The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [180]
Urine drainage bags are available in a wide selection of sizes ranging from the large 2 litre bag, which is used more commonly in non-ambulatory patients and overnight, to 350–750 mL leg bags (Figure 6.6, Figure 6.7). There are also large drainage bags that incorporate urine-measuring devices, which are used when very close monitoring of urine output is required (Figure 6.8).
Figure 6.6 Urinary catheter bag, standard.
Figure 6.7 Urinary catheter leg bag.
Figure 6.8 Urinary catheter with urometer.
There are a number of different styles of drainage bags, from the new body-worn ‘belly bags’ (Pomfret 2003) to the standard leg-worn bags. They allow patients greater mobility and can be worn under the patient’s own clothes and therefore are much more discreet, helping to preserve the patient’s privacy and dignity. Shapes vary from oblong to oval and some have cloth backing for greater comfort in contact with the skin. Others are ridged to encourage an even distribution of urine through the bag, resulting in better conformity to the leg. The length of the inlet tube also varies (direct, short, long and adjustable length) and the intended position on the leg, that is thigh, knee or lower leg, determines which length is used (Robinson 2006, 2008). The patient should be asked to identify the most comfortable position for the bag (Pomfret 2003). The majority of drainage bags, even the new belly bag, are fitted with an antireflux valve to prevent the backflow of urine into the bladder (Madeo and Roadhouse 2009). Several different tap designs exist and patients must have the manual dexterity to operate the mechanism (Robinson 2008). Most leg bags allow for larger 1–2 litre bags to be connected via the outlet tap, to increase capacity for night-time use.
Leg drainage bag supports
A variety of supports are available for use with these bags, including sporran waist belts, leg holsters, knickers/pants and leg straps (Doherty 2006, Roe 1992).
Leg straps
The use of thigh straps (e.g. Simpla G-Strap) and other fixation devices (e.g. Bard StatLock, Comfasure, Clinimed CliniFix) helps to immobilize the catheter and thus reduce the trauma potential to the bladder neck and urethra (Eastwood 2009). It is particularly appropriate for men, due to the longer length and weight of the tube being used; however, some women may also find the extra support more comfortable. Guidance from the Royal College of Nurses (RCN 2008) and NHS Scotland (NHSQIS 2004) reiterates the importance of catheter tetherage to promote patient comfort and to limit the potential complications of catheter migration and subsequent need for recatheterization. The application of these devices is not without potential complications; for example, restriction of the circulation to the limb may give rise to deep vein thrombosis while tension and traction to the urethra can cause trauma and necrosis, especially in men (Bierman and Carigan 2003).
Catheter valves
Catheter valves, which eliminate the need for drainage bags, are also available. The valve allows the bladder to be emptied intermittently and is particularly appropriate for patients who require long-term catheterization, as they do not require a drainage bag.
Catheter valves are only suitable for patients who have good cognitive function, sufficient manual dexterity to manipulate the valve and an adequate bladder capacity. It is important that catheter valves are released at regular intervals to ensure that the bladder does not become overdistended. (These valves must not be used on patients following certain operations to the prostate or bladder, as pressure caused by the distending bladder may cause perforation or rupture; in most of these instances the urethral catheter is only