A urinary catheter, sometimes called an indwelling urinary catheter (IDC) or just catheter, is a tube that carries your child's urine from the bladder to a drainage bag for disposal.

This tube may come out through:

• the urethra (the hole where urine comes out)
  
• your child's abdomen – this is called a suprapubic catheter (SPC), and is inserted during an operation.

Your doctor will tell you what type of catheter your child needs.

Why does my child need a catheter?

There are many reasons why your child may need a catheter, for example to relieve a build-up of urine in the bladder or to manage urinary incontinence. If your child is having surgery that will prevent them from using a toilet normally, they may have a catheter until they are able to toilet normally.

The catheter may be inserted during surgery if your child is having an operation, or it may be inserted while your child is awake. If it is being inserted while they are awake, it may be uncomfortable for your child. See our fact sheet Reducing your child's discomfort during procedures. 

Care at home

Usually catheters are removed in hospital, but if your child needs to leave their catheter in when they go home, your child's doctor or nurses will tell you how to care for the catheter and what to do if it accidentally comes out.

• Always wash your hands before and after touching the catheter.
  
• Keep the catheter taped securely; ask your child's nurse how to do this before you are discharged.
  
• Clean around the area where the catheter leaves the body with warm, soapy water.
  
• If your child's catheter comes out through their urethra, they can still have a bath or shower.
  
• If your child has an SPC, a daily sponge bath is preferred. Try to keep the dressings dry.
  
• To help the urine drain, it is important to keep the bag below the level of the bladder (e.g. on the floor if your child is sitting in a chair).
  
• Make sure the tubing does not become kinked or twisted in a spiral.  This may block the urine flow and cause pain and distress for your child.
  
• Encourage your child to drink a normal amount of fluids.

Caring for the drainage bag

The drainage bag can be strapped to your child's leg during the day. Older children may need a second bag attached at night if there is a large amount of urine being produced. The night bag can be taken off in the morning and emptied, then washed out with warm soapy water and reused.

You need to check the drainage bag every few hours and empty it when it is half full. To empty the bag, open the tap over a toilet or container. Close the tap again once the bag is empty. Observe how much urine has drained and the colour (urine should be pale yellow).

Change the bag or tubing if you notice any holes. When changing the bag or tubing, clean the end with an alcohol swab and allow it to dry before connecting the new bag or tubing.

What should I do if there's a problem with the catheter?

The catheter is not draining

• Check tube for kinks or twisting. Change the tubing if it keeps kinking in the same spot.
  
• Check the taping on the catheter.
  
• If you think the catheter has come out, call the hospital for advice.
  
• Ensure the drainage bag is below the level of your child's bladder.
  
• Urine may not drain if your child is dehydrated. Give your child extra fluids to drink until their urine is a healthy colour (it should be clear or pale yellow, not dark yellow, orange or brown).
  
• The catheter tube may be blocked and need flushing. Only flush the catheter if you have been shown how to do so by staff before going home from hospital. 

The catheter bag or tube is leaking

• Try to find where the leak is coming from. If the bag or tube is damaged, they will need to be replaced.
  
• Check the tap is closed.
  
• Check the tube connection going into the bag, and ensure it is tightly connected.

Urine is leaking around the catheter tube

If you notice urine in your child's nappy or underpants, urine may be leaking around the catheter tube. This is called catheter bypass, and means the urine is bypassing the catheter and coming out of the urethra.

• Make sure the catheter is not kinked or twisted.
  
• Try flushing the catheter only if you have been shown how to, and observe for further leakage.
  
• If it continues to leak around the tube, take your child to see their doctor.

The catheter has been pulled out

Follow the management plan in place for what to do if the catheter comes out, if you have one. If you don't have a plan, contact the treating hospital immediately. For some conditions seeing a doctor it is not urgent, but others may require you to go to the emergency department.

When to see a doctor

If you have any questions or concerns about your child's catheter care, contact your GP or nearest hospital emergency department.

Take your child to a hospital emergency department if:

• the catheter stops draining and you are unable to flush it
  
• you notice a change in your child's urine e.g. smelly, cloudy or urine which contains blood (urine is red in colour)
  
• your child has a fever (temperature 38.5°C and above) or increased pain
  
• you notice any discharge/pus or signs of infection, such as redness, swelling or heat of the skin  (especially around the SPC dressing).

Key points to remember

• Always wash your hands before and after touching the catheter.
  
• Make sure the tubing does not become kinked or twisted in a spiral.
  
• Keep the drainage bag below the level of your child's bladder.
  
• Encourage your child to drink a normal amount of fluids, and check that the urine in the drainage bag is clear or pale yellow in colour. If your child is dehydrated, give them extra fluids to drink.
  
• Know what to do in case the catheter comes out accidentally, and follow your management plan if you have one.

For more information

• See your GP or treating doctor.

Developed by The Royal Children's Hospital General Surgery and Urology departments. We acknowledge the input of RCH consumers and carers.

Reviewed July 2018.

This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.