Urinary Drainage Bags

Fig. 5.1

Types of UDBs, non-concealable , concealable—Courtesy of Hollister Inc.

Drainage bags that cannot be worn and concealed are commonly referred to as “nighttime or overnight bags,” “large capacity bags,” or “bedside bags” (see Fig. 5.2) (although these designations may be misnomers as these bags may also be used during daytime hours and/or away from beds). Drainage bags that can be worn and concealed are commonly referred to as “leg bags” (although this designation may also be a misnomer in some cases as not all concealable bags attach to legs) (see Fig. 5.3) or abdominal bags, also known as “belly bags.” (see Fig. 5.4)

Fig. 5.2

Disposable overnight or large capacity UDBs —Courtesy of Medline

Fig. 5.3

Leg bag with straps and extension tubing—Courtesy of Hollister Inc.

Fig. 5.4

Abdominal bag (belly bag)—Courtesy Diane K Newman, DNP Corp.

The most commonly used UDBs are disposable products, but there are reusable UDBs that can be washed and reused for a longer period of time (see Fig. 5.5). They are mainly latex, though some are silicone. It is recommended that reusable UDBs be replaced every 30 days. These bags are commonly used with external male catheters (see Chap. 3) and tend to be smaller capacity bags (e.g. <500 milliliter (ml)) (see Fig. 5.6).

Fig. 5.5

Reusable Latex bag with tubing—Courtesy of Coloplast Corp.

Fig. 5.6

(a) Reusable small capacity UDBs—Courtesy of Urotex, (b) External male catheter with small capacity drainage bag, AlphaDry—Courtesy of UroDry LLC

There are two main factors when deciding to use any type of UDB : manual dexterity and lifestyle. Patients may also alternate between the use of a leg bag, a nighttime bag, and a belly bag. Manual dexterity should be evaluated and considered in all patients. Men and women with impaired hand movement may be challenged by emptying their drainage bags and may need to rely on caregivers to empty their bags. As leg bags are smaller and require more frequent emptying, a nighttime or belly bag may be more appropriate for these men and women. The cognition of the person emptying and cleaning a UDB is an additional factor to consider, and patient lifestyle is a highly important factor to consider when choosing a drainage bag. Men and women with active lifestyles may prefer an abdominal bag or leg bag to improve their freedom of movement and to keep their urinary catheters and drainage bags hidden. However, as nighttime urine production is approximately 50–60 ml/hour, individuals using leg bags during the day may elect to switch to a nighttime bag or belly bag to prevent sleep interruption.

Patients with nephrostomy tubes commonly use a specific drainage bag called a nephrostomy bag (see Fig. 5.7). These bags are relatively similar to leg bags, with the exception of tubing specifications, that will be discussed in the designs section of this chapter. Depending upon the type of nephrostomy tube being utilized, nighttime bags and/or leg bags may also be connected to nephrostomy tubes and serve as “nephrostomy bags.”

Fig. 5.7

Remington nephrostomy bag with straps—Courtesy of Urotex

Materials

For all types of UDBs, healthcare providers should be reminded to ask about an allergy to latex. Although most disposable UDBs are latex free and made of polyvinyl chloride, some latex UDBs are still available for order. Latex is commonly used for reusable bags (see Figs. 5.5 and 5.6). Leg bag straps may also be made of latex.

