Intermittent Catheters Articles

Articles

  • Best Practices for Management - Intermittent Catheters

    Intermittent catheterization can have a significant physical and/or emotional impact on patients’ lives.

    Written by: Diane K. Newman, DNP, ANP-BC, FAAN
    Published February 1, 2013
  • 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.

    Written by: Diane K. Newman, DNP, ANP-BC, FAAN
    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 March 4, 2020
  • Definition - Intermittent Catheters

    What is an intermittent urinary catheter?

    Intermittent catheterization (IC) is the insertion and removal of a catheter several times a day to empty the bladder. The purpose of catheterization is 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).

    catheter

    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).

    Written by: Diane K. Newman, DNP, ANP-BC, FAAN
    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 November 29, 2019
  • Indication of Catheterization for Intermittent Catheters (IC)

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

    Written by: Diane K. Newman, DNP, ANP-BC, FAAN
    Published March 4, 2020
  • Intermittent Catheter Types

    The number of catheter types and designs has increased with the advancement of new technology. This has added complexity to the catheterization process for both the nurse and the patient

    General Considerations

    Intermittent catheter types and sizes

    Catheter Sizing

    Catheter types are now gender specific, acknowledging the anatomical differences in urethral length between men and women.

    • Standard male catheter length is 16” (~40cm)
    • Female catheters range in length from 6-12
    • Pediatric lengths are 6-10”.

    Many women find that shorter catheters do not shift and are easier to grasp and insert.

    Measurement Units

    A catheter diameter is measured in French units, similar to the size of indwelling urinary catheters.  Sizes range from 6-12 French for children and 14-22 French for adults. The funnel end of the catheter is often color coded to allow for easier size identification.  

    Catheter Sizes

    Packaging

    Some catheters are sold individually packaged, are more compact, and can be easily carried in a purse or pocket.  

    Different style of intermittent catheter packaging

    Intermittent Catheter Types

    There are two main designs of catheters used for intermittent bladder drainage: coated and uncoated.

    Noncoated

    Noncoated catheters require separate external gel lubrication, before insertion and catheters with a coating that provides the lubrication when water is applied.  Uncoated red rubber catheters are not appropriate for anyone with latex sensitivities and the flexibility of a red rubber catheter can make it difficult to insert.

    Coated

    Coated catheters are designed to improve catheter lubrication and ease of insertion, which may reduce trauma and urinary tract infections. The most common coating is a hydrophilic coating as there is evidence supporting single-use HC catheters’ ability to prevent some of the most common catheter-associated complications, such as urethral trauma and CaUTIs.   

    In addition, design changes include the integration of all needed equipment (such as catheter, water-based lubricant, and drainage receptacle/ bag) into a compact and user-friendly system (closed system). The clinician who instructs the patient usually recommends the catheter choice, so knowledge of the different types of catheters is important.

    Impact of Packaging

    Standalone catheter

    The type of catheter packaging can be decisive in the choice of a catheter. Consideration is made to the general clinical condition of the patient (injury, hand dexterity, any visual impairment, urethral considerations, gender, and age, are also considered before the cause of the bladder dysfunction.

    The patient may need to try several catheters before finding the preferred type. Often patients require one type of catheter for use in their home and another for use when traveling or working or bring away from their own home.

    Comparison of Types

    Types

    Characteristics

    Concerns

     Non-coated

    • Most commonly used catheter - made of medical-grade plastic (PVC) or silicone
    • Available in range of stiffness
    • Generally packaged with a seperate gel. Usually in a foil packet that must be opened and applied directly to the catheter prior to insertion.

     

    • Applying the lubrication gel is an extra step, can be messy, and can be difficult to ensure complete lubrication of the entire catheter.

     

     Hydrophilic coated (HC) 

     

    • Have a polymer coating that adheres to the catheter surface that becomes slippery and smooth when wet. Coating ensures lubrication of the entire urethra during the catheter insertion and withdrawal, thereby reducing the coefficient of friction by at least 95%. Developed with the goal of reducing trauma during the catherterization process.

     

    • Becomes slippery and the sleeve provides ease for the patient to grasp and manipulate for insertion.
    • Single use only.
    • May not be covered by patients medical insurance.

