Certified Nursing Assistants (CNAs) serve as direct caregivers, providing a majority of the hands-on assistance patients require daily. Understanding the legal and professional boundaries of their role is important for patient safety. For specific procedures, such as those involving urinary catheters, the question of a CNA’s scope of practice often arises. A CNA’s ability to perform a task depends on the nature of the procedure itself, the direction of a supervising nurse, and specific state regulations.
The Critical Distinction: Maintenance Versus Insertion
Changing a drainage bag is generally considered routine maintenance of a pre-existing medical device. This process involves disconnecting the tubing from one collection bag and connecting it to another, such as switching from a leg bag used during the day to a larger night bag. It is a non-invasive procedure focused on managing the external drainage system.
The procedure CNAs are universally prohibited from performing is the insertion of the catheter itself. Catheter insertion requires introducing a sterile tube through the urethra into the bladder, which is considered an invasive procedure that carries significant risk of infection. This task requires specialized training in sterile technique and anatomical knowledge, placing it firmly within the scope of practice for licensed nurses (RNs or LPNs).
Delegation and the Standard CNA Role
Emptying or changing a catheter drainage bag is a task that a CNA may perform under the process known as delegation. Delegation occurs when a licensed nurse (RN or LPN) authorizes a competent, unlicensed person to perform a specific task for a patient. The nurse determines that the task is appropriate for delegation, which is usually the case for routine drainage bag changes.
The nurse retains accountability for the patient’s overall care, but the CNA is responsible for performing the delegated task correctly. Before accepting a delegated task, the CNA must receive specific training and demonstrate competence in the procedure, ensuring they can perform it safely. This includes understanding infection control principles, such as maintaining a closed system and performing hand hygiene to minimize the risk of catheter-associated urinary tract infections (CAUTIs).
CNAs are expected to follow specific steps, like ensuring the new bag is connected without contamination and that the drainage bag is always positioned below the level of the patient’s bladder to prevent backflow. The CNA must promptly report any issues, such as tubing obstruction, leakage, or changes in the urine’s appearance, back to the supervising nurse.
State Regulations and Facility Policy Variations
The ability of a CNA to change a catheter bag is not uniform across the United States; it is governed by the Nurse Practice Act (NPA) of the state where the CNA is employed. These state laws define the legal scope of practice for all levels of nursing personnel, including the parameters for delegation. While many states permit the delegation of catheter bag changes, some states have specific training or certification requirements, sometimes classifying the task as an advanced skill requiring a Nurse Aide II certification or equivalent.
Specific facility policies can create additional restrictions that go beyond state law. A facility might prohibit CNAs from performing any type of catheter tubing disconnection, regardless of what the state NPA allows. Therefore, a CNA must always adhere to the most restrictive rule, whether it is the state law or the employer’s policy. CNAs should consult their facility’s policy manual and supervising nurse to confirm authorized tasks.