It reflects National Occupational Standards (PDF) and professional responsibilities.

The full publication explains and provides further detail on the six competencies for catheter care that the RCN identified alongside Skills for Health in 2006.

Urinary catheter care is a fundamental part of nursing practice. Catheters can support people to manage bladder function, but they must only be used when clinically necessary.

Indwelling catheters should never be used for convenience; alternatives must always be considered first.

Health care professionals must work within their scope of competence and understand their responsibilities and accountability in relation to national guidance, local policies and organisational procedures.

Key points include:

• Only undertake catheter care if you are trained and competent.
• Seek advice or supervision if a task is outside your competence.
• Maintain competence through regular practice and updates.
• Use evidence-based guidance to inform practice.
• Be accountable for your actions and decisions.

Registered nurses must maintain competence throughout their career and follow the NMC Code, including when delegating tasks to others.

A safe competence pathway includes:

• gaining theoretical knowledge
• practising on models under supervision
• observing procedures on patients and performing them under supervision
• progressing to independent practice.

Clinicians should maintain skills in aseptic technique, assessing catheter need, obtaining urine samples, changing drainage systems and catheter insertion and removal.

Ongoing experience, regular updates at least every five years and participation in clinical audit, all support high quality catheter care.

When delegating catheter care, the registered professional is accountable for their delegation of tasks.

You must:

• Only delegate tasks within the other person’s competence.
• Provide clear instructions.
• Offer appropriate supervision and support.
• Confirm the task meets the required standard.
• Complex assessments, such as managing blocked or bypassing catheters, should not be delegated to staff who lack the skills to assess and plan care. The NMC Code outlines expectations when delegating to others.

Valid consent is required before any aspect of catheterisation or catheter care.

Consent must be:

• given by the patient
• informed, voluntary and documented
• based on a clear explanation of risks, benefits and alternatives.

If a patient lacks capacity, catheterisation must be documented as being in their best interests, with involvement of the multidisciplinary team where required.

Patients should understand:

• why a catheter is needed
• the risks of catheter use
• the plan for review and removal
• that the procedure will use aseptic technique.

Catheters should only be used after all alternatives have been considered.

Clinical indications include:

• acute or chronic urinary retention
• urodynamic testing
• monitoring urine output and renal function during critical illness
• surgical procedures
• obtaining a sterile urine specimen when clinically indicated
• bladder irrigation or medication instillation
• bypassing obstruction or voiding difficulties
• maintaining skin integrity (which will be compromised due to incontinence) when all other measures have failed.

The need for a catheter must be reviewed regularly, with removal planned as early as possible.

Risk assessment is essential before inserting, continuing or removing a catheter and is ongoing once it is in place.

Consider:

• whether a catheter is clinically necessary
• the type and size of catheter
• infection risks, including a urinary tract infection (UTI)
• patient factors such as age, immunity, renal function and mobility
• whether alternative management would be safer.

Patients at higher risk include older people, women, those with impaired immunity and those with a history of urinary infection.

Additional caution is required where blood clots or meatal bleeding have been observed. Cardiac and renal issues will also put people at higher risk.

Assessment should also consider dignity, comfort and ability to manage equipment.

Accurate and clear documentation is a legal and professional requirement.

Documentation should:

• record what care was given and why, including ongoing observations
• support communication between professionals
• provide a legal record.

and include:

• reason for catheterisation
• consent
• risk assessment outcomes
• catheter type, size and batch details
• care provided and patient response
• plans for review, change or removal.

Records must be legible, factual and free from jargon. Where used locally, catheter passports should be updated at every intervention.

Urinary catheters and drainage systems must be used according to manufacturer’s instructions.

Health care professionals must understand:

• catheter types and sizes
• drainage systems and fixation devices
• ordering, storage and disposal
• how to support patient choice.

Equipment must be correct for the patient’s needs, in date and stored appropriately.

Single-use equipment must never be reused.

It is also worth considering allergy risks, for example, to latex, soap or gels.

Suprapubic catheters may be used when urethral catheterisation is unsuitable or not tolerated.

Potential advantages include:

• reduced urethral trauma
• improved comfort
• easier access for care
• reduced contamination from bowel flora.

Risks include infection, over granulation, blockage and pain during removal or change.

Only trained staff should change suprapubic catheters in line with local protocols.

A trial without catheter (TWOC) assesses whether catheter removal is possible.

Consider:

• patient’s medical status
• catheter history
• risk assessment
• ability to consent and cooperate.

Stop TWOC if there is significant pain, bleeding, failure to pass urine or withdrawal of consent. Where possible, TWOC may be carried out at home to reduce infection risk.

Intermittent self-catheterisation is the gold standard for bladder drainage where appropriate.

Benefits include:

• reduced infection risk in comparison to indwelling catheters
• maintenance of bladder function
• increased independence.

Teaching must be provided by competent professionals. Patients require education, review and access to suitable equipment.

Essential knowledge includes understanding infection risks, including risks linked to procedures and devices and when they are clinically needed (medical indication).

Staff must use standard precautions, keep the environment clean, know when to do urinalysis or take a urine sample, and use aseptic technique. A closed drainage system is essential to reduce infection risk.

High quality catheter care protects patients from avoidable harm and supports dignity, comfort and wellbeing. Consistent review, accurate documentation and adherence to evidence-based practice ensure safe, effective and person-centred management throughout the catheter journey.

The full PDF explores this topic in more detail. The publication may include case studies, images, tables, good practice checklists, glossaries and suggested questions to ask patients. You’ll also find a concise list of references and links to useful organisations and websites.