Introduction to Assisting with Elimination

Every patient has elimination needs.There are a number of ways the Home Health Aide/Personal Care Aide can assist a patient by providing for elimination needs. Patients who are unable to get out of bed due to mobility issues or injury may benefit from using a bedpan. Male patients may benefit from using a urinal at the bedside to prevent having to walk to the bathroom. Some male patients have condom catheters, which are external urinary drainage systems where a condom is applied to the penis and attached to a urinary drainage bag. Other patients may have indwelling catheters in which the catheter is inserted into their bladder. The catheter is attached to an external urinary drainage bag. The Home Health Aide/Personal Care Aide has an important role in providing assistance with elimination and cleansing the genital area after elimination. This section will explore how to offer a patient a bedpan or urinal, how to apply a condom catheter, and how to cleanse the genital area and catheter tubing. Instruction is provided about how to empty urinary drainage bags that are attached to condom catheters and indwelling catheters and how to properly measure urine output.

Procedure – Use of a Bed Pan

Patients who are unable to get out of bed may need to use a bedpan when urinating or for bowel movements. The standard bedpan looks like a toilet seat and has a wide, high rim. These types of bedpans are placed under the patient with the widest end under their buttocks. The fracture pan has a lower, thinner rim. The smaller, flatter end is placed under the buttocks. The higher end with the handle is placed facing the patient’s feet. The fracture pan should be used for patients who are unable to lift their hips for bedpan placement after back or spinal injuries or surgeries.

• Explain the procedure to the patient.
• Wash and dry your hands. Always apply gloves when offering and removing a bedpan.
• Adjust the bed to a safe working height. Lock brakes. Lower the head of the bed and position the patient in the supine position.
• Provide privacy for the patient by closing doors and curtains.
• Fold down top linens just enough to slide the bedpan under the patient.
• Place a towel or disposable protective pad under the patient as needed. This helps to protect bed linens from getting urine or feces on it in case of accidental spilling of bedpan contents.
• Assist the patient with removing pants and undergarments if they are unable to do so.
• Home Health Aides/Personal Care Aides can dust the bedpan with talcum powder to help prevent the patient’s skin from sticking to the bedpan. Check with a supervisor before doing so. Ensure the patient does not have an allergy to the powder.
• Place bedpan near hips. Position a standard bedpan with the wider edge aligned with the buttocks.
• Position a fracture pan with the flatter end under the patient’s buttocks and the handle toward the foot of the bed.
• If the patient is able, they can bend their knees and lift their hips as you slide the bedpan under their buttocks. You can provide assistance for the patient as they raise their hips by placing one hand at the small of their back to help raise their buttocks.
• If the patient is unable to lift their hips, roll them to the side facing opposite you. Position the waterproof pad under the patient’s buttocks. Then, position the bedpan under their buttocks, pressing firmly but gently downward on the bedpan, against their buttocks. Hold the bedpan securely against the patient as you roll the patient back toward you. Check to ensure the bedpan is adequately underneath the patient’s buttocks.
• Ensure a blanket is covering the patient. Provide privacy. Raise the head of the bed if the patient prefers so that the patient is more closely in a sitting position. This position allows for a more natural feel for the patient to eliminate. Raise the side rails.
• Provide the patient with toilet paper.
• Dispose of your gloves and wash your hands.
• When the patient has finished using the bedpan, put on clean gloves.
• Lower the head of the bed so the patient is put into a supine position.
• If the patient is able, ask them to lift their hips. While they do this, firmly grasp the bedpan and remove it from under them. Assist with cleaning the patient’s perineum as appropriate.
• If the patient is unable to lift their hips, assist the patient to roll to the side facing away from you. While the patient is rolling, ensure you have a firm grasp on the bedpan. You may have to have one hand on the patient’s hip to assist with rolling, and use your free hand to grasp the bedpan. Remove the bedpan.
• Clean the patient’s perineum. For female patients, wipe the buttocks from front to back, away from the vaginal area. This ensures bacteria from the anal area and from feces do not enter the vaginal area and cause a possible infection.
• Lower the bed to its lowest setting for safety. Reposition the patient for comfort. Ensure side rails are raised.
• Dispose of the contents of the bedpan into the toilet. Rinse and clean the bedpan with hot, soapy water.
• Dry and put the bedpan away.
• Measure urine as required. Document output of urine or feces as appropriate.
• Dispose of your gloves. Wash and dry your hands.
• Document procedure and any observations or changes in condition or behavior.

