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Common problems with intermittent self catheterisation

Director of continence services Ann Yates describes problems that may occur during intermittent self catheterisation and their remedy.

Blood on tip of catheter during catheterisation

This is a common problem (Royal College of Nursing, 2008). Reassure the patient that it can be caused by the catheter scratching the delicate lining of the urethra on insertion or removal. If bleeding is heavy or clots appear they should seek medical help or contact their specialist nurse.

Insertion difficulties

Men may have difficulty inserting the catheter past the prostatic bed or through tense sphincter muscles. Advise them to relax, take some deep breaths and to give a slight cough when they insert the catheter. If they still fail, they should contact the specialist nurse.

Women may have difficulty identifying the urethra. Assessment and instruction by a professional skilled in teaching intermittent self catheterisation (ISC) will help to alleviate some of these difficulties (Skills for Health, 2007) and they will also be able to access assistance aids (RCN, 2008) - see page 12 for more information.

Removal difficulties

Advise the patient to relax and the catheter will usually come out. Coughing may help. Rotating it may help ease removal if the bladder mucosa is sucked into the eyes of the catheter (RCN, 2008).

False passage

This is rare and occurs when a catheter has been inserted aggressively through a weak part of the urethra. Symptoms include pain, bleeding and no drainage of urine. Patients need immediate medical attention (RCN, 2008).

Leakage in between catheterisation

Leakage can occur for a variety of reasons including:

  • Stress urinary incontinence;
  • Too long an interval between catheterisation, resulting in overflow;
  • Overactive bladder symptoms.

These problems require individual assessment and an appropriate treatment plan.

Urinary tract infections

Patients undertaking ISC should be offered antibiotic therapy for symptomatic urinary tract infections confirmed by microscopy and culture. If recurrent infections occur it is important to review ISC technique, frequency, levels of hygiene and type of catheter used.

Ann Yates, BN, DipN, FETC, RGN, is director of continence services, Cardiff and Vale University Health Board

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