How To Stop Someone with Dementia from Pulling Out Their Catheter 

When caring for loved ones with dementia, you may have experienced them fiddling with their catheter and sometimes you’ve had to stop them from pulling out their catheter. It can be very difficult to know what to do. In this article, we’ll look at different ways to prevent someone from pulling out their catheter. This not only reduces the risk of complications such as infections or trauma, but also pain and injury that might require medical help.

Why Someone with Dementia is Pulling Out their Catheter

The behaviour of pulling out catheters can stem from various reasons related to the nature of dementia. Cognitive impairment, including memory loss and reduced understanding of their condition, can make it difficult for loved ones with dementia to understand the purpose, or the need and importance of a catheter for their health. They may feel discomfort or have sensory issues, leading to a desire to remove the catheter.

Our personal experience is mum likes playing with the catheter, the sensory experience, but I also know that she also feels discomfort related to catheter issues that she has dealt with.

Attempts at removing catheters can also stem from restlessness or agitation. Factors such as confusion, discomfort, and the need for sensory stimulation can all contribute to the urge to pulling out their catheter.

It is crucial to understand the underlying reasons behind these behaviours to prevent their recurrence and understand what measures can ease it to ensure effective catheter care. 

Here are some practical strategies to reduce the risk of someone with dementia pulling out their catheter. Some of them may work for you.

Properly Securing the Catheter 

One preventive measure is ensuring the catheter is secured properly to prevent it from being dislodged. Use devices that help keep the catheter in place, and act as a barrier to help keep the catheter in place. You can use leg straps to hold the catheter bag and also a catheter strap to secure the catheter tube to the leg and catheter sleeves to hold the leg bag. You can also consider securing the catheter underneath the thigh with tape, so there is no gap suggested for high risk cases  

Protective Clothing and Equipment 

In some cases, using protective clothing and equipment can provide an additional layer of security. We’ve used leggings, you can try tights, tracksuit bottoms, long johns, lycra shorts etc that can all help keep the catheter out of sight and out of reach. I know that some families have provided mittens at night in particular to reduce pulling or grabbing at the catheter, but that has to be agreed with your loved one. The same confusion or memory impairment that can cause someone to pull at “the foreign object” in confusion would also apply with mittens or body suits. They can be scary or confusing to loved ones with dementia, especially if waking from sleep, so discuss it carefully and weigh up the pro & cons of using things that can limit movement.

I know my mum prefers clothing that hides the catheter rather than mittens that restrain her!  Hiding the catheter from mum with clothing and catheter sleeve has been the significant change for us and has reduced the frequency of mum pulling on her catheter.

Check for Discomfort 

Ensure the catheter has been fitted & draining properly. If there is a kink in the catheter in any way, it can cause the buildup of urine in the bladder and increasing the feeling of “needing to go” for your loved one, resulting in them tugging at the catheter. Are there any signs of a UTI present, which could cause itching or pain and increase the likelihood of your loved one attempting to remove the catheter? Your loved one may be experiencing discomfort from bladder spasms or catheter movement, all contributing to the need to pull or tug the catheter out. Regularly assess the need for adjustments or need for medical treatment to improve comfort levels for your loved ones. 

Related: Indwelling Catheter -11 Things You Should Know!

Distraction Techniques 

Engaging your loved one with meaningful activities and providing sensory stimulation can help redirect their attention away from the catheter. Distraction techniques, such as listening to music, engaging in gentle exercises, or participating in recreational activities, can help reduce the likelihood of catheter removal. The use of sensory items like fidget blankets or fidget toys can also help minimise catheter pulling from “busy hands”. Fidget blankets are helpful, in our case, and we use various sensory items as mum likes to stroke and pull things with her right hand in particular. You know your loved one best. What can help to distract them from this behaviour?  

Related: How to make a Dementia Fidget Blanket from a Cushion

Environmental Adjustments 

Creating a safe and comfortable environment plays a crucial role in preventing catheter-related incidents. Making environmental adjustments can help minimise restlessness and agitation, which may contribute to the urge to pull out the catheter. Ensure a calm and clutter-free space to promote a sense of ease. Think about incorporating visual cues to remind your loved one about the catheter and reduce the risk of its removal. Provide emotional support and reassurance by communicating calmly, using gentle touch, and explaining the process can help alleviate anxiety and promote a sense of security, reducing the risks of catheter being pulled. 

Related: 12 Tips to Ease & Prevent Dementia Anxiety and Agitation for Caregivers

Decoy Catheter 

If all else fails , what about a fake decoy catheter? You can secure a decoy catheter to the leg, firmly enough for it not to be removed easily. This can help to distract your loved one from pulling out the real catheter.

“Multiple decoy catheters can be used if necessary to keep confused patients occupied. This has proven to be a very simple and effective technique for protecting Foley catheters from even the most persistent patients who seem determined to pull out their Foleys traumatically” 

Prevention of Inappropriate Self-Extraction of Foley Catheters

Monitoring and Assessment 

As dementia caregivers, you’ll be regularly monitoring the catheter, being on high alert, especially on days where your loved one is agitated or distressed to ensure it’s not dislodged or pulled out. Monitoring closely and assessing the situation is the only thing you can do.

However, educating yourself on catheter & dementia care, talking to your health team, urologist etc can all help in improving your knowledge to be able to deal with most situations. But sometimes you many need to discuss the removal of the catheter, especially where injury is occurring or distress outweighs the benefits. Your doctor will advise if that is an option like removing the catheter or suggesting alternative catheter types  

Alternative Catheter Types  

You’re loved one may want to try alternative catheter types if the use of Foley indwelling catheter can’t be tolerated. Speak to your doctor or urologist about the different options. These can include: – 

Intermittent Catheters 

These catheters are inserted into the bladder to drain urine and are removed once the bladder is empty. Intermittent catheterisation may be suitable for loved ones who can do this themselves, in some cases, a district nurse could train a caregiver to be able to do this for a loved one if they’re unable to do it themselves. Again, there are issues of how traumatic being repeatedly catheterised multiple times during the day for someone living with dementia can be.

Suprapubic Catheters  

These can be considered for someone with dementia who continually removes their traditional Foley catheters. One such alternative is the suprapubic catheter. This type of catheter is surgically inserted through the abdominal wall. Suprapubic catheters may be used for acute or chronic conditions, providing a more secure and stable solution. They offer less variable discomfort levels and can be hidden with clothing but can still be subjected to pulling or tugging.

External Condom Catheter  

Another alternative is the external condom catheter. These are specifically designed for males with incontinence. They are placed over the penis and connected to a drainage bag, serving as an alternative to indwelling urinary catheters. Condom catheters need to be replaced daily, ensuring proper hygiene and minimizing the risk of infection. 

Conclusion

Our aim, as dementia caregivers, is to support and ensure our loved one’s comfort and well-being, but sometimes that’s complicated when your loved one keeps pulling out their catheter. Preventing that is crucial for maintaining their safety and ensuring effective catheter care. Implementing these strategies, you can significantly reduce that risk or, if need be, decide to investigate other catheter options.