Toileting.


        A care recipient may need assistance with toileting. If they can’t use the toilet in the bathroom, the family caregiver will need to help with the use of a bedpan or a commode. You may have to help the care recipient who can use the toilet, but is unable to do it alone. A bedpan is used when the care recipient cannot get out of bed. Sometimes, it is used only at night, when it is more difficult to get to the regular toilet. Women use the bedpan for urination and bowel movements, while men use the bedpan usually for a bowel movement only. Bedpans are made of plastic or stainless steel. A stainless-steel bedpan should be lightly warmed before use, by running warm water over it. The bedpan is cleaned after each use and is stored covered. The bedpan should be cleaned immediately after it is used. This will prevent the spread of microorganisms, the development of odors, and possible spilling of the contents. Clean by emptying the contents in the toilet, rinsing in cold water, and wiping both the inside and outside with disinfectant. When the care recipient can get out of bed, but is still unable to get to the regular toilet, a bedside commode may be used. A bedside commode is a portable chair with an open center for voiding. The collection holder may be a bedpan or pail that needs to be emptied and cleaned after use, as the bedpan is. Good hygiene following toileting is very important in the prevention of urinary tract infections. Remember to always wipe the genital area from front to back and change the location on the washcloth with each wipe. Use soap and water or pre-moistened wipes.

        When assisting the care recipient with toileting, follow these general rules:

  • Help them with a toileting as soon as requested.
  • Have the care recipient assume a normal voiding position of sitting upright whenever possible. 3. Make sure the bedpan is warm.
  • Always ensure the care recipient’s privacy.
  • Make sure the care recipient is covered for warmth.
  • If the care recipient is weak, provide assistance.
  • When a care recipient is strong enough to be alone, leave for 5 minutes to use the bedpan, commode, or toilet.
  • Always make sure toilet paper is within easy reach for the care recipient.
  • Provide perineal care as needed.
  • Allow the care recipient to wash his/her hands and genital area after using the bedpan, commode, or toilet. Assist when necessary.
  • Offer the opportunity for toileting regularly, as the care recipient may not ask.

        Confused, frail, or unsteady clients may need to be helped to the bathroom regularly to avoid toileting accidents and injuries from falls.

  •  Follow the procedure for transfers, if necessary.
  • Assist the client to loosen and remove clothing before being lowered onto the toilet.
  • Provide toilet tissue. Provide privacy, if possible. Leave the client alone only if safe.
  • Leave the bathroom door unlocked and stay close to the door so you are available to assist if needed.
  • After using the toilet the client may need help to clean the genital area:
  • WEAR GLOVES. Wipe from the front to the back; from cleanest to most soiled area.
  • Remove gloves and wash hands.
  • Assist the client to re-dress as necessary.
  • Encourage the client to wash hands after using the toilet.
Assisting with a Commode

        A commode is used for clients who are able to get out of bed but not able to walk to the bathroom. It is a chair with a toilet seat positioned over a removable container and is often left at the bedside. Some commodes have wheels, which should be locked for the safety of the client.

        The commode should be emptied and washed out after each use to avoid the spread of infection and to reduce odors. Toilet tissue and hand washing supplies should be kept next to the commode. (Follow the above guidelines to assist the client in using the commode).

Cleaning the commode
WEAR GLOVES
  • Remove the container from the commode and empty contents into the toilet. Avoid splashing.
  • Swish a mixture of household disinfectant (Lysol or bleach) and water. Use a toilet brush if necessary.
  • Rinse with clear water and dry the outside with paper towels.
  • Replace the container.
  • Remove gloves and wash hands thoroughly.
Assisting with the Urinal

        Urinals are used by men for urination. They are jug-like containers with handles that allow them to be hooked onto the sides of beds or chairs. The urinal can be used with the man standing, sitting, or lying down. The more normal position for male urination is standing; attempt to help the client to stand if possible.

Procedure:
  •       Wash hands and gather equipment: Urinal, disposable gloves, washcloth, and towel (perhaps basin, soap, and water).
  •       Ask the client which position he will use.
  •       Assist him to stand or sit at the edge of the bed, as necessary.
  •       Offer the urinal to him. (If necessary, put on gloves and assist him to place his penis into the urinal).
  •       Provide privacy for the client.
  •       Ask him to call when he is finished or if he needs help.
  •       Step away or out of the room if he can be left alone briefly. (Remove gloves, wash hands).
  •       Return to the bedside when he finishes urinating. Put on gloves.
  •       Receive the urinal from the client. Offer him the washcloth and towel and encourage him to wash his hands.
  •       Empty the urinal into the toilet. Rinse and disinfect the urinal (using bleach solution, Lysol or another household disinfectant).
  •       Return the clean urinal to the bedside.
  •       Clean up the area and put away supplies.
  •       Remove and discard gloves.
  •       Wash hands thoroughly.
Assisting with a Bedpan

        The client who is confined to bed will need assistance using the bedpan for bowel movements. Female clients will also need to use the bedpan for urinary elimination. As with all personal care procedures, encourage the clients to do for themselves as much as possible. Bedpans are available in different sizes and shapes. Some are made of stainless steel, some are plastic. The traditional bedpan is usually used for larger adult clients. The “fracture pan” is smaller and flatter, often used with children and thin adults.

