Getting to the Bathroom Safely
To help ensure the person you are caring for can get to the bathroom safely, ensure the pathway is well lit with nothing in the way. Obstructions such as furniture, rugs, pets, or toys are a tripping hazard. If he/she cannot tell you when they need to urinate and/or defecate, consider taking them to the bathroom on a regular schedule.
If accidents are occurring, track when these occur as information for a toileting schedule. For example, if he/she has an accident about every two hours, take them to the bathroom every two hours to help prevent accidents from happening. If the person you are caring for is too weak to get to the toilet, other options may include using a bedside commode, bedpan or urinal. The bedside commode can be placed right next to the bed so the patient doesn’t have to walk to the bathroom. If they cannot get out of bed, a bedpan may be used (he/she rolls onto one side and the bedpan is placed on the bed next to the lower back and buttocks; he/she then rolls onto the bedpan).
Consider the following information if the person you care for cannot control when he/she needs to go to the bathroom:
- Clean them promptly if he/she has urinated or defecated; this will help protect the skin from sores, prevent infection, and promote comfort and dignity. If he/she has the strength and you think it can be done safely, help them take a shower or a bath. Consult your Hospice nurse if you are unsure. If he/she is bedbound, take off their dirty undergarments and wipe their skin clean. For females it is very important to wipe from front to back to prevent urinary tract infections. Be sure to dry the skin thoroughly and apply a protective lotion if appropriate before placing a new brief on them.
- Use absorbent undergarments(such as adult briefs) and waterproof pads to protect the bed and furniture.
- Reassure him/her when accidents occur. Help them to know it is not their fault.
Catheter Care
A urinary catheter is a soft tube placed into the bladder to release urine; the urine drains through the tube into a bag. For those who are incontinent of urine, a catheter can be used to help keep the skin dry and protect it from rashes. A catheter can also help to empty the bladder if urinary retention is an issue, improving overall comfort. Here are some tips to care for the catheter:
- Because the urine drains out of the bladder and into the catheter bag by gravity, be sure the urine bag is always below the hips.
- Hang the bag on the bed frame or place it in a clean waste basket on the floor next to the bed. This will prevent the urine from flowing back into the bladder. If possible, never raise the bag above the bladder.
- Clean around the insertion site once a day and after bowel movements, using soap and water or hospice-provided hygiene spray, and making sure to rinse and dry the area afterward.
- Be careful not to tug on the catheter tubing; this can cause injury and/or pain.
- To clean the catheter tubing, gently start at the insertion site and move away from the body. Clean with soap and water or hygiene spray, and rinse. Try not to use creams and powders near the insertion site as this can increase the risk of infection.
How to Empty a Catheter Bag
The supplies you need include gloves, a container to drain the urine into, and a towel or absorbent pad to place on the floor under that container. There are different types of catheter bags that come with different kinds of clamps. Your Hospice nurse can teach you how to use the clamp for the bag in use. To drain the catheter bag, unclamp the clamp, empty the bag into the container you have placed underneath it, swab the outside of the clamp with an alcohol swab and re-clamp the bag when empty. This should be done at least twice per day and whenever the bag is more than halfway full.
Troubleshooting Catheter Problems
If no urine is draining into the catheter bag, check the catheter tubing for kinks. If the tubing is twisted, bent or kinked, urine flow may be blocked. If you notice leaking around the insertion site, blood in the catheter bag or large amounts of mucus, contact Hospice. If there is no urine output for greater than 12 hours (unrelated to a kink) contact Hospice. Sometimes the urine will become darker or have in it what looks like white clots. The change in color is normal and generally not a concern. The white clots are usually mucus and this is normal in small amounts.
Skin Care
If the person you are caring for is incontinent, check them (and clean as needed) at least every two hours to ensure he/she is kept clean and dry. If they are bedbound, reposition him/her every two to four hours because when left in the same position for too long, circulation becomes impaired causing pain and the potential for bedsores.
When repositioning, roll him/her onto a different side or onto the back to maintain circulation. Pillows may be placed behind the back and bottom to help maintain the new position. Place pillows between the knees, arms, and ankles to prevent rubbing. When the patient is on his/her back, place pillows under the lower part of the legs to relieve pressure on the heels of the foot; this is called “floating” the heels and will help to prevent sores from developing.
Certain areas are more susceptible to developing sores, such as the tailbone and the heels. There are also areas susceptible to skin ailments, such as a yeast rash or raw skin. These areas include the groin and between skin folds, including under the breasts and between abdominal folds. Monitor these areas closely and keep them clean and dry. Notify Hospice if you notice any redness, open areas, bruising, rashes or abnormal spots on the skin.