Different types of urinary catheterisation Conditions that may require urinary catheterisation Choosing the right catheter and equipment Alternative catheter treatments Using a catheter — taking care of yourself at home Where to get help. Different types of urinary catheterisation The two main types of urinary catheter are: indwelling catheter — inserted through the urethra, or through the wall of the stomach, into the bladder and left in place for a period of time intermittent catheter — inserted through the urethra into the bladder to empty it, then removed, several times a day.
Indwelling catheters Indwelling catheters remain in place continuously and are changed regularly, as required for example every eight weeks , by a nurse. Indwelling catheters may be drained: continuously via a tube into a drainage bag — for example the supra-pubic catheter, which is the preferred choice for people with cervical spinal cord injury or other conditions that limit hand dexterity and where clean intermittent self-catheterisation is not an option intermittently via a catheter valve — which can be opened, when required, to allow urine to drain into a toilet, then closed to allow the bladder to refill.
This avoids the need for a permanently attached drainage bag and allows the bladder to fill and empty intermittently, helping maintain good bladder shape. The valve must be released regularly to prevent over filling of your bladder. It is usually connected to a larger bag for drainage at night. A catheter valve is discreet and comfortable and can provide greater independence.
It also reduces the possibility of trauma and infection in your bladder. Intermittent catheters An intermittent catheter is when a new catheter is inserted each time you need to drain urine. If you develop recurrent urine infections while doing CISC, see your nurse for a review.
Conditions that may require urinary catheterisation Urinary catheterisation can be useful for people with bladder problems, such as: urinary retention — inability to empty the bladder, for example due to neurological conditions such as stroke and multiple sclerosis, or other factors such as faecal impaction or enlarged prostate bladder obstruction — for example, caused by bladder stones or narrowing of the urethra the passage from the bladder to the outside.
It can also be useful on a temporary basis, such as: to help people to retrain their bladder — catheterisation can be discontinued as soon as bladder control is re-established after surgery to the genital area — such as prostate gland or hip surgery or a hysterectomy as an indwelling catheter for the first few days after major surgery or to monitor fluid output in patients receiving intravenous fluids.
Choosing the right catheter and equipment Your health professional will help you choose the right catheter and equipment for you. Decisions involved in choosing the correct catheter include: external circumference of the catheter inside space of the catheter the lumen — the right size for you is the smallest size possible to drain your bladder adequately material — for example, silicone, latex or Teflon, or a combination of these.
The material selected will depend on how long the catheter will be in place length, shape, design and structural features — decisions about the length of the tube, the size of the collection bag and the means of attachment will depend on factors such as whether you are able to walk, how and where you intend to store or wear your collection bag, and how frequently you will be able to empty it how to secure or anchor your catheter — to make you comfortable and reduce possible trauma.
Catheter supports prevent unnecessary tugging of the catheter tubing on the bladder and irritation of the urethra and its opening lifestyle needs — your catheter should be customised to your lifestyle choices — for example, it may need to be easily portable, discreet, and have all the necessary features for you to be able to use it confidently, such as a handling aid.
Alternative catheter treatments In some cases, male patients who are incontinent but not urine retentive may be able to wear a catheter attached to a condom. If not, reinflate the balloon to its initial volume with water.
Deflation of the balloon happens easily with a 6Fr catheter. Use of a balloon catheter in neonates should only be with consultation with the treating medical team. Consider the need to remove and reinsert a new catheter in consultation with the treating medical team.
Check amount of water used to inflate IDC balloon. Gather equipment required for removal Ensure patient privacy and have patient in supine position. If resistance felt and catheter cannot be easily removed do not force, leave catheter in situ and consult medical team. Consider cutting the catheter at the balloon inflation point to ensure the balloon is deflated.
Once removed inspect catheter for intactness. Report if not intact. Perform hand hygiene. Document catheter removal in the LDA activity. Observe for urine output post catheter removal.
Discuss findings with the treating medical team. Ensure adequate procedural pain relief and distraction is in place during the procedure. Escalate to the treating medical team and consider the need for a referral to the urology team. In young girls, the urethra can be difficult to localise and the catheter can go directly in the vagina. In this case, leave the first catheter in the vagina and use another one to place immediately above, which will be more likely to go in the urethra.
Urethral injury may occur from trauma sustained during insertion or balloon inflation in incorrect position: it is very important to ensure the catheter is in the bladder before inflating the balloon, this can be confirmed by visualising the stream of urine prior to balloon inflation.
Urethral strictures following damage to urethra. Regular hygiene should be maintained whilst IDC is in situ. Where possible avoid disconnecting the IDC circuit to minimise risk of contamination Monitor for and report signs of infection including fever, offensive smelling urine, unexplained blood or cloudy urine. Psychological trauma Paraphimosis due to failure to return foreskin to normal position following catheter insertion: To minimise risk, remember to replace the foreskin to normal position in non-circumcised patients and check at catheter care or nappy change that the foreskin is in place.
