Part 3 in this series on urinary catheters explains the procedure of self-catheterisation
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Citation: Yates, A. (2008) Urinary catheters part 3 - intermittent self-catheterisation. Nursing Times; 104: 41, 26-27.
Author: Ann Yates, BN, DipN, FETC, RGN, is director of continence services, Cardiff and Vale NHS Trust.
Intermittent catheterisation (IC) is the passing of a catheter (Fig 1) into the bladder to remove urine with the catheter then being immediately removed. Patients who need to undertake intermittent self-catheterisation (ISC) have voiding or storage problems, resulting in retention of urine. These patients include those with spinal injuries, spina bifida, outflow obstruction, post-surgery and neurological disorders. A catheter can also be used to dilate the urethra after urethrotomy.
It is important that catheterisation is carried out often enough to prevent bladder distension and the frequency will depend on the individual’s bladder assessment. This may be up to six times daily for bladder emptying. Patients are normally taught how to undertake the procedure themselves.
It is vital that the patient is able to store urine in their bladder. Patients must be able to understand the technique for ISC, have reasonable dexterity and mobility and be motivated to commit to the procedure. However, if a patient is unable to undertake this procedure, a carer/partner may undertake the catheterisation. If the procedure is carried out in hospital by a healthcare professional, an aseptic technique must be used (RCN, 2008; Skills for Health/RCN, 2008).
There are advantages to undertaking ISC including: minimising urinary tract complications; maintenance of normal bladder function; and improved quality of life for patients as they become less reliant on continence aids. However, there are complications, which increase with long-term use, including: urinary tract infections; prostatitis; and trauma including haematuria, urethral strictures and false passages.
There are a wide range of intermittent catheters available on the drug tariff. Hydrophilic coated (single use) require water to activate and hydrate the coating (Fig 2).
Some hydrophilic catheters come with their own water supply. Pre-gelled (single use) have integral gel in the pack while reusable Nelaton catheters (single patient use) can be used with water-soluble lubricating/anaesthetic gel at home (Association for Continence Advice, 2008). This type of catheter can be reused at home as it can be cleaned with soap and water/boiled/disinfected/microwaved, air dried and stored in a plastic bag/box (Fig 3).
The type of catheter used should be guided by research and patient choice. The Charriere (Ch) or French gauge is the external diameter of the catheter. Sizes range from 6Ch-24Ch. Intermittent catheters used for children would normally be 6Ch-10Ch, adults 10Ch-14Ch and, for dilation, 16Ch or higher.
- The patient must be fully assessed, understand why they have to undertake the procedure and what is involved. Consent should be obtained and recorded. Training should be provided at the patient’s own pace and may take more than one session.
- Patients should identify a position comfortable for them to undertake ISC, for example sitting on the toilet, standing over the toilet, sitting on a chair or side of the bath, one leg slightly elevated on a stool, sitting in a wheelchair or lying on their side in bed.
- It is important that patients are instructed on hand hygiene, including cleaning their nails, and not to touch anything other than items needed until the procedure is complete. This is to prevent infection and should always be undertaken before starting the procedure.
- Patients should prepare the catheter according to the manufacturer’s instructions. They should try to pass urine prior to catheterisation if at all possible.
- Wash the genital area. Women should wash from the urethra towards the anus. Advise them to part the labia with index and middle finger of the non-dominant hand, and identify the urethra. Some women like to use a mirror, others prefer to identify by touch (Fig 4). Men should retract the foreskin to clean the glans. Advise them to hold the penis with the non-dominant hand pointing in an upward direction towards the stomach. This helps to extend the urethra and makes it easier to insert the catheter.
- Gently insert catheter into the bladder (Fig 5), pointing the funnel end into the toilet or collection receptacle (Fig 6).
- If the patient finds difficulty in inserting the catheter, it may be helpful to cough or advise them to try to pass urine. Continue to insert the catheter until urine starts to flow.
- When urine stops flowing, slowly remove the catheter. If urine starts to flow again, wait and then gently begin to withdraw the catheter to catch any last drops. To avoid any dribbles or spillage place a finger over the funnel before finally removing from the urethra.
- Dispose of the catheter according to manufacturer’s instructions. Single-use catheters should be placed back in their sleeve and discarded in general waste. Do not flush them down the toilet as they may cause blockage. Single-patient-use (reusable) catheters should be cleaned - according to manufacturer’s instructions - after every use and disposed of after one week of use.
- Provide patients with information leaflets and monitoring charts. They should also be advised on hygiene needs, fluid advice, signs of infection, the make and type of catheter they use and how to order further supplies.
- Patients who perform ISC need regular reviews to monitor how they are coping to help them maintain the procedure.
This procedure should be taught only after approved training, supervised practice and competency assessment, and carried out in accordance with local policies and protocols.