Tags

clean technique self-catheterization

  • Complications - Intermittent Catheters

    Urethral Adverse Events  |  Scrotal Complications  |  Bladder-related Complications  |  Pain  | Urinary Tract Infections  |  Causes of IC-related UTIs  |  Video Lecture  |  References

    Intermittent catheterization (IC) is the preferred procedure for people with incomplete bladder emptying not satisfactorily managed by other methods. Complications and adverse events can arise in both men and women but are seen especially in male patients performing intermittent self-catheterization long-term.

    References: Intermittent catheterization (IC) is the preferred procedure for people with incomplete bladder emptying not satisfactorily managed by other methods. Complications and adverse events can arise in both men and women but are seen especially in male patients performing intermittent self-catheterization long-term. Urethral/scrotal events can include bleeding, urethritis, stricture, the creation of a false passage, and epididymitis. Bladder-related events can cause UTIs, bleeding, and stones. The most frequent complication of IC is urinary tract infection (UTI).
    Published February 1, 2013
  • Definition - Intermittent Catheters

    Intermittent catheterization (IC) is the insertion and removal of a catheter several times a day to empty the bladder. This type of catheterization is used to drain urine from a bladder that is not emptying adequately or from a surgically created channel that connects the bladder with the abdominal surface (such as Mitrofanoff continent urinary diversion). Intermittent catheterization is widely advocated as an effective bladder management strategy for patients with incomplete bladder emptying due to idiopathic or neurogenic detrusor (bladder) dysfunction (NDO).

    References: Intermittent catheterization (IC) is the insertion and removal of a catheter several times a day to empty the bladder. This type of catheterization is used to drain urine from a bladder that is not emptying adequately or from a surgically created channel that connects the bladder with the abdominal surface (such as Mitrofanoff continent urinary diversion). Intermittent catheterization is widely advocated as an effective bladder management strategy for patients with incomplete bladder emptying due to idiopathic or neurogenic detrusor (bladder) dysfunction (NDO).
    Published February 1, 2013
  • Indications - Intermittent Catheters

    Intermittent catheterization (IC) can be indicated as treatment for voiding problems due to disturbances or injuries to the nervous system, non-neurogenic bladder dysfunction, or intravesical obstruction with incomplete bladder emptying.

    Intermittent catheterization should be performed in the presence of a residual urine volume and symptoms or complications arising from this residual volume of urine.  

    Published February 1, 2013
  • Prevention Strategies - Intermittent Catheters

    Adherence to basic daily prevention habits may help avoid UTIs in the higher-risk intermittent catheterization population.  The table below summarizes this information.

    The most important prevention measures in preventing a UTI are: 

    • adequate education
    • patient compliance
    • the use of appropriate catheter type and material
    • consistent catheterization technique 

    Less frequent catheterization results in higher catheterized urine volumes and places the patient at increased risk for developing a UTI.  More frequent catheterization and the avoidance of bladder overfilling is an extremely important prevention measure.

    Catheterization between four and six times a day is recommended for most individuals. More frequent catheterization, however, increases the risk of introducing harmful bacteria.

    Another measure that may reduce infection is the acidification of urine with cranberry juice or capsules, foods containing lactobacillus, and vitamin C capsules.

    Cranberries inhibit bacterial adherence to the uroepithelial wall and have been primarily studied with Escherichia coli (E. coli). In a community-based survey of patients with a spinal cord injury on intermittent catheterization, it was found that those who ingested cranberry or vitamin C agents decreased their incidence of UTI.

    Suggestions for Prevention of UTIs Associated with Intermittent Catheterization

     

    Maintenance of hygiene, particularly of the hands and perineum

    1. Hands should be thoroughly washed before attempting catheterization
    2. The genitalia should be washed daily with soap and water and always cleansed from front to back
    3. Preferable to perform catheterization before bowel program to minimize E. coli bacteria contamination of the urethra
    4. Immediate perineal hygiene is recommended after vaginal intercourse  
    5. Avoidance of spermicidal lubricants in sexually active females because these products may lower urethral flora

      2.   Teach male patients the correct positioning of the male urethra during insertion of the catheter to minimize trauma 

      3.   Be careful to avoid touching the tip of the catheter and/or letting it touch other surfaces

      4.   If a postmenopausal female patient has hypoestrogenized perineal tissue, consider transvaginal estrogen medication

      5.   Use a generous amount of lubricant along the length of the catheter, since dry catheters may cause excoriations in the
            urethra, leading to an entry point for bacteria contamination

      6.   Keep the bladder as empty as possible by having patients catheterize at least four to six times a day 
            Keeping the bladder as empty as possible will prevent over-distension of the bladder 

      7.   Encourage use of a new catheter each time performing intermittent catheterization  
            Most catheters are manufactured and packaged for single sterile use

      8.   Acidification of the bladder may prevent bacterial growth 
            In non-catheterizing populations, cranberry capsules and juice have been shown to help prevent the growth of bowel
            bacteria in the urethra and the bladder
            Cranberry ingestion may be contra-indicated in some patients (patients prone to oxalate or uric acid calculi) 
            Cranberry is contraindicated in patients on anticoagulation therapy and should not be recommended to this group
            Lactobacillus in the diet (yogurt) has been shown to prevent E. coli from growing in the urethra
            Hiprex® 1000 mg combined with vitamin C 1000 mg capsules twice daily is thought to acidify urine enough to prevent
            bacterial growth in the bladder and is recommended in patients with recurrent UTIs

    References

    Hess, M.J., Hess, P.E., Sullivan, M.R., Nee, M., & Yalla, S.V.Evaluation of cranberry tablets for the prevention of urinary tract infections in spinal cord injured patients with neurogenic bladder. Spinal Cord, 2008; 46(9), 622-626. 
    Igawa, Y., Wyndaele, J.J., & Nishizawa, O.  Catheterization: Possible complications and their prevention and treatment. International Journal of Urology, 2008; 15(6), 481-485.
    Jepson, R.G., & Craig, J.C.  Cranberries for preventing urinary tract infections. Cochrane Database System Review, 2, 2008 CD001321.
    Newman, D.K., Fader, M., & Bliss, D.Z. (2004). Managing incontinence using technology, devices and products. Nursing Research, 53(6, Suppl.), S42- S48.
    Newman, D.K., & Wein, A.J.  Managing and treating urinary incontinence (2nd ed). 2009 Baltimore: Health Professions Press.
    Woodbury M.G., Hayes K.C., & Askes H.K. Intermittent catheterization practices following spinal cord injury: A national survey. Canadian Journal Urology, 2008; 15(3), 4065-4071.
    Wyndaele, J.J. Complications of intermittent catheterization: Their prevention and treatment. Spinal Cord, 2002; 40(10), 536-541.
    Published February 1, 2013
  • Techniques and Procedures for Use - Intermittent Catheters

    Techniques & Procedures for Use
    References: Medicare Changes Reimbursement Policy to End Re-use of Intermittent Catheters.  This change allows for up to 6 catheter changes a day in hopes to stop re-use of FDA labeled "single-use" catheters. The old policy made individuals sterilize and clean their catheters any way they knew how which lets a very high-risk opportunity to have the individual get infected with catheter-associated bacteria to arise.  No longer will catheter users suffer from severely painful UTIs.
    Published February 1, 2013
E-Newsletters

Newsletter subscription

Free Daily and Weekly newsletters offered by content of interest

The fields of GU Oncology and Urology are rapidly advancing. Sign up today for articles, videos, conference highlights and abstracts from peer-review publications by disease and condition delivered to your inbox and read on the go.

Subscribe