Designs

Nighttime bags/bedside bags generally come in a standard design (Fig. 5.8). They are usually cylindrical bags that hold approximately 2000 ml of urine and contain separate inflow and outflow ports (see Fig. 5.9). The inflow port receives urine from clear tubing, which attaches to the catheter. The inflow port also typically contains an anti-reflux device that prevents urine in the drainage bag from reentering the drainage tubing and catheter. Many UDBs have a breather patch and are vented to prevent excessive negative intravesical pressure, which can occur as a result of gravity pulling urine from the bladder. Nighttime bag/bedside bag tubing is typically a few feet long, and the proximal end of the drainage bag tubing has a graduated nozzle that allows for easy connection to the urinary catheter. Often a clip is attached to the tubing, which can be used to secure the tubing to a bed sheet. Additionally, most bags have straps that can be used to suspend bags from beds or chairs. Many bags have a urine sampling port that is incorporated into the tubing. These sampling ports allow clinician to obtain a urine sample without disconnecting the tubing and opening the system which increases infection risk. The acute care setting uses indwelling catheter systems that have the bag preconnected to the catheter (see Chap. 1) and contain a separate collection meter, which allows for accurate measurement of urine output (see Fig. 5.10).

Fig. 5.8

Bedside overnight UBD with short (left) and long (right) tubing—Courtesy of Coloplast Corp.

Fig. 5.9

Overnight drainage bag with identified components—Courtesy of C.R. Bard, Inc.

Fig. 5.10

Bedside drainage bag with urine meter—Courtesy of C.R. Bard, Inc.

Other nighttime bags/bedside bags do not have a distinct collection meter but have marks on the bag itself to allow for urine output measurement. Accurately measuring urine output is important for inpatient care. Several outflow port devices are available for UDBs, including the lever-type valve, T-bar valve, slide valve, push–pull valve, twist valve, and clamp valve (see Fig. 5.11a–d). Patients with limited manual dexterity may find the lever-type valve to be the easiest to use. For patients concerned about self-image, urinary drainage bag covers are available.

Fig. 5.11

(a) TwistPort: twisted to open and close, catheter valves (b) T-Bar Closed-Port: pushed in one direction to open and the other direction to close, (c) Lever Port: pulled down to empty, (d) Lever Port: pulled up to close

Leg bags come in a variety of sizes, shapes, and materials (see Fig. 5.3). Compared to nighttime bags/bedside bags, they hold smaller volumes of urine (approximately 500 ml). They may be horizontal or vertical and are secured to the leg (calf or thigh) with elastic, mesh, or Velcro™ straps. A knitted bag or a cloth undergarment specifically designed to secure the bag can be used (see Figs. 5.12 and 5.13), or the bag can be enclosed in a stockinet holder (see Fig. 5.14). Some bags are made of a non-woven material (see Fig. 5.15). Men with an indwelling urinary catheter post-prostatectomy preferred non-latex cloth-backed leg bags with elastic/cloth straps over latex leg bags [5]. Rubber straps are still available but these can be constrictive around the thigh or lower extremity.

Fig. 5.12

UroBag™ System : Self-adhesive MEC, reusable Latex 700 ml Leg Bag with Leg bag holder cloth undergarment—Courtesy of Uro Concepts, Inc.

Fig. 5.13

Overnight reusable drainage-bag with undergarment bag holder—Courtesy of Arcus Medical

Fig. 5.14

(a) Cloth bag sleeve (b) Thigh cloth bag holder

Fig. 5.15

Non-woven 250 ml cloth leg bag designed to wear horizontally on the upper thigh—Courtesy of Coloplast Corp.

These bags may be secured to essentially any part of the leg. (For the remainder of this section, leg bags will refer only to those bags that are secured to patients’ legs.) Although it is often easiest to secure a leg bag to the calf, women who wear skirts may prefer to secure a leg bag to the thigh. Similar to nighttime bags/bedside bags, leg bags typically have separate inflow chambers which can reduce the sloshing effect in the bag (Fig. 5.16). Some bags are intended to conform to the thigh, calf, abdomen, or knee. The inflow port is attached to tubing, which attaches to the urinary catheter. This tubing comes in various lengths (4–45 centimeter (cm)), as patients wearing leg bags on their calves require longer tubing. Most tubing is 8 millimeter (mm) in diameter and some have an anti-kink feature. Some leg bag tubing also contains urine sampling ports. Leg bags also come with various outflow port designs, similar to overnight bags. But using the term “leg bag” to describe all types of UDBs that can be worn and concealed is somewhat of a misnomer.