Procedure – Use of a Urinal

The use of a urinal helps the male patient to privately and safely urinate without having to ambulate to the bathroom or commode. Many male patients may find it easier to urinate in a high sitting or a standing position. Assist the patient into the position they are most comfortable and can safely assume during urination. Home Health Aides/Personal Care Aides may need to assist some patients with positioning and holding the urinal while they urinate.

1. Explain the procedure to the patient.
2. Wash your hands. Don gloves.
3. Provide for privacy.
4. Adjust the bed to a safe working height. Lock bed wheels. Raise the head of the bed to put the patient in a sitting position in bed or at the side of the bed. Alternatively, assist the patient to a standing position. Refer to Procedures Transfer to a Sitting Position in Bed, Procedure Helping the Patient to Sit at the Side of the Bed, and Helping the Patient to Stand.
5. Place a protective pad or towel under patient’s hips as needed.
6. If the patient is able, hand them the urinal.
7. If the patient requires assistance, place the urinal between the patient’s legs. Position the head of the penis into the urinal, ensuring it is completely inside the container.
8. Be patient while assisting with urination. Allow for quiet during this time. Provide privacy by covering the patient with a blanket if they are in bed.
9. Provide privacy for the patient to urinate if they do not require assistance by leaving the room. Check on the patient every five minutes, knocking before entering. Provide toilet paper.
10. Discard gloves and wash your hands.
11. When the patient has finished using the urinal, wash your hands and don clean gloves.
12. Close the cap on the urinal.
13. Lower the bed to the lowest height. Ensure bed rails are raised.
14. Remove the urinal and supplies.
15. Measure urine and record output as required.
16. Dispose of urine into toilet. Flush toilet. Rinse and then store urinal. Do not store a urinal on a bedside table. Hang the urinal on a bed rail near the patient so they may easily access it.
17. Dispose of gloves. Wash your hands.
18. Document procedure and any observations or changes in condition or behavior.

Procedure – Assisting with the Use of a Condom Catheter

Condom catheters are worn by some males to assist with urination. This urinary drainage system allows a patient to engage in their normal activities, while not having to be concerned about problems with urination such as incontinence. It is a less invasive urinary drainage system than an indwelling catheter and has a low risk of infection. It is important for Home Health Aides/Personal Care Aides to ensure the tubing to this urinary drainage system is not kinked or twisted, and that the drainage collection bag is worn below the level of the bladder.

