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Cleanliness During Self-Intermittent Catheterization

“Urinary retention is the inability to voluntarily empty the bladder completely, resulting in the build-up of residual urine in the bladder. This may lead to complications such as urinary incontinence, bladder damage, kidney disease, and urinary tract infections (UTI). Urinary retention can be acute or chronic. Intermittent catheterization is the first line of recommended treatment for people with chronic urinary retention. This is a procedure that people can do at home, in which a tube (catheter) is inserted into the urethra or a surgically created opening (stoma) in the abdomen to drain the bladder. The catheter is immediately removed after the urine has drained. A person with complete urinary retention typically self-catheterizes 4 to 6 times per day to empty the bladder”1

The word intermittent refers to the sporadic or irregular frequency, in this case, of self-catheterization. The catheter remains inside your body only temporarily and for a short duration of time. Hence, clean self-intermittent catheterization means that you perform your own catheterization in a sanitary fashion every time urinary urgency is felt and the catheter itself remains inserted only until voiding is complete. The whole purpose of course, of clean intermittent self-catheterization is to drain your bladder from urinary waste by using intermittent catheters while avoiding or minimizing your chances of acquiring a urinary tract infection (UTI). There are certain medical conditions that necessitate self-catheterization as we will see below.

“Clean Intermittent Self-Catheterization (CISC) is a way to empty the bladder by using a clean catheter. It involves putting the catheter in and taking it out several times a day. CISC helps people who cannot empty their bladders the usual way. By emptying your bladder regularly, you can help prevent bladder infections.”2

Intermittent catheterization is typical of the following medical conditions

The following conditions may call for intermittent catheterization:

  • Urinary Incontinence
  • After certain surgical procedures such as a Cystectomy
  • Various psychological disorders such as Dementia.

“People who need to perform CIC include those who have certain medical conditions, including:

  • Stroke
  • Parkinson’s disease
  • Multiple sclerosis
  • Spinal cord injuries
  • Spinal surgeries
  • Erectile dysfunction
  • Trauma/accidents
  • Central nervous system tumors
  • Cerebral palsy
  • Heavy metal poisoning

If you have to perform CIC, you will be inserting and removing the catheter several times a day; your doctor will tell you how many times. By performing this procedure every day, you will not have to wear a catheter all the time. In addition, you will help prevent kidney infection and keep your bladder from stretching.”3

People who have started practicing intermittent self-catheterization or are looking forward to entering this practice must learn proper sanitary techniques; otherwise, the risk of complications or counterproductive results may be too great.

“To prevent UTI a non-infecting technique is needed. But also some additional factors can play a role in infection prevention. Nursing education is important and educational intervention by a clinic nurse is a simple, cost-effective mean to decrease the risk of UTI’s in individuals with SCI on IC who are identified as at risk.”4

The inability to completely empty your bladder carries great risks like urinary tract infections, which may lead to renal failure if left untreated. The utilization of unpolluted intermittent self-catheterization will facilitate to avoid urinary tract infections and other harmful risks that come along with it so thorough and hygienic voiding is the ultimate goal.

How to self-catheterize

“You should drink 1500 to 2000 mls a day. This is 6 to 8 large glasses of fluid a day. Each time you catheterize, the amount of urine needs to be 400 to 600 mls. Avoid becoming overdistended. This means that you have too much urine in your bladder. Pick times during the day that will drain the right amount of urine so your bladder does not get overdistended.”5

The method of uncontaminated intermittent self-catheterization for females is completely different from the method for males as the bladder systems differ greatly.

“Urine will drain through your catheter into the toilet or a special container. Your health care provider will show you how to use your catheter. After some practice, it will get easier. Sometimes family members or other people you may know, such as a friend who is a nurse or medical assistant, may be able to help you use your catheter.”6

For Her

Clean your hands with soap and water; follow this up by cleaning the region around your urinary meatus. You also must be able to identify the urethral opening. Prepare the intermittent catheter with lubrication and gently insert it into the urethra.

“With one hand, gently pull the labia open, and find the urinary opening. You can use a mirror to help you at first. (It is sometimes helpful to sit backwards on the toilet with a mirror propped up to help see the area.) With your other hand, wash your labia 3 times from front to back, up and down the middle, and on both sides. Use a fresh antiseptic towelette or baby wipe each time. Or, you may use cotton balls with mild soap and water. Rinse well and dry if you use soap and water.”7

As the catheter reaches the bladder, urinary waste will drain into the catheter’s drainage bag. When urine flow has halted, extract the inserted catheter. It is important for the amount of urine drained into the bag to be measured and recorded. Dispose of the urine collected and sanitize both the catheter and the container that collected the drained urine with regular soap and boiling water right after use for proper storage.

For Him

The first step is to always cleanse your hands thoroughly with soap and water. The glans penis should be given the same sanitary treatment next, especially around the urethra. Prepare for insertion by lubricating several inches of the catheter. Carefully begin insertion.

