Intermittent Catheterization Tips

Intermittent Catheterization Tips

Posted by AskNurseLinda on Nov 9, 2015 1:34 pm

Catheterization is a process to empty the bladder of urine when an individual cannot perform that function. Some tips will help you maintain a good catheterization technique.

Wash your hands with warm/hot water and soap before catheterizing. If an attendant is performing the catheterization, they should wash their hands. This is the most important part of the catheterization process and cannot be stressed enough. Keep washing for the length of time to sing Happy Birthday or reciting the alphabet. Just rinsing your hands is not enough.

People wash their hands upon leaving the rest room but do so before catheterization. Clean hands are the first line of defense to avoid infection so wash your hands before, too. Even if you use gloves your hands, especially around the fingernails, need to be clean as that is where bacteria are hiding. Once you transfer to the toilet and have touched bars or the toilet seat, use a hand sanitizer to clean what you have picked up during the transfer.

Catheterize while sitting up to take advantage of gravity. In elimination, gravity is extremely useful for everyone with or without paralysis. The process of elimination depends on gravity so use it to your advantage. Emptying will be easier and more complete.

Remember you only have one attempt to insert the catheter. If you miss, you have contaminated the catheter and need a fresh one.

Expose the area. For men this is unzipping the pants. For females, the legs need to be spread. You can place one leg over the side of the wheelchair or put the feet up on a toilet set or if on the toilet, put them up on the wheelchair so your knees are bent, exposing the urethra.

Under ware can be optional for males or females if it becomes difficult to move them for the catheterization. Males under ware can be moved below the penis. It might be possible to adjust women's panties to the side.

The catheter has to be lubricated prior to insertion with a lubricant, not anything else. Do not touch the catheter to the lubricant in the tube. Squirt it out either onto a sterile towel in the packaging of the catheter or onto the catheter directly but do not touch the tube to the catheter to keep both clean.

Clean the urethra, the external opening to the bladder, with soap and water. The last wipe should be just with water to remove the soap residue from entering and irritating the urethra. If out in the community, an unscented wipe can be used. Do not wash back and forth. This is a hard habit to stop because that is the way people wash. In this case, it will bring bacteria to the area you want to be clean. For men, start from the tip of the penis and work up the shaft with each wipe. For women, wipe from the front of the body to the back only. This avoids carrying bacteria from the vagina to the urethra.

Males should position the penis straight up for catheter insertion. This is because when it is in the resting position, there is an extra turn which has to be made internally. This anatomical turn is internal so you cannot see it. Holding the penis straight out will avoid this extra turn.

Females have to hold the labia open to expose the urethra. Be sure just to spread the labia open. Do not spread and pull forward. This stretches the urethra out of place making insertion traumatic. Labia opening devices are being developed which can help you open without pulling as well as giving you a free hand to assist with catheterizing.

Learning to catheterize on the toilet requires some time and practice. Maintaining your balance is an issue. You may need to use one available arm to support yourself, leaving one arm for catheterization. Think about the benefits to toilet catheterization. You may or may not choose to expend your energy here.

Do not think you have to sit on the toilet facing the front. Many people will wheel up to the toilet and transfer directly forward so they are actually sitting backwards on the toilet. If at home, you can use the tank as a work space. Your balancing might actually be much easier sitting backwards. Then just transfer yourself back in to your chair. This is a great technique for tight spaces or public toilet stalls that are never quite big enough.

If unable to use the toilet, try to sit up as much as possible. Men's anatomy will basically stay the same when sitting upright. Women's anatomy will change angles so it is not quite the same approach as when catheterization lying down. Float a mirror in the toilet to see where you need to insert the catheter. After a few times, you will begin to know the ‘feel' of where to place your hands and the catheter. On the toilet, women will not be able to visualize the opening for the catheter but just as you learn to type without looking at the keys, you will learn how to place the catheter without contamination.

Reflexes are an often overlooked opportunity for reflexive bladder emptying. If you have an upper motor neuron injury (a bladder with tone or spasticity), urine will spontaneously be expelled from the bladder when it contains a threshold amount. This amount will be different for everyone. By stretching the anus, as with a bowel program, a spontaneous expulsion of urine may occur. Intermittent catheterization after this elimination may reveal an empty bladder. If this is the case, you might choose to use reflexive voiding. Be sure to discuss the finer points of this technique with your healthcare professional to make sure you are safe to use this technique.

In the past, pressure over the abdomen in the area of the bladder used to be used to help empty urine. This practice has been stopped as the pressure causes urine to travel and be forced out of the urethra as well as up into the ureters into the kidneys. This technique should not be used due to the complications. If you practice this method, discuss alternatives with your healthcare provider.

Children can learn effective catheterization skills at a young age. They should become involved in the process at the time of toilet training. Parents need to remember that catheterization is a different way of emptying the bladder from their experience but it is the only way the child knows so it is normal to them. Maturity is the guide for how much of the procedure a child can do. If they have the physical capability, they should be able to catheterize by school age. If they can catheterize independently or need assistance, the school nurse's office is typically made available for privacy. The student does not need to explain what they do there. They can tell their companions that they are working on a project with the nurse or just that they need some assistance from the nurse. Choosing to disclose their purpose should be thought out before sharing too much information.

There are a variety of catheters available for your needs. Some people use the traditional red rubber catheter which can be transported in a full sized toothbrush travel holder, Tupperware or ziplock bag. There are short catheters for females, extra-long catheters for reaching from chair to toilet, self-lubricating catheters, self-contained catheters with drainage bags, some with guide tips for insertion. Check with your payor as some of these catheters can be less expensive than what you currently use but many are extremely expensive.

Keep your catheterization equipment in a bag that you can hang on your chair so it is always available. You do not want to be caught without it.

Catheterizing can become a force over your life if you let it. You do not have to let the process dominate you if you think of the process just like any other activity. Everyone empties their bladder. You do, too. Keep it simple and to the point. Maintain a schedule. You might have to be more attentive to the time of emptying your bladder but becomes second nature overtime. I am sure many readers have developed some tips and ideas that would be helpful to add to this list.

I'm online in this community every Wednesday from 8-9 PM ET to answer your SCI and paralysis related questions.

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Nurse Linda

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