Continence advisor Kate Welford explains the pros and cons of indwelling and intermittent catheterisation and how to decide which method is best for a particular situation
Urethral catheters made of reeds, straws or curled palm leaves were used in ancient times and were presumably for intermittent or short term use. Indwelling catheters were not used regularly until Frederick Foley developed the one piece balloon catheter in 1935; this method has become the most common form of bladder drainage. Modern day intermittent self catheterisation (ISC) was introduced in the 1970s as an alternative method of bladder emptying; it has several advantages over indwelling catheterisation:
- Urinary tract infection (UTI): 80% of healthcare associated UTIs are related to indwelling catheters - the presence of a urinary catheter and length of insertion are contributory factors (Department of Health, 2007). Intermittent catheterisation (IC) has a lower risk of infection compared with indwelling catheterisation, and so should be considered in preference to an indwelling catheter (National Institute for Health and Clinical Excellence, 2010);
- Blocked indwelling catheters: blockages often occur as a result of encrustation and cause urinary retention, pain, distress and urine bypassing of the catheter. Intermittent catheters are not left in place long enough to become encrusted and, if the intermittent catheter becomes blocked, it can be easily removed and another reinserted;
- Stricture formation: this can occur following traumatic insertion of indwelling urethral catheters (Pomfret, 2000), or by using a catheter with a larger diameter than required (recommended female 10-12Ch; male 12-14Ch). It may be necessary to use a larger size catheter for stricture dilation. As the intermittent catheter does not remain permanently in the bladder, problems such as blocking paraurethral glands, which can lead to abscess formation, are minimised;
- Promoting independence: indwelling catheters can improve independence and social life but for some patients they can cause a greatly altered body image and indicate a failure of bodily function (Pellatt, 2007). ISC can increase morale and self esteem (Parker, 2008) and reduce dependence on healthcare professionals;
- Sexual function: sexual intercourse with an indwelling catheter is possible although it can be uncomfortable or even painful. ISC can help patients feel less sexually restricted and allow them to enjoy a physical relationship (Parker, 2008);
- Quality of life: Royal College of Nursing (2008) guidelines suggest ISC improves quality of life but research on ISC and quality of life is limited. Shaw et al (2007) identified a positive impact on quality of life by alleviating lower urinary tract symptoms, but research is still needed to compare quality of life using both types of catheter.
Advantages of intermittent catheterisation
- Improves self care and independence
- Reduces risk of urethral trauma and urinary tract infection
- Eliminates problem of catheter encrustation
- Improves body image and expression of sexuality
Source: Getliffe (2003)
Limitations of ISC
ISC may not be possible in those with:
- Profound physical disabilities or poor manual dexterity;
- Psychological barriers to using the technique;
- Small bladder capacity (below 200ml) as this would require frequent catheterisation;
- Inadequate urethral pressure, which makes it impossible to maintain continence between episodes of catheterisation (Pomfret, 2008).
Selecting a method of catheterisation
IC and indwelling catheters are not mutually exclusive and can both be used depending on individual patients’ needs and circumstances (Pomfret, 2008). For example, a wheelchair user who regularly performs ISC may decide to have an indwelling catheter if they are going to take a long flight where toilet facilities may be difficult to manage.
Author Kate Welford, BSc, RGN, is continence adviser, University College London Hospitals Foundation Trust
Department of Health (2007) Saving Lives: Reducing Infection, Delivering Clean and Safe Care. High Impact Intervention No 6. Urinary Catheter Care Bundle. London: DH.
Getliffe K (2003) Catheters and catheterization. In: Getliffe K,
Dolman M (eds) Promoting Continence: A Clinical and Research Resource. London: Bailliere Tindall.
National Institute for Health and Clinical Excellence (2010) Lower Urinary Tract Symptoms: The Management of Lower Urinary Tract Symptoms in Men. London: NICE. guidance.nice.org.uk/CG97
Parker G (2008) An overview of female intermittent catheterisation. Continence Essentials; 1: 60-65.
Pellatt G (2007) Urinary elimination: Part 2 - retention, incontinence and catheterization. British Journal of Nursing; 16: 8, 480-485.
Pomfret I (2008) The use of catheters in patients with urinary incontinence. Continence Essentials; 1: 49-54.
Pomfret I (2000) Catheter care in the community. Nursing Standard; 14: 27, 46-54.
Royal College of Nursing (2008) Catheter Care: RCN Guidance for Nurses. London: RCN.
Shaw C et al (2007) Effect of clean intermittent self-catheterization on quality of life: a qualitative study. Journal of Advanced Nursing; 61: 6, 641-650.
Comparing indwelling and intermittent catheterisation