Intermittent Catheterization
Intermittent catheterization involves the regular introduction of a catheter to empty the bladder and then removal of the catheter; this leaves the patient catheter-free in between. The catheter (a flexible, fine tube) is passed into the bladder via the urethra; urine is drained and the catheter removed and washed or discarded (see Figures 15A, B, & C). Research has shown that regular bladder emptying reduces intravesical bladder pressure and improves blood circulation in the bladder wall making the bladder mucous membrane more resistant to infectious bacteria. Intermittent catheterization (IC) dates back thousands of years (with use of silver, gold, and then stainless steel) but the practice has only become more acceptable over the last 40 years when it was pioneered by an American urologist, Dr. Lapides, who showed that "clean" as opposed to "sterile" self-catheterization did not increase the incidence of renal damage or urinary tract infections. Clean intermittent catheterization (CIC) is most used in elderly patients with urinary retention but is also a treatment for overflow UI secondary to urethral obstruction.
PVC Straight Catheters. Photo courtesy of Coloplast.
Intermittent Straight Catheter. Photo courtesy of Coloplast.
Intermittent Straight Catheter Without Coating. Photo courtesy of Astra Tech.
Sterile technique is used for intermittent catheterization in acute care facilities because of the high risk of nosocomial infections. However, there is very little data about the safest method in long-term facilities. The use of long-term antibiotics in people regularly using CIC is not necessary because such long-term use is associated with the presence of resistant bacterial strains. But, if an infection occurs, it should be treated.
Age is not a deterrent to recommending CIC. Considerations include (a) the physical ability of the person who will perform the catheterization; (b) the willingness and self-discipline of both patient and caregiver; (c) presences of leg spasms and/or decreased flexibility or balance; (d) decreased finger/hand dexterity, intentional tremors, and poor eyesight of person performing the catheterization; (e) decreased perineal sensation; and (f) obesity that prevents adequate visualization of the urinary meatus in the female patient. Aids such as a catheter holder can be helpful in patients with decreased finger and/or hand dexterity or grip (see Figure 16A).
There are two main designs of intermittent catheter: those that have a hydrophilic coating (which becomes slippery when immersed in water to aid insertion) (see Figures 16A, B, & C) and those with no coating (see Figures 15A, B, & C). There may be large differences in the slipperiness of the coatings, with some catheters showing a marked propensity to "stick" to the wall of the urethra on removal (Fader et al., 2001a). However, to date there has been no evaluation comparing coated and noncoated catheters. The clinician who instructs the patient usually makes the catheter choice. Red rubber catheters are more flexible and some elderly patients find them more difficult to insert. The preferred catheters used for CIC are clear and made of plastic material. Polyvinyl chloride (PVC) are the most common as they are flexible but firm, require lubrication, and are usually reused for up to 1 week (see Figure 15A). Prelubricated hydrophilic cathe ters are coated with a substance that absorbs water and binds it to the catheter surface (see Figures 16A, B, &C). Prior to insertion this catheter is immersed in water. This extremely slippery layer of water stays on the catheter during insertion and withdrawal. This type may be indicated for patients who experience particular discomfort during catheterization or have difficulty with other types of catheters (Diokno, Mitchell, Nash, & Kimbrough, 1995). Self-contained systems are closed systems that provide sterile catheterization and are 100% latex-free, prelubricated hydrophilic or PVC catheters. The catheter passes through a special guide mechanism at the top of the pocket (see Figures 17A, B, C, & 18). This guide provides two main benefits: it keeps the catheter straight as it is advanced and, when squeezed, it prevents the catheter from slipping during insertion. Once inserted the urine drains into the bag. The use of this system may decrease chances of infection. In patients who have bacterial, nonspecific urethritis, a catheter that contains a coating of antibacterial agent (for example, nitrofurazone) in the outer layer to produce local antibacterial activity may be indicated.
Catheter Holder. Photo courtesy of Astra Tech.
Intermittent Straight Catheter Without Coating. Photo courtesy of Coloplast.
Hydrophilic Catheter (Lofric). Photo courtesy of Astra Tech.
Self-Contained System with PVC Catheter (Self-Cath). Photo courtesy of Mentor.
Self-Contained System (Self-Cath) With Gloves and Lubricant. Photo courtesy of Hollister.
Self-Contained System With Hydrophilic Cathete. Photo courtesy of Astra Tech.
Self-Contained Pre-Lubricated System. Photo courtesy of Coloplast.
Catheter tip configuration is also important when choosing a catheter for CIC. An olive, Coudé or curved-tip catheter may help a woman in identifying her urethra (see Figure 19). Using a Coudé tip catheter can make it easier for an elderly man to advance the catheter past the prostate gland (see Figure 20). Both of these types of catheters have "blue line guide strips" to help patients maintain correct position for insertion curved tip is pointed up to the head. An additional consideration when teaching an elderly patient how to perform catheterization is the catheter length which is either 5 inches (for women) or 12 inches (for men).
Coudé Olive Tip PVC Catheter. Photo courtesy of Mentor.
Coudé Tip PVC Catheter. Photo courtesy of Mentor.
Entry Points for Introduction of Microorganisms. Graphic courtesy of Diane Newman.
The catheterization schedule should be based on the urine volume. As a general rule, bladder volume should not exceed 400 to 500 mls. When starting CIC, patients and/or caregivers should record the amount of urine drained from the bladder. If the patient voids, catheterization should always be performed after voiding. Based on a person's average output, catheterization is usually done three to four times during the day.
Urol Nurs. 2004;24(4) © 2004 Society of Urologic Nurses and Associates
Cite this: Incontinence Products and Devices for the Elderly - Medscape - Aug 01, 2004.
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