A 50-Year Review of Lapides' Clean Intermittent Catheterization

A Revolutionary, Life-Saving, Quality-of-Life Improving Technique for Bladder Management

Ananias C. Diokno

Disclosures

Urol Nurs. 2019;39(5):229-234. 

In This Article

Teaching Clean Intermittent Self-catheterization

A few principles essential in teaching CIC are worth mentioning.

Teaching starts by educating the patient and family members as to why CIC is chosen as the appropriate treatment for his/her bladder dysfunction. Explaining the rationale for why CIC will work for his/her condition is helpful in convincing the patient to embrace this technique.

Educate the patient/parents about the anatomy of the bladder, urethra, and external genitalia. The physiology of the bladder and urethral function (storage and evacuation) is an essential part of teaching, especially the knowledge of bladder capacity and the relation of bladder volume to fluid intake because it relates to the normal frequency of voiding day and night.

Familiarize the patient with different types of catheters, including the composition (e.g., latex, plastic, silicone), pre-lubricated or not, size measured in French, and the shape of the tip (straight, Coudé [curved tip]) of the catheter. Recently, there is a trend to not reuse catheters (one-time use catheter). This issue must be discussed with the patient and the decision to reuse or not, and the type of catheter and schedule for use/reuse must be individualized (Lamin & Newman, 2016; Prieto, Murphy, Moore, & Fader, 2014).

For female patients, many tricks allow the woman to locate her urethral meatus with ease. The use of a mirror at the start (not always) to have a visual understanding of the location of the urethral meatus in relation to the vagina is helpful. Once the woman is aware of the urethral meatus, identifying it blindly with the use of a finger, usually the forefinger opposite the hand holding the catheter, is a very useful trick. Some will place the opposite finger in the vagina and direct the catheter to the urethra.

For men and boys, locating the urethral meatus is usually not a problem unless one is dealing with an obese individual with a concealed penis or an uncircumcised patient with redundant prepuce. Once the patient is instructed on how to expose the meatus, the patient must be instructed that the penis must be constantly stretched gently upwards while catheterizing to prevent urethral wall folding and allow the catheter to slide all the way to the bladder without hitting any urethral fold.

The external sphincter in men, as well as among patients with paraplegia and quadriplegia and many patients with MS, are generally spastic. They may go into spasm as the tip of the catheter passes deep in the urethra during self-catheterization. The phenomenon must be pointed out to the patient during catheterization teaching. To prevent or reduce the spasm, the catheter and urethra must be lubricated adequately, and the catheterization must be performed in a gentle, smooth, and continuous insertion rather than stopping at the middle of the urethra or inserting it in a jerky intermittent fashion. Another trick is to take a deep breath as the catheter is being passed because it tends to relax the sphincter. Most of the trauma and false passage in men and boys occurs at the bulbo-membranous junction of the urethra. When the sphincter goes into spasm and the catheter is pushed through this spastic sphincter, the tip of the catheter could hit the mucosa at the junction. If resistance is met, providers or the men themselves should be instructed to pull the catheter out halfway, pause, and then gently try again in a continuous smooth manner. If this is a constant problem, the use of a Coudé catheter may be beneficial because the spastic sphincter pulls the urethra upward, creating an acute angulation of the urethra that will be more appropriate for a Coudé catheter.

No one position is recommended during self-catheterization. Catheterization can be accomplished in the standing, sitting, or lying down position. The best position may be discovered by experimenting and then embracing the best and easiest way, which could be sitting in the toilet with the legs spread widely for women and the standing position for men.

Several 'gadgets' are helpful for disabled patients. For patients who are wheelchair-bound, the use of an extension tubing with a light weight attached to the end may be helpful in directing the urine directly to the toilet. Another option is to attach the catheter to a collecting device that can be emptied later at appropriate places. For patients with quadriplegia, catheter holders may be developed to enhance the ability to insert the catheter into the male urethra by the patient. For ambulatory patients, a clean container and a used catheter storage purse/bag may be convenient so as not to wash each catheter after every use, but rather, do it once at the end of the day.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....