Discharge information Some children will be discharged from the hospital with their IDC insitu. It is important to teach the families how to care for the catheter, how to perform hygiene, how to monitor the output and how to troubleshoot. Pediatric Nursing Interventions and Skills.
Hockenberry, D. Rodgers Eds. Louis, Missouri: Elsevier. Systematic review and meta-analysis of the effectiveness of antiseptic agents for meatal cleaning in the prevention of catheter-associated urinary tract infections. Journal of Hospital Infection, 95 3 , Galiczewski, J. An intervention to improve the catheter associated urinary tract infection rate in a medical intensive care unit: direct observation of catheter insertion procedure.
Intensive Critical Care Nursing. Indwelling Catheter: Blockage. Before being discharged from hospital, a specialist nurse will give you detailed advice about looking after your catheter. You will be given a supply of equipment to take with you when leaving hospital, and told where to get further supplies in the future. In most cases, catheter equipment is available on prescription from pharmacies.
If you have been taught to use intermittent catheters, you should insert them several times a day to drain urine into a toilet or bag. These catheters are usually designed to be used once and then thrown away. How often intermittent catheters need to be used differs from person to person. You may be advised to use them at regular intervals spaced evenly throughout the day, or only when you feel you need the toilet.
Indwelling catheters can either drain into a bag attached to your leg, which has a tap on the bottom so it can be emptied, or they can be emptied into the toilet or suitable receptacle directly using a valve. Bags should be emptied before they become completely full around half to three-quarters full. Valves should be used to drain urine at regular intervals throughout the day to prevent urine building up in the bladder.
At night, you will need to attach a larger bag to your valve or regular bag. This should be placed on a stand next to your bed, near the floor, to collect urine as you sleep. Depending on the type of night bag you have, it may need to be thrown away in the morning or it may be emptied, cleaned and reused for up to a week.
The catheter itself will need to be removed and replaced at least every 3 months. This will usually be done by a doctor or nurse, although sometimes it may be possible to teach you or your carer to do it.
Having a long-term urinary catheter increases your risk of developing urinary tract infections UTIs , and can also lead to other problems, such as blockages. You will be advised about when it is safe for you to go to work, exercise, go swimming, go on holidays, and have sex. If you have an intermittent or suprapubic inserted through your tummy catheter, you should be able to have sex as normal. For example, men can fold the catheter along the base of their penis and cover them both with a condom.
In some cases, you may be taught how to remove and replace the catheter so you can have sex more easily. You should contact a district nurse or nurse practitioner you may be given a phone number to call before discharge from hospital or your GP if:. Living with a catheter can be a challenge and you may find it useful to seek more information and advice from support groups and other organisations.
The main disadvantage of using a urinary catheter is that it can sometimes allow bacteria to enter the body. This can cause an infection in the urethra, bladder, or less commonly the kidneys. These types of infection are known as urinary tract infections UTIs. UTIs resulting from catheter use are one of the most common types of infection affecting people staying in hospital.
This risk is particularly high if your catheter is left in place continuously an indwelling catheter. Contact your GP, district nurse or nurse practitioner if you think you have a UTI, as you may need to take antibiotics. Bladder spasms, which feel like stomach cramps, are also quite common when you have a catheter in your bladder.
The pain is caused by the bladder trying to squeeze out the balloon. In these cases, a longer standard-length catheter can be used to avoid skin damage and improve patient comfort. For routine drainage a 10ml balloon size should be used; this is usually inflated with 10ml of sterile water.
Some catheters are supplied with a pre-filled syringe of glycerine solution or a pre-filled 10ml balloon of sterile water. Discuss the procedure with the patient, explaining any associated risks or benefits, to gain valid informed consent. Check for allergies to the lubricating or anaesthetic gel Yates, Box 1. Screen the bed to ensure privacy and maintain dignity. Obtain the equipment needed to perform the female catheterisation procedure Fig 1a , following aseptic non-touch technique ANTT guidance.
This equipment should include:. Ensure she is not unnecessarily exposed by covering her thighs and genital area with a towel until you are ready to begin the procedure.
Use a protective covering for bed linen to keep the bed dry. Open additional equipment using ANTT. Leave the urinary catheter in its inner sterile plastic protective wrapping until the time of insertion, to protect it from potential physical and environmental contamination. Wash your hands and put on sterile gloves.
Using low-linting swabs, separate the labia with your non-dominant hand so you can see the urethral meatus. Hold the labia open and, with your dominant hand, clean the urethral meatus with 0. Squeeze the gel into the urethra, remove the nozzle and discard. Box 1 outlines further relevant information. If you are using a plain aqueous lubricating gel without anaesthetic you can continue with the procedure immediately. When the anaesthetic gel has taken effect, wipe away any excess, dispose of the gloves, wash and dry your hands and put on new sterile gloves.
Hold the labia open. Holding the catheter in your dominant hand, introduce the tip into the urethral orifice in a slightly upward and backward direction, feeding it out of the sterile packaging this adds a further layer of physical protection for the duration of the insertion procedure.
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