine observations (color, clarity, approximate amount in bag). Report any abnormal findings to the nurse immediately rather than waiting until the end of your shift.

Emptying the Drainage Bag (Separate Procedure)

Emptying the drainage bag is a related but separate procedure from catheter care. The drainage bag should be emptied when it is approximately two-thirds full, or per your facility's policy and schedule. To empty the bag:

1. Apply gloves before touching the bag.
2. Place a clean graduate under the drain port at the bottom of the bag.
3. Open the drain clamp and allow urine to flow into the graduate. Do not let the drain tip touch the graduate or the floor, as this contaminates the closed drainage system.
4. Close the clamp when the bag is empty.
5. Read the amount in the graduate at eye level.
6. Record output with time and amount.
7. Observe urine characteristics as described above.
8. Clean the drain tip with an alcohol wipe if required by facility policy before returning it to its holder.
9. Remove gloves and wash hands.

Always use a separate, clean graduate for each resident. Sharing graduates is an infection control violation.

What the Examiner Looks For

• Gloves are applied before any contact with the catheter or perineal area
• Privacy is provided before starting
• Drainage bag position is checked and confirmed below bladder level
• Tubing is checked for kinks and free drainage
• Urine is observed and any abnormalities noted
• Perineal care is performed before catheter tube cleaning
• Catheter tube is cleaned outward from the insertion site, not toward it
• At least 4 inches of tubing are cleaned
• Catheter is secured to the inner thigh with appropriate slack
• Drainage bag is not touching the floor
• Procedure and observations are documented
• Gloves removed and hands washed at end

Common Mistakes to Avoid

• Raising the drainage bag above bladder level. Even briefly lifting the bag above the resident's abdomen, such as when repositioning the resident, allows urine to flow back toward the bladder. Always clamp the tubing or keep the bag below the bladder during any repositioning.
• Not securing the catheter to the inner thigh. An unsecured catheter pulls on the urethra with every movement the resident makes. This causes tissue injury over time and is an infection risk. Check and reapply the securing strap at every catheter care.
• Cleaning toward the urethra instead of away from it. Cleaning inward pushes bacteria from the external tube surface toward the urethral opening. The rule is always outward: away from the body.
• Disconnecting the catheter from the drainage tubing. The closed drainage system is a key infection control feature of the catheter setup. Once you break the seal between the catheter and the drainage tubing, bacteria can enter the system. Do not disconnect unless specifically ordered.
• Allowing the drainage bag to touch the floor. The floor in a patient care room is heavily contaminated. A drainage bag resting on the floor picks up pathogens on its exterior, which can then be transferred to hands, to the bed, and eventually to the resident.
• Not observing urine at each catheter care. Changes in urine appearance are early indicators of infection, dehydration, or other problems. Every catheter care is an opportunity to observe and report.

Printable Practice Checklist

Use this checklist when practicing with a lab partner. Check off each step as you complete it.

1. Washed hands
2. Gathered all supplies
3. Identified resident
4. Explained procedure
5. Closed door and drew curtains
6. Applied gloves
7. Positioned resident supine and placed waterproof pad
8. Inspected drainage bag: confirmed below bladder, not touching floor
9. Checked tubing for kinks, loops, and compression under resident
10. Observed urine: color, clarity, odor, amount
11. Performed perineal care (front to back for females)
12. Cleaned 4 inches of catheter tubing from insertion site outward
13. Used clean section of cloth per stroke
14. Did not disconnect catheter from drainage tubing
15. Confirmed catheter secured to inner thigh with slack
16. Confirmed drainage bag below bladder, not on floor
17. Removed waterproof pad and repositioned resident
18. Lowered bed and placed call light within reach
19. Removed gloves and washed hands
20. Documented procedure and urine observations
21. Reported any abnormal findings to nurse

Catheter care requires careful technique around sensitive areas. Practicing on a mannequin builds the confidence you need for exam day. Explore CNA programs in your area to find one with skills lab hours.

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