Editing Nursing Skills and Procedures (section)

=== Maintenance and complications ===
Keep the closed drainage system intact. Perform perineal care with soap and water daily and after bowel movements. Do not routinely irrigate. Ensure adequate fluid intake unless contraindicated. Clamp the tubing briefly and withdraw specimens only from the needleless sampling port after disinfecting it, never from the collection bag and never by disconnecting the tubing.

Traditional teaching, still reflected on many licensure exams, is to drain no more than roughly 750 to 1000 mL at one time in a chronically distended bladder to reduce the risk of hypotension and mucosal hemorrhage. Contemporary evidence suggests rapid complete drainage is usually well tolerated. Follow facility policy, monitor blood pressure, and know the classic exam answer.

Absent urine output after insertion is assessed before it is escalated: check for kinks, dependent loops, bag position, and constipation, and confirm the catheter is in the bladder and not the vagina. Bladder scanning determines whether the bladder actually holds urine. Suprapubic distension with no output in a patient with an intact catheter suggests obstruction and requires notification.

Autonomic dysreflexia is a life-threatening emergency in patients with spinal cord injury at or above T6, most often triggered by a distended bladder or bowel. Presentation is sudden severe hypertension, pounding headache, bradycardia, flushing and sweating above the level of injury, and pallor below it. The nurse raises the head of the bed immediately, then removes the trigger, most often by relieving the obstructed catheter, and notifies the provider.