Inserting Hydrophilic Catheters

Hydrophilic catheters are manufactured with a ‘water-loving’ coating so they arrive ready to use. It also saves the patient time by not having to lubricate the catheter. Hydrophilic coating just means that they are covered with a substance that is activated with water. Such coating makes a flat, soft and oily surface when it gets it touch with water, making the insertion procedure much easier and less painful for the patient.

“In the normal urinary tract, the regular flushing of the urethra as the bladder empties helps to impede the ascending infection of the tract by the bacteria that normally colonize the periurethral skin. Any bacteria that manage to migrate into the bladder are also washed out during micturition. In addition, the bladder is lined by urothelial cells coated with a glycosaminoglycan mucin, which provides a surface resistant to the adherence of bacteria. Bacterial adherence, when it does occur, initiates invasion of the urothelium. This activates microbial-sensing proteins in the superficial umbrella cells, triggering the host defenses with a cascade of cellular and molecular effectors to eliminate the bacteria.

In people with impaired bladder function, whether retention or incontinence, a safe and reliable system is required to collect and contain the urine, whether for short- or long-term use.

In those males and females for whom the method is feasible, clean intermittent self-catheterization is the optimal procedure to manage urinary retention. This mimics normal bladder function, allowing the bladder to fill and periodically to empty completely, thus minimizing the risk of infection. Although some find the procedure uncomfortable and distasteful, with practice clean intermittent self-catheterization is usually quite easy to perform.”1

“Low-friction hydrophilic catheters were introduced in 1983 to reduce catheter-related complications and have demonstrated the potential to reduce UTIs in persons who used IC. Hydrophilic catheters are coated along the entire length with a hydrophilic substance, primarily polyvinyl-pyrrolidone, which, when combined with water, produces a smooth, slippery surface that has 10- to 15-fold less friction than a standard polyvinyl catheter.”2

“The hydrophilic coating is designed to reduce the friction, as the catheter is inserted with the intention of reducing the risk of urethral damage. It has been suggested that because the hydrophilic catheters do not require manual lubrication they are more sterile and thus less likely to cause infection. Most hydrophilic catheters are prepackaged in sterile water, or there is a pouch of sterile water that is broken and released into the catheter package when the catheter is ready to use.”3

“Proper catheter placement is critical, as failed attempts at catheterization may lead to iatrogenic injury. Forcing a catheter past the point of resistance can cause injuries ranging from a mucosal tear and bleeding to more serious false passages (perforations), which are associated with infection, urethral stricture, and subsequent surgical management. Repeated and unsuccessful attempts may result in stress and pain for the patient, injury to the urethra, which potentiates urethral stricture formation requiring surgical reconstruction, and problematic subsequent catheterization. Improper insertion of catheters also can significantly increase healthcare costs due to added days of hospitalization, increased interventions, and increased complexity of care.”4

Here are some basic steps on how to use a hydrophilic catheter

  • Have all your medical supplies ready and near you.
  • Wash your hands (you can also use antibacterial gel) and put on medical gloves.
  • Cleanse your genital area in circular movements, especially around the urethra opening, using water and antiseptic soap or use a cotton swab treated with antibacterial agents (Betadine) if available. You can also use disposable wipes with benzalkonium chloride.
  • Hydrophilic catheters have a saline solution, free of any microbial presence, which can be on the inside of the package or in a separate aluminum package. If the catheter has one of these separate packages, you need to first open it and apply it to the catheter to activate the hydrophilic properties of it. Make sure that the entire solution is applied and allow 30 seconds to hydrate completely.
  • Once activated, remove the catheter from the package.
  • For men, aim the penis upwards and hold it at a 45-degree angle from your stomach. Insert the catheter slowly into your urethra. If there is resistance when the catheter reaches the urethral sphincter, breathe deeply and gently apply pressure. Do not force the catheter. When the urine starts to flow, insert the catheter another inch more and slightly lower the angle of your penis. Allow the urine to flow in the toilet or into another container. When the fluid of urine finishes, slowly remove the catheter.

For women

  • Make yourself comfortable by seating on the toilet and relax your body.
  • Slowly and gently insert the catheter into your urethra, make sure you use gentle movements. Continue to insert the catheter until it reaches your bladder without forcing it through the urethral sphincter.
  • Once urine starts to flow, insert the catheter another inch more. When the flow stops, remove the catheter slowly to ensure that you drain any remaining urine at the base of your bladder.
  • You can dispose of the catheter with the packaging. Do not flush it down the toilet.

“Insertion of a hydrophilic guidewire intraurethrally will usually gain access to the bladder without traumatizing the urethra and with minimal pain to the patient. The guidewire can then be used to enable placement of a urethral catheter directly or after a preliminary urethral dilatation. […]

Comparison with Other Methods

The options available to the attending casualty officer or urologist include using a different size of urethral catheter or a coudee-tipped catheter, use of a catheter introducer or urethral dilators, or insertion of a suprapubic catheter. Equipping the casualty department and the urology ward with the hydrophilic guidewire, Pollack catheter and ureteric dilator enable this technique to be used when encountering difficulties with urethral catheterization. The present technique only requires items that are readily available in every urology department, and generally enables successful urethral catheterization at the bedside. The technique is well-tolerated by the patient and significantly reduces the possibility of atrogenic urethral trauma. Successful urethral catheterization will also reduce the need for emergency hospital admission and its consequent cost implications.”5

“The instructions provided are intended as complimentary tips to the advice you have been given by your nurse, physician or specialist.

