Nursing care
Intermittent vs indwelling urinary catheters: choice, infection risk and care
Written and reviewed by Dana Whitfield, RN, MSN · 4 min read · Updated October 2026
Short answer
An intermittent catheter is inserted to drain the bladder and removed straight away, while an indwelling catheter stays in place, held by a balloon, and drains continuously into a bag. Intermittent catheterisation is generally preferred for long-term bladder emptying problems because a catheter left in place provides a continuous route for infection.
Focus on dwell time as the key difference
The defining distinction is how long the catheter stays in the bladder. An intermittent catheter is passed, drains urine and is removed, then repeated at scheduled intervals. An indwelling catheter remains for days or weeks, secured by an inflated balloon and connected to a closed drainage system.
Infection risk rises with the duration of catheterisation, so the longer a device stays, the greater the opportunity for bacteria to travel along it. This is why guidelines favour intermittent catheterisation for people with bladder emptying dysfunction, such as some spinal cord injuries, and why indwelling catheters should be removed once no longer needed. Reviewing the need for an indwelling catheter each day keeps this principle in practice.
Know the appropriate reasons for an indwelling catheter
Accepted reasons include acute urinary retention or outlet obstruction, accurate output measurement in critically ill patients, selected surgical procedures, helping sacral or perineal wounds heal in incontinent patients, prolonged immobilisation, and comfort at the end of life. Each indication implies the catheter's need should be reviewed as the situation changes.
An indwelling catheter is not a substitute for incontinence care, and it should not be inserted simply to collect a urine specimen from someone who can void. On the exam, options that place a catheter for staff convenience, or keep one in without a documented reason, are generally incorrect choices.
Compare the care each type requires
Indwelling catheter care centres on the closed system. Keep the drainage bag below bladder level and off the floor, keep tubing free of kinks, secure the catheter to limit movement and urethral trauma, and use standard precautions when emptying the bag. Catheters are changed according to clinical need, such as blockage, rather than on a fixed routine. Record urine colour, volume and any sediment so changes are noticed early.
Intermittent catheterisation is done at regular intervals to prevent bladder overdistension. In acute care it uses aseptic technique, while in the community clean technique is an acceptable and practical alternative for people who catheterise long term. Some units use a bladder scanner to decide when catheterisation is needed, reducing unnecessary insertions.
Teach to the device the person goes home with
People performing self-catheterisation need hand hygiene, the correct technique for their equipment, a timetable that prevents overfilling, and recognition of infection signs such as fever, cloudy or offensive urine and new pain. Teach-back is useful, and practice under supervision before discharge builds confidence and reveals technique errors.
People going home with an indwelling catheter need to know how to keep the bag below the bladder, change between leg and night bags without breaking the system unnecessarily, and report blockage, bypassing, blood, fever or pain. Discussing adequate fluid intake within any prescribed limits is part of routine teaching.
Work through a hypothetical catheter decision
Consider a hypothetical client recovering from surgery whose indwelling catheter was placed for the procedure. Two days later they are mobile, alert and continent, and a colleague suggests leaving the catheter in until discharge to save trips to the bathroom. The options include agreeing, changing the bag, or raising removal with the prescriber.
Raising removal is the strongest response, because the original indication no longer applies and every extra day adds infection risk. Convenience is not an appropriate reason to keep a catheter. After removal, the nurse monitors voiding and, if the client cannot empty their bladder, follows the protocol, which may include a scan and intermittent catheterisation.
Sources and further reading
CDC: CAUTI Guideline Summary of Recommendations. Appropriate and inappropriate indwelling catheter uses, preference for intermittent catheterisation, clean technique, regular intervals, closed drainage, bag position and change based on need.
NHS: Urinary catheters. Definitions of intermittent and indwelling catheters, reasons for use, infection risk rising with duration and other complications.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our basic care and comfort practice questions are the closest set to what this page covers.
One question from the basic care and comfort set
A nurse is preparing to feed a client who had a stroke and has mild dysphagia. Which action best reduces the risk of aspiration?
Rationale
Upright at 90 degrees with a chin tuck narrows the airway entrance and directs the bolus toward the esophagus — it is the single highest-yield positioning intervention for dysphagia. Thin liquids and straws move fastest and aspirate most easily, side-lying removes the gravity you want, and large bites overwhelm a swallow that is already impaired.
Answer: B
Common questions
Why is intermittent catheterisation associated with less infection?
The catheter does not remain in the bladder, so there is no continuous pathway for bacteria along the device. Guidelines prefer it for long-term bladder emptying problems when it is practical.
Is clean technique acceptable for intermittent catheterisation?
For people who catheterise long term outside acute care, clean technique is considered an acceptable and practical alternative to sterile technique. Acute care settings use aseptic technique.
Should indwelling catheters be changed on a fixed schedule?
Current guidance supports changing them based on clinical need, such as blockage or infection, rather than at fixed intervals. Follow local policy and the manufacturer's instructions.