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

Reusable Versus One-use Catheters and use of Antibiotics

There are several principles to remember regarding catheter usage and use of antibiotic prophylaxis and/or antibiotic treatment.

First, urine should be sterilized by identifying the bacteria and treating it appropriately before and during the teaching of CIC. The reason behind this approach is to avoid infection; the teaching may be somewhat traumatic, and trauma can initiate infection in the presence of bacteria. It is advisable to continue antibiotics used before and during the teaching for a few more days after teaching. No antibiotics or antibacterial agents are given after the initial treatment.

Second, patients with decreased immunity, including those on immunosuppression, steroids, and chemotherapy, will need low-dose suppression antibacterial therapy, such as methenamine and cranberry pills, to help acidify the urine and enhance the effectiveness of methenamine. These patients may be the ideal candidates to use pre-lubricated catheters for single use or at least one catheter for reuse in a single day (Diokno, Mitchell, Nash, & Kimbrough, 1995).

Third, our original recommendation was to prepare several catheters a day by washing them with soap and water, and keeping them in a container for use during the entire day. Alternatively, one catheter must be washed with soap and water before each use. We advocated washing hands with soap and water before each catheterization, and generously lubricating the catheter prior to each use. The duration of the use of the catheter varied with our patients. Some patients use the same catheter for a month, others for a week, and some use one catheter a day. The duration depends upon the tolerance of each patient to development of symptomatic infections, which we find very rarely.

For those with frequent symptomatic infections, a single-use catheter may be the best option. Although asymptomatic bacteriuria is a frequent finding, it is of no consequence unless the patient is to undergo an invasive procedure or is not adhering to the principles of avoiding overdistention. Attempts to eradicate these bacteria can lead to the development of resistant pathogenic strains. Further, we do not advocate doing frequent urine cultures if the patient is not symptomatic unless an invasive procedure is to be undertaken. Routine urine cultures done in an asymptomatic patient on CIC increases health care cost and serves no purpose because treatment of asymptomatic bacteriuria is not recommended (Lamin & Newman, 2016).

Finally, current review of available data regarding long-term intermittent catheterization failed to show any convincing evidence that the incidence of urinary tract infection is affected by aseptic or clean technique, coated or non-coated catheters, single (sterile) or multiple-use (clean) catheters, self-catheterization, or catheterization by others or by any other strategy (Prieto et al., 2014). Therefore, until clear evidence evolves following a well-designed trial, which is needed, the choice of CIC strategy must be individualized, and the most convenient inexpensive option should be preferred.

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