Some form of bladder management program is necessary to initiate voiding or ensure complete emptying of the bladder. Bladder management programs may include interventions such as medications, timed voiding, indwelling urinary catheter, manual expression, urinary diversion and intermittent catheterization.

Intermittent catheterization is one of the most effective and commonly used methods of bladder management in patients with a neurogenic bladder. Regular bladder emptying reduces intravesical bladder pressure and improves blood circulation in the bladder wall, making the bladder mucous membrane more resistant to infectious bacteria. By inserting the catheter several times during the day, episodes of bladder over distention are avoided.

Intermittent Self-Catheterization – Complications

Although intermittent catheterization is the preferred catheterization method for ensuring bladder emptying, complications and adverse events can arise, especially in patients performing intermittent self-catheterization longterm. Urethral, scrotal, and bladder-related complications may occur. Urethral/scrotal events can include bleeding, urethritis, stricture, creation of a false passage, and epididymitis. Bladder-related events can cause UTIs, bleeding, and stones.

Urethral Adverse Events

 Urethral problems, seen primarily in men, include urethritis or inflammation of the urethral meatus from frequent catheter insertion. Urethral bleeding is frequently seen in patients when initiating intermittent catheterization and can occur regularly in one-third of patients performing intermittent catheterization on a long-term basis. Persistent bleeding in a patient who has been performing intermittent selfcatheterization long-term may be a sign of a UTI. A more common urethral adverse event is the creation of a false passage, which may occur in men with persisting urethral strictures or who have an enlarged prostate. The false passage may occur at the site of the external sphincter, just distal to the prostate. Urethral trauma can be secondary to the use of a poorly lubricated catheter or forcible catheterization in a urethra, causing spasms. It is believed blind catheterization may lead to both urethral bleeding and formation of a false passage.

Urethral strictures can occur in the anterior portion of the urethra (meatus, penile-pendulous urethra, bulbar urethra) or in the posterior portion (membranous urethra and prostatic urethra). These strictures may be the result of an inflammatory response to repeated trauma and are seen more often in patients who perform intermittent self-catheterization. Difficulty with catheter insertion may be a sign of the presence of a urethral stricture. Increased frequency of catheterization may correlate with fewer urethral changes. This may be because individuals who regularly perform intermittent self-catheterization are more skilled in catheterization, and therefore, have less chance of urethral trauma. Repeat catheterization, however, may induce local traumatic reactions of the urethral wall, especially in male patients performing self-catheterization longer than 1 year.”6

“Hydrophilic catheters have a smooth and slippery surface that is less irritating than standard polyvinyl catheters. In the general population, the long-term use of hydrophilic catheters can decrease urethral irritation and reduce urethral microtrauma. Hydrophilic catheters have a high level of patient satisfaction because they are comfortable.”7

“The data on quality of life and satisfaction with hydrophilic catheters in patients with neurogenic bladder are extensive. Patient satisfaction is important, because acceptance is required for long-term compliance. Overall, in patients with neurogenic bladder, high rates of satisfaction are seen with hydrophilic catheters compared with PVC. […] A mostly neurogenic population significantly favored a hydrophilic catheter over PVC in terms of convenience and comfort of insertion; this increased comfort is supported by findings in healthy volunteers.”8

 

References:

(1) Feneley, R. C., Hopley, I. B., & Wells, P. N. (2015). Urinary catheters: history, current status, adverse events and research agenda. Journal of medical engineering & technology, 39(8), 459-470. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4673556/

(2) Cardenas, D. D., & Hoffman, J. M. (2009). Hydrophilic catheters versus noncoated catheters for reducing the incidence of urinary tract infections: a randomized controlled trial. Archives of physical medicine and rehabilitation, 90(10), 1668-1671. Available online at https://www.archives-pmr.org/article/S0003-9993(09)00374-8/pdf

(3) Health Quality Ontario. (2006). In vitro fertilization and multiple pregnancies: an evidence-based analysis. Ontario health technology assessment series, 6(18), 1. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3386556/

(4) Abbott, J. E., Heinemann, A., Badalament, R., & Davalos, J. G. (2015). A clever technique for placement of a urinary catheter over a wire. Urology annals, 7(3), 367. Available online at http://www.urologyannals.com/article.asp?issn=0974-7796;year=2015;volume=7;issue=3;spage=367;epage=370;aulast=Abbott

(5) Zammit, P. A., & German, K. (2004). The difficult urethral catheterization: use of a hydrophilic guidewire. BJU international, 93(6), 883-884. Available online at https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1464-410X.2003.04732.x

(6) Newman, D. K., & Willson, M. M. (2011). Review of intermittent catheterization and current best practices. Urologic nursing, 31(1). Available online at https://pdfs.semanticscholar.org/fd42/607a51cbd1198b8c5e4055250ddf14c61d40.pdf

(7) Chartier‐Kastler, E., & Denys, P. (2011). Intermittent catheterization with hydrophilic catheters as a treatment of chronic neurogenic urinary retention. Neurourology and urodynamics, 30(1), 21-31. Available online at https://www2.imop.gr/sites/default/files/intermittent_catheterization_with_hydrophilic_catheters_as_a_treatment_of_chronic_neurogenic_urinary_retention.pdf

(8) Li, L., Ye, W., Ruan, H., Yang, B., & Zhang, S. (2013). Impact of hydrophilic catheters on urinary tract infections in people with