Intermittent catheterization 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 bladder dysfunction. Catheterization is performed by either sterile or clean technique. Sterile (aseptic) technique implies genital disinfection and the use of sterile catheters, gloves, and other equipment. Clean technique implies the use of disposable or cleansed reusable catheters handwashing with soap and water, and cleansing the perineum only if fecal or other wastes are present. There is no benefit to the use of an antiseptic solution for daily periurethral cleansing prior to catheterization. In 1972, Jack Lapides, a Urologist at the University of Michigan, and his colleagues determined that Clean Intermittent Self-Catheterization (CIC) is a safe and effective alternative method of emptying the bladder It continues to be used more than forty years later to help protect the kidneys, prevent incontinence and decrease the number of infections a patient may acquire by promoting adequate drainage of the bladder while lowering intravesical pressure. Catheterizations performed in institutions, such as acute and rehabilitation hospitals and nursing homes, are done aseptically. Intermittent catheterization has been performed by the patient in the home environment using a clean technique involving the re-use of catheters.
The rationale for using Intermittent Catheterization:
- The bladder contracts and the pelvic floor muscles relax during voiding to allow urine to pass through the urethra.
- Normally, after the bladder empties, a small amount of urine may remain in the bladder called the postvoid residual (PVR).
- If the person cannot urinate or empty the bladder completely, the PVR increases and can contribute to UTIs, overflow UI, and permanent damage to the bladder and kidneys.
- Research has shown that regular bladder emptying reduces intravesical bladder pressure and improves blood circulation in the bladder wall, making the bladder mucosa more resistant to infectious bacteria.
- By inserting the catheter several times during the day, episodes of bladder overdistention are avoided.
- In addition, the bladder wall is susceptible to bacteria that circulate in retained urine. When the bladder becomes stretched from retained urine, the capillaries become occluded, preventing the delivery of metabolic and immune substrates to the bladder wall.
- The key to avoiding UTIs is avoidance of high intravesical pressure and overdistention of the bladder, thus preserving an adequate blood supply to the bladder wall.
In April 2008, the Centers for Medicare and Medicaid Services (CMS) of the Department of Health and Human Services, USA eliminated the mandatory reuse of intermittent catheters for outpatients who receive such prescriptions from doctors. In short, no more cleaning and reusing catheters at home for people who self-catheterize. Healthcare professionals use their clinical judgment to determine which technique and type of catheter to use, in conjunction with patient preference. Differential costs and insurance coverage of catheters/techniques may also influence decision-making.
Heard, L. & Buhrer, R. How do we prevent UTI in people who perform intermittent catheterization? Rehabilitation Nursing, 2005: (30): p 44–45.
Lapides, J., Diokno, A.C., Silber, S.J., & Lowe, B.S., Clean, intermittent self-catheterization in the treatment of urinary disease. 1972. Urology:107; p458.
Lapides, J., Diokno, A.C., Silber, S.M., & Lowe, B.S. Clean, intermittent self catheterization in the treatment of urinary tract disease. 1972. Journal of Urology: 167; p1584–1586.
Lemke, J.R., Kasprowicz, K., & Worral, S. Intermittent catheterization for patients with a neurogenic bladder: Sterile versus clean: Using evidence-based practice at the staff nurse level. 2005. Journal Nursing Care Quality 20; p 302-306.