1. Explain the procedure to the patient.
2. Wash your hands. Apply gloves.
3. Assemble equipment needed (soap, wash cloth, towel, condom catheter, skin protectant, drainage bag).
4. Raise bed to a safe working height. Lock the brakes. Place the patient in a supine position.
5. Maintain patient’s privacy. Only expose genital area.
6. Remove the old condom catheter if one is in place by detaching it from the drainage system tubing and rolling the condom down and off the penis, starting at the base of the penis and rolling towards the tip of the penis. Dispose of the old condom catheter.
7. Wash the penis carefully with soap and warm water (temperature no greater than 105 degrees Fahrenheit). For uncircumcised males, push the foreskin down the shaft of the penis and clean the head (glans) of the penis. The glans of the penis should be washed using a circular motion from the opening of the urinary meatus outward. Wash the shaft of the penis using downward strokes. Dry well. Remember to move the foreskin back up. If the foreskin is not reduced (put back into its original place), swelling will result due to circulation of blood to the penis being cut off.
8. Observe the penis for sores, open or red areas, and broken skin.
9. Attach the condom catheter to tubing of the collection system.
10. Push pubic hair away from the shaft of the penis to prevent it from sticking to the skin protectant or condom.
11. Apply skin protectant to the shaft of the penis and allow to dry. It will be sticky.
12. Hold the base of the penis with your non-dominant hand. With your dominant hand, roll the condom catheter onto the penis, starting at the tip of the penis and then over the shaft of the penis, toward the base. Leave about 1 inch of space between the glans of the penis and the drainage tip to prevent irritation.
13. If tape is being used to secure the condom in place, apply it in a spiral manner, starting at the top of the penis, working downward.
14. Ensure that the tubing for the collection system is connected to the condom.
15. Secure the tubing to the patient’s thigh with tape, a Velcro leg strap, or the method directed by the agency.
16. Ensure that the tip of the condom is not twisted. Ensure the tubing to the collection system is not kinked or twisted. The collection system tubing and drainage bag should always be kept below the level of the bladder. This ensures that urine from the drainage bag does not move back up to the penis.
17. Lower the bed to its lowest position. Ensure bed rails are raised.
18. Discard used supplies.
19. Discard gloves and wash your hands.
20. Document application of the condom catheter and any skin conditions, such as sores, swelling, red, or raw areas observed.

Procedure – Assisting with Cleaning the Skin and Catheter Tubing

Providing personal hygiene care is an important part of the Home Health Aide/Personal Care Aide’s job. Cleaning the catheter tubing should be completed on a daily basis when providing bathing and perineal care for the patient.

1. Explain the procedure to the patient.
2. Wash and dry your hands. Apply gloves.
3. Gather equipment and supplies needed (soap, wash cloth, towel, waterproof pad).
4. Raise the bed to a safe working height. Lock brakes.
5. Provide for patient privacy. Expose only the genital area.
6. Position the patient on their back to expose the perineal area and catheter tubing.
7. Place a towel or disposable protective pad under the patient.Wash the patient’s genital area gently with soap and warm water (no greater than 105 degree Fahrenheit).
8. For males, start at the meatus (urinary opening) and clean outward in a circular motion. Clean the shaft of the penis with downward strokes. For uncircumcised males, gently push back on the foreskin to clean under this area. You should use a clean area of the washcloth with each stroke. Remember to replace the foreskin.
9. For female patients, separate the labia and using a clean part of the washcloth, wipe from front to back on each side, using a clean part of the washcloth for each stroke. Wipe from top to bottom down the middle to the opening of the vagina. Clean the area between the vagina and anus last, washing from front to back. Never move from back to front.
10. Take care to not pull on the catheter at any time, as this could cause injury to the patient. The catheter tip is inside the bladder. Pulling on the tubing could cause injury to the bladder.
11. Hold the tubing with one hand, close to the meatus (urinary opening), while gently cleansing the length of the tubing, starting from the point of entry (urinary opening) and moving down the tubing.
12. A warm soapy washcloth can be used, unless otherwise directed in the Care Plan. Replace with clean washcloths as needed. When done washing the tubing, use a clean, wet washcloth to rinse the tubing.
13. Always move from the urinary opening downward. Never clean the bottom part of the tubing and move toward the urinary opening. This could introduce bacteria into the urinary system.
14. Observe the genital area around the catheter for sores, swelling, crusting, leakage, or bleeding. Document and report these observations.
15. Ensure the catheter tubing is taped or that a catheter securement device is in place, according to the Care Plan.
16. Position the patient so that the catheter tubing does not kink or pull. The urinary drainage bag should be below the level of the patient’s bladder.
17. Dispose of dirty linens and water. Remove the bed protector or towel from under the patient.
18. Lower the bed to its lowest setting and ensure side rails are up for patient safety.
19. Discard gloves and wash your hands.
20. Record time of procedure and any observations or changes in behavior or condition.