Fig. 5.16

Bags with contoured separate chambers—Courtesy of Coloplast Corp.

Abdomen bags are UDBs that are secured to the lower abdomen, thus the term “belly bag.” They can also be worn and concealed (see Fig. 5.17). Abdomen bags have two main advantages over traditional leg bags (that strap to patients’ legs): size and comfort. Abdomen bags, such as the “Belly Bag^®,” may have larger capacities than traditional leg bags. These bags have a one-way inlet valve that prevents urine reflux. Abdominal bags are secured to the abdomen with a soft expandable belt which eliminates problems associated with traditional leg bags, such as inadvertent catheter extraction and leg bruising from securement straps. They also typically have soft, non-woven backings to prevent perspiration, which can lead to skin irritation and bag slippage. On the other hand, some patients may find abdominal bags to be uncomfortable and may prefer traditional leg bags. As there is no UDB that is universally best for all patients, the optimal drainage bag for an individual patient is often found by trial and error.

Fig. 5.17

Belly Bag^® 1000 ml capacity—Courtesy of Teleflex

Nephrostomy bags are relatively similar in design to leg bags (see Fig. 5.18). These bags typically also hold approximately 500 ml of urine and can be attached to the leg or the abdomen via straps, belts, or garments. They may also possess an anti-reflux mechanism. The most significant design difference between nephrostomy bags and legs bags is the bag tubing. Typically, nephrostomy bag tubing has a smaller diameter. In addition, while a leg bag usually attaches to the urinary catheter via a graduated nozzle, nephrostomy bags are usually attached to nephrostomy tubes via a male Luer Lock connector. At times (e.g., after renal stone surgery), patients may have an indwelling urinary catheter or Council catheter as a nephrostomy tube. In these instances, a nighttime bag or leg bag can be connected to the patient’s “nephrostomy” and serve as a “nephrostomy bag.”

Fig. 5.18

Nephrostomy bag

Techniques/Procedure for Use

Patients and healthcare providers should wash their hands with antibacterial soap prior to connecting a UDBs to a catheter or emptying a UDB. Additionally, healthcare providers should wear gloves. Disposable absorbent pads (i.e., blue chucks) should be placed in the surrounding area in case of urine leakage. To connect a UDB to a catheter, insert the graduated nozzle on the proximal end of the UDB tubing into the distal end of the catheter. Then properly secure the catheter, tubing, and bag to the patient’s leg and/or bed or chair. Then open the drainage port and direct the urine into the toilet or container. Once the bag is empty, an alcohol pad can be used to wipe the outflow port. Then close the outflow port and measure and empty the container of urine. After emptying drainage bags, one should ensure that there are no kinks in the tubing and that the UDB and tubing are not on the floor.

Problems

Complications

Urethral trauma can be a complication of UDBs. When filled, a UDB is heavy and can put traction on the urethra if not properly secured. Other UDB complications include skin changes (on legs) and bruising, which can occur from leg bag straps that are too tight and restrict circulation. Additionally, nephrostomy tubes may become dislodged if the UDB is not properly secured.

Adverse Events

Urinary drainage bags are associated with several adverse events. Catheter-associated urinary tract infections (CAUTI) are a significant problem in many healthcare systems and have been associated with considerable adverse outcomes, ranging from increased length of hospital stay to mortality [6]. Presence of bacteria within and on the UDB is thought to play a considerable role in CAUTI development. Obstruction, leakage, and poor UDB concealment comprise other adverse events. Leg bags can be hard to conceal, can bulge beneath clothing as they fill with urine, and can be associated with audible sloshing of urine [5, 7, 8]. Kinks in the drainage tubing and overly filled bags are two common causes of obstruction and leakage. Avoiding urine-filled dependent loops in the drainage tube can potentially decrease the likelihood of a CAUTI, especially in indwelling urinary catheters [9, 10].

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