     Closed systems

    • Gel
    • Hydrophilic
    • Antibacterial 
    • Pre-lubricated intermittent catheter with an attached collection bag and often includes a protective introducer tip
    • All inclusive - includes gloves, drape, underpad, antiseptic wipe or swabs 
    • Allows user to catheterize without touching the catheter 
    • Used for sterile technique 
    • Can be difficult for some with limited dexterity to advance the catheter through the collection bag
    • Single use only 

     

    Video Lecture - Catheter Types and Designs


    ic types designs part1

     


    animation

    References

    1. Chartier-Kastler E, Amarenco G, Lindbo L, et al. A prospective, randomized, crossover, multicenter study comparing quality of life using compact versus standard catheters for intermittent self-catheterization. J Urol. 2013;190(3):942-947.
    2. Christison K, Walter M, Wyndaele JJM, et al. Intermittent catheterization: The devil is in the details. J Neurotrauma. 2018 Feb 1. doi: 10.1089/neu.2017.5413doiChristison K, Walter M, Wyndaele JJM, et al. Intermittent catheterization: The devil is in the details. J Neurotrauma. 2018 Feb 1. doi: 10.1089/neu.2017.5413
    3. DeFoor W, Reddy P, Reed M, et al. Results of a prospective randomized control trial comparing hydrophilic to uncoated catheters in children with neurogenic bladder. J Pediatr Urol. 2017.
    4. Goetz LL, Droste L, Klausner AP, Newman DK. Catheters Used for Intermittent Catheterization. Clinical Application of Urologic Catheters, Devices and Products. Cham: Springer International Publishing; 2018:47-77.
    5. Håkansson MA. Reuse versus single-use catheters for intermittent catheterization: what is safe and preferred? Review of current status. Spinal Cord. 2014;52(7):511-516.
    6. Newman DK. Devices, products, catheters, and catheter-associated urinary tract infections. In: Newman DK, Wyman JF, Welch VW, editors. Core Curriculum for Urologic Nursing. 1st ed. Pitman (NJ): Society of Urologic Nurses and Associates, Inc; 2017. p.439-66.
    7. Newman DK, Willson MM. Review of intermittent catheterization and current best practices. Urol Nurs. 2011 Jan-Feb;31(1):12-28, 48; quiz 29. PubMed PMID: 21542441
    8. Rognoni C, Tarricone R. Intermittent catheterization with hydrophilic and non-hydrophilic urinary catheters: systematic literature review and meta-analyses. BMC Urol. 2017;17(1):4.
    9. Shamout S, Biardeau X, Corcos J, Campeau L. Outcome comparison of different approaches to self-intermittent catheterization in neurogenic patients: a systematic review. Spinal Cord. 2017;55(7):629-643.
    10. Sun AJ, Comiter CV, Elliott CS. The cost of a catheter: An environmental perspective on single-use clean intermittent catheterization. Neurourol Urodyn. 2018;37(7):2204-2208.


    Last Updated: August 2019

    Written by: Diane K. Newman, DNP, ANP-BC, FAAN
    Published March 3, 2020
  • Techniques and Procedures for Use - Intermittent Catheters

    Techniques & Procedures for Use

    Written by: Diane K. Newman, DNP, ANP-BC, FAAN
    References: 1. Beauchemin, Lisa, Diane K. Newman, Maureen Le Danseur, Angela Jackson, and Mike Ritmiller. "Best practices for clean intermittent catheterization." Nursing2019 48, no. 9 (2018): 49-54.

    2. Goetz, Lance L., Linda Droste, Adam P. Klausner, and Diane K. Newman. "Catheters used for intermittent catheterization." In Clinical Application of Urologic Catheters, Devices and Products, pp. 47-77. Springer, Cham, 2018.

    3. Lapides, Jack, Ananias C. Diokno, Sherman J. Silber, and Bette S. Lowe. "Clean, intermittent self-catheterization in the treatment of urinary tract disease." The Journal of urology 107, no. 3 (1972): 458-461.

    4. Lindehall, B., K. Abrahamsson, U. Jodal, I. Olsson, and U. Sillén. "Complications of clean intermittent catheterization in young females with myelomeningocele: 10 to 19 years of followup." The Journal of urology 178, no. 3 (2007): 1053-1055.

    5. Moore, Katherine N., Jean Burt, and Donald C. Voaklander. "Itermittent catheterization in the rehabilitation setting: a comparison of clean and sterile technique." Clinical rehabilitation 20, no. 6 (2006): 461-468.

    6.Moore, Katherine N., Mandy Fader, and Kathryn Getliffe. "Long‐term bladder management by intermittent catheterisation in adults and children." Cochrane Database of Systematic Reviews 4 (2007).
    Published February 5, 2020
  • The Effect of Bladder Catheterization Technique on Postoperative Urinary Tract Infections After Primary Total Hip Arthroplasty.

    Urinary bladder catheters are potential sources of infection after total hip arthroplasty (THA). Therefore, the goal of this study was to determine if intermittent catheterization provides a decreased risk of postoperative urinary tract infections (UTIs) compared with indwelling catheterization in THA patients.

    Published February 25, 2020