Nursing assistants can help care for urinary catheters but cannot insert or remove them. That single distinction is the most tested fact on CNA certification exams and the most important rule in daily practice. Insertion requires sterile technique and is exclusively a nurse’s responsibility, while nursing assistants handle the ongoing maintenance tasks that keep the catheter functioning safely.
What Nursing Assistants Can Do
The day-to-day work of catheter care falls heavily on nursing assistants, even though the procedure of placing the catheter does not. The Agency for Healthcare Research and Quality identifies several key maintenance tasks that nursing assistants routinely perform:
- Emptying the drainage bag and measuring urinary output, typically recorded in milliliters each shift
- Providing perineal care around the catheter site using soap and water or a gentle cleaning agent
- Keeping tubing free of kinks so urine flows without obstruction
- Positioning the drainage bag below the bladder at all times to prevent urine from flowing backward
- Changing leg bags when a patient switches between a larger bedside bag and a smaller leg-worn bag
These tasks matter more than they might seem. When a physical therapist needs to move a patient or a transporter is preparing someone for a procedure, the drainage bag should be emptied first, and a nurse or nursing assistant is the person responsible for doing it. Intake and output totals are calculated over a 24-hour period and monitored by the nurse, but the shift-by-shift measurements are typically the nursing assistant’s job.
What Nursing Assistants Cannot Do
Inserting, removing, irrigating, or replacing an indwelling catheter falls outside a nursing assistant’s scope of practice. These procedures require sterile technique and sterile equipment, and only licensed nurses (or physicians) perform them. This rule holds across U.S. states, though the exact number of training hours required for CNA certification varies. Michigan, for example, requires a minimum 75-hour state-approved training program.
The reasoning is straightforward. Catheter insertion involves threading a tube into the urethra and inflating a small balloon inside the bladder to hold it in place. Done incorrectly, this can cause tissue trauma, bleeding, or introduce bacteria directly into the urinary tract. Sterile technique is not something that can be improvised, and it requires clinical training beyond what CNA programs cover.
Keeping the Drainage System Closed
One of the most critical rules for anyone handling a catheter is maintaining what’s called a closed drainage system. This means the connection between the catheter tube and the drainage bag should stay sealed. Every time that seal is broken, bacteria have an opportunity to enter and travel up into the bladder.
This is particularly relevant for nursing assistants because changing leg bags, which CNAs do perform, temporarily opens the system. That moment of disconnection is a real infection risk, so it should be done carefully and quickly, with attention to keeping connection points clean. The CDC emphasizes maintaining the catheter’s closed sterile drainage system as a core prevention strategy for catheter-associated urinary tract infections, commonly called CAUTIs.
Why Infection Prevention Falls on Everyone
CAUTIs are one of the most common healthcare-associated infections, and prolonged catheter use is the single biggest risk factor. The longer a catheter stays in, the higher the chance of infection. This is why hospitals and nursing homes push to remove catheters as soon as patients no longer need them.
Nursing assistants spend more time at the bedside than almost any other staff member, which puts them in a unique position to notice early signs of trouble. In nursing home residents, confusion or an unexplained fever may be the only symptoms of a catheter-related urinary tract infection. There is no burning with urination or urgency the way there would be without a catheter, because the catheter bypasses those normal signals. Recognizing subtle changes and reporting them promptly to the nurse is a core part of the CNA’s role.
What to Watch For and Report
Nursing assistants are not expected to diagnose problems, but they are expected to observe and report. Several catheter complications are visible during routine care:
- Urine color changes: Blood in the urine can signal irritation, bladder stones, or more serious conditions. Some bleeding during initial insertion is normal, but persistent blood-tinged urine should be reported.
- Leakage around the catheter: Urine leaking at the site where the catheter enters the body is common, occurring in 25 to 65 percent of patients with indwelling catheters. It still needs to be reported because it can indicate a blockage further down the line.
- Reduced or no urine output: Encrustations can build up on the inside of the catheter and eventually block flow completely. If the drainage bag isn’t filling as expected, the tubing may be kinked or the catheter may be obstructed.
- Catheter dislodgment: Accidental removal, sometimes with the retention balloon still inflated, is a traumatic event that requires immediate attention from a nurse.
- Signs of infection: Fever, confusion, foul-smelling or cloudy urine, or new abdominal discomfort should be communicated to the supervising nurse right away.
Securing the Catheter Properly
A catheter that moves around causes irritation to the urethra and increases infection risk. Securing the tubing to the patient’s thigh (or abdomen, depending on catheter type) with a strap or securement device prevents tugging and accidental dislodgment. Nursing assistants should check that the catheter is secured during repositioning, transfers, and ambulation. The tubing should have enough slack that movement doesn’t pull on the catheter, but not so much that it loops below the drainage bag or drags on the floor.
Proper bag placement is just as important. The drainage bag always stays below the level of the bladder, whether the patient is in bed, sitting in a wheelchair, or walking. If the bag rises above the bladder, urine can flow backward through the tubing, carrying bacteria with it. During transfers between bed and wheelchair, this is an easy detail to miss, and it’s one of the most common mistakes nursing assistants are trained to avoid.
Different Catheter Types, Different Roles
Most CNA training focuses on indwelling (Foley) catheters, the type that stays inside the bladder with an inflated balloon. But nursing assistants may also encounter external catheters, which fit over the outside of the body like a sheath and connect to a drainage bag. These carry a lower infection risk because nothing enters the urethra. Applying or changing an external catheter may or may not fall within a CNA’s scope depending on the state and facility policy.
Suprapubic catheters, which are surgically inserted through the abdominal wall directly into the bladder, require the same drainage bag care as a standard indwelling catheter. Research from nursing home settings has found that standard urethral catheters are associated with higher rates of CAUTIs compared to suprapubic catheters, likely because of the catheter’s proximity to bacteria near the perineal area. Regardless of type, the nursing assistant’s responsibilities around bag emptying, output measurement, and observation remain the same.