Procedure for use of the bedpan:
  1. Assemble equipment and supplies:
    • Bedpan
    • Toilet tissue
    • Bed protector (newspaper, towel, plastic trash bag)
    • Disposable gloves
    • Moist washcloth or disposable wipette
  2. Wash hands and put on gloves.
  3. If using a metal bedpan, warm it with warm water before offering it to the client.
  4. Line the bedpan with toilet tissue if the client is having a bowel movement. This will make cleaning easier.
  5. Apply a small amount of lotion or talcum powder to the edge of the bedpan that will come in contact with the client’s skin. This will prevent the skin from “sticking” to the pan.
  6. Have the client remove clothing from the lower body. Help with undressing as necessary. Provide privacy by covering the client with a sheet or towel.
  7. Have the client lie on their back, knees bent, feet flat on the bed, and raise her hips on the count of three. Work together to save energy.
  8. Quickly place the bed protector on the bed and slide the pan under the client’s hips. Have client lower their hips once the pan in its place. OR if the client is unable to lift their hips, have the client roll onto their side – away from you. While they are on their side, position the bedpan on their bottom and help them to roll back onto it while you hold it in place.
  9. Use pillows to prop the client into a sitting position, if possible. (Sitting is a more natural position than lying down for elimination). A weaker client may need your assistance to hold her up in a sitting position. Ask the client about the position of the bedpan; it may need to be adjusted for comfort.
  10. Adjust the bed linens to provide privacy.
  11. Leave the toilet tissue within reach.
  12. If the client is strong and reliable enough to be left alone, step out of the room, but stay close by.
  13. Instruct the client to call for you when they are finished with the bedpan.
  14. Leave the room, unless the client can’t be left alone.
  15. Remove gloves and wash hands.
  16. Wait a few minutes until client has finished, then knock and re­ enter the room.
  17. Put on disposable gloves. Place a chair next to the bed. Prepare a warm, wet washcloth and towel and bring them to the bedside.
  18. Have the client roll away from you or lift their hips as before and carefully slide the bedpan out and place it on the bedside chair.
  19. Clean the genital area if the client cannot do so. Clean from front to back using toilet tissue. Provide peri-care if necessary. Use a second washcloth and towel. (See the “Complete Bed Bath” section)
  20. Offer a clean washcloth and towel and encourage the client to wash their hands.
  21. Take the bedpan to the bathroom and pour the contents into the toilet. Avoid splashing.
  22. Rinse and then clean the bedpan with disinfectant and a toilet brush if necessary.
  23. Rinse again and return to its usual place.
  24. Cover the clean bedpan with plastic or a paper towel.
  25. Remove and discard gloves. Clean up the area.
  26. Help the client get dressed if necessary.
  27. Wash hands thoroughly.
Emptying the Catheter Bag

The PCW/P may need to assist a client with emptying the catheter bag. The catheter is a tube that leads into the client’s bladder and drains urine away from the body to a collection bag. The catheter needs to be handled very carefully to avoid introducing germs to the client and causing a bladder infection. The PCWIPshould not disconnect the tubing between the client and the bag.

(        This is a task done only by persons with special training: CNA’s and supervisors.)

Procedure for emptying the catheter bag:
  1. Explain what you will be doing, if necessary.
  2. Gather supplies:
  • Disposable gloves;
  • Container for collecting the urine;
  • Newspaper or other disposable items to protect the floor or bed from spillage;
  • Alcohol wipe or disposable wipe (or paper towel, with soap or disinfectant)Wash hands. Put on gloves.
  1. Spread newspaper under the collection bag.
  2. Locate the clamped hose at the bottom of the collection bag.
  3. Clean the end of the hose with a disposable wipe.
  4. Open the drain and allow the urine to drain into the container.
  5. Be sure that the end of the drain does not touch the container or any other surface. (This could cause contamination of the tubing and create an infection for the client).
Procedure for Cleaning Used Bag:

        This procedure is to be followed only if the client, a family member, or the supervisor has removed the collection bag from the catheter system.

        (The PCW/P should not disconnect the tubing between the catheter and the BAG.)

  1. Wash hands and put on gloves.
  2. Empty urine from bag.
  3. Rinse out urine, allowing water from tap to flow freely through bag.
  4. Wash with hot, soapy water, using an irrigation syringe.
  5. Rinse thoroughly with clear water.
    1. Fill inside of bag with bleach solution (one ounce of bleach to one quart of water, made fresh daily).
    2. Immerse bag in bleach solution (in basin or sink) for 20 minutes to disinfect both outside and inside of bag.
    3. Open lower drain and empty bag.
    4. Close the bottom drain of bag and tuck the drain tube into its pocket.
    5. Fill the bag with air, using an irrigation syringe.
    6. Cap the upper opening and allow bag to dry in a clean place.
    7. If no tubing cap is available, cover end of tubing with a clean piece of plastic or clean gauze.
    8. Clean and disinfect all equipment. Use hot soapy water and a bleach solution.
    9. Dispose of waste, using Standard Precautions.
    10. Remove and discard gloves and wash hands thoroughly.
    11. Once dry, the clean bag and tubing should be stored in a clean plastic bag or covered with a clean towel, ready for re-use.