Best Practices for Securing Urinary Catheters

Until rather recently, securement of indwelling urinary catheters was more or less an afterthought. Most attention had been placed on sterile technique, proper placement, and balloon inflation. While these are still very important, the best practices for securing urinary catheters are now being formally studied. These studies show the importance of proper securement for indwelling urinary catheters for patient health and safety. 

Why do we need best practices for securing urinary catheters?

Nurses in some specialties (e.g., wound care nursing, urology, gynecological surgery, etc.) know very well the consequences of improper catheter securement. If Foley or other indwelling urinary catheters are not properly secured, the device can cause trauma to the bladder and urethra, bleeding, bladder spasms, and skin erosion around the urethral meatus.1 Indeed, the term CALUTS stands for catheter-associated lower urinary tract symptoms and includes increased frequency, increased urgency, burning and/or pain during urination, and suprapubic pain.2 On the other hand, catheter dislodgment is usually preventable through proper technique, and preventing dislodgment and catheter-related trauma decreases the need for catheter reinsertion and reduces the physical and psychological burden on indwelling catheter use.

Catheter securement best practices

Recent scholarship is demonstrating what good nurses have known for years:

  • Urinary catheters should be secured externally. Best practices stipulate that all urinary catheters should be secured externally, hat is, not relying solely on the balloon within the bladder. In fact, this balloon should be thought of as a way to keep the tip of the catheter in the bladder itself, not a means of stabilizing and immobilizing the entire catheter. True urinary catheter securement takes place outside of the body. Perhaps surprisingly, external urinary catheter securement is not widely performed.3 External catheter securement greatly reduces the occurrence of CALUTS.4
  • The placement of the securement matters. Urinary catheters are usually either secured to the upper thigh or the abdomen. Generally speaking, catheters for women should be secured to the thigh, and for men, secured to the upper thigh or lower abdomen.3 Interestingly, recent work suggests that while either location is better than no external securement, thigh fixation may be superior to abdominal securement, regardless of gender.4 Clinicians may need to start with one location and switch to the other if complications arise. In addition, ambulatory patients strongly prefer upper thigh securement for its convenience compared to abdominal securement.
  • Account for tension in two places: proximal and distal to the securement. External urinary catheter securement is intended to protect the bladder, urethra, and genitals from trauma. So, clinicians should consider the forces involved. The length of catheter between the bladder and external securement site should be great enough to allow movement of the person and the upper leg, but not so long that it could get caught on other structures or devices. The second consideration is the weight of the drainage bag and the chance for tugging between the securement and the bag. Simply put, the securement needs to be gentle on the bladder, but firm on outside forces. 

Adhesive versus non-adhesive catheter securements 

Medical tape is the tried-and-true method to secure urinary catheters. It is inexpensive, readily available, and works (when it is used properly). Over the years, companies have developed a number of devices, such as straps and anchors, that do not adhere to the patient’s skin but rather bind the catheter in place. While these devices are more expensive and some are specific to the type of catheter used, they also work well (when properly used). The choice between adhesive and non-adhesive catheter securements rests on patient preference, ease of use, and (if ambulatory) the ability of the patient to use the securement properly. 

Best practices for medical tape securement of urinary catheters

Most nursing textbooks suggest using crisscross, chevron, or horizontal medical tape placement. No controlled trials have indicated which, if any, is best. Regardless of taping method, the resulting securement needs to hold fast against the forces mentioned previously. In this, the choice of medical tape is probably more important than the taping pattern. Researchers have noted that tape may loosen and cause localized skin reactions.3 Moreover, adhesive residue may accumulate on the tube, serving as a possible source of catheter-associated urinary tract infections (CAUTI).

Hy-Tape is a top choice for urinary catheter securement

Hy-Tape should be considered one of the top choices for urinary catheter securement. Its hold is remarkably strong, even in the moist environment of the upper thigh. Though the drainage bag should be secured separately in all cases (e.g., on a hook, in a pouch, etc.), Hy-Tape can help guard against unexpected tugs and pulls on the distal end of the catheter. Unlike most medical tapes, Hy-Tape does not become more aggressive over time. It releases cleanly, leaving little to no adhesive residue. Hy-Tape also releases gently, which is important for patient comfort and to protect delicate, friable, or edematous skin. In fact, while device-specific anchors can and should be used (since this is a “sunk cost” as part of the catheter system), the best approach may be to secondarily reinforce the non-adhesive catheter securement with a medical tape such as Hy-Tape.

References

1. Hanchett MS. Techniques for Stabilizing Urinary Catheters. Home Healthcare Now. 2002;20(3). 

2. Ryu JH, Hwang JW, Lee JW, et al. Efficacy of butylscopolamine for the treatment of catheter-related bladder discomfort: a prospective, randomized, placebo-controlled, double-blind study. Br J Anaesth. 2013;111(6):932-937. 10.1093/bja/aet249

3. Smith JM. Indwelling catheter management: from habit-based to evidence-based practice. Ostomy Wound Manage. 2003;49(12):34-45. 

4. Zhu L, Jiang R, Kong X, et al. Effects of various catheter fix sites on catheter-associated lower urinary tract symptoms. Exp Ther Med. 2021;21(1):47. 10.3892/etm.2020.9478