Pay attention to the first 6 inches of insertion because the urethral sphincter (the sphincter that controls the expelling of urine from the bladder) may resist further insertion. If this is the case, breathe easy and deeply to continue insertion. When urine flow has ceased, slowly remove the catheter. Measure and record the amount of urine drained and then empty the collection bag. Clean the catheter and urine receptacle device with soap and hot water immediately thereafter. Rinse the supplies and air dry for storage in a clean and dry place.

“After your Self-catheterization your penis may feel irritated after you catheterize. This is normal. You may have some bleeding during or after your catheterization. Your urine may turn light pink due to this blood, so drink some water. This will flush your bladder.”8

Your doctor might require a log of your daily liquid intake and output, so as to keep an eye on normal renal and bladder functions. Intake includes something you drink, like water, juice, soda, tea, alcoholic beverages, and coffee. Usually, it is recommended to drink 8 – 10 cups of fluid, ideally water, per day.

If your kidneys are operating properly, you ought to flush out a similar quantity of fluid as you’re taking in over the course of the day. If your recorded output does not match up with your intake, inform your doctor.

What are the possible secondary effects?

Intermittent Catheterization will involve some discomfort because the tubing is inserted into the bladder via the urethra. It might take some time to become used to intermittent self-catheterization. At first, you will need help from a medical practitioner. Cleanliness is everything; the last thing a person needs is to contract a urinary tract infection. Luckily, sanitation can be achieved with common sense, discipline, and good sanitary habits.

“Prostatitis can be a cause of recurrent UTI. Either acute or chronic it is difficult to diagnose in patients with neurogenic bladder and special tests have been developed for this. Urethral bleeding is frequently seen in new patients, and occurs regularly in one-third on a long-term basis. Trauma of the urethra especially in men can cause false passages, meatal stenosis but the incidence is rare.”9

Be sure to inform your doctor if you are experiencing abdominal and/or lower back pain as well as any feeling of burning throughout the catheterization procedure as these are often symptoms of a UTI.

“Although hospitals and long-term care facilities use a new sterile catheter for every catheterization, the reuse of intermittent catheters in the home setting is common in some countries and remains controversial. Reasons for reuse are mainly related to costs and environmental concerns, and reuse is less common in countries that reimburse people for single-use catheters.”10

“If reusable urinary catheters are to be used for IC, the method of sanitation becomes particularly important. Several methods have been reported in the literature, including: cleaning with antibacterial soap and water; alcohol sterilization; using aseptic solutions, such as chlorhexidine 1.5% and cetrimide 15%, microwave sterilization; or simply rinsing with water and combinations of these methods.”11

“Age was found to be an important factor when proposing CISC. Self-catheterization becomes less practical with age because of comorbidities (e.g., tremor, vision impairment) or loss of the skills needed to perform CISC. However, it is remarkable that even younger age (<55 years old) was taken into account, although one would assume that the majority of these patients are perfectly capable of performing self-catheterization.“12

 

References:

(1, 10) Intermittent Catheters for Chronic Urinary Retention: A Health Technology Assessment. Health Quality Ontario. Ontario Health Technology Assessments Series. 2019.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6395058/

(2) Clean Intermittent Self-Catheterization (CISC). Newman, D. National Institutes of Health. 2006. https://www.cc.nih.gov/ccc/patient_education/pepubs/bladder/ciscwomen5_22.pdf

(3) Clean Intermittent Catheterization. Cleveland Clinic. Cleveland CLinic. 2014.https://my.clevelandclinic.org/health/treatments/15434-clean-intermittent-catheterization

(4, 9) Complications of intermittent catheterization: their prevention and treatment. Wyndaele, J. Spinal Cord. 2012. https://www.nature.com/articles/3101348

(5) Intermittent Self-Catheterization – A Guide for Men and Women. St. Joseph’s Healthcare Hamilton. 2013. https://www.stjoes.ca/patients-visitors/patient-education/patient-education:-f-j/intermittent-self-catheterization—a-guide-for-men-and-women-pdf 

(6, 7) Self catheterization: For Females. Shah, S. MedLine Plus: Trusted Health Information For You. 2019. https://medlineplus.gov/ency/patientinstructions/000144.htm

(8) Self-Catheterization for Males. Memorial Sloan Kettering Cancer Center. 2017. https://www.mskcc.org/cancer-care/patient-education/self-catheterization-males

(11) Clean intermittent catheterization: Single use vs. reuse. Hossein, S., Shepherd, S., Van Asseldonk, B., & Elterman, D. Canadian Urological Association Journal. 2019. https://cuaj.ca/index.php/journal/article/view/5357

(12) Clean Intermittent Self-Catheterization as a Treatment Modality for Urinary Retention: Perceptions of Urologists. Weynants, L., Hervé, F., Decalf, V., Kumps, C., Pieters, R., De Troyer,  B., & Everaert, K. International Neurourology Journal. 2017. https://www.einj.org/journal/view.php?doi=10.5213/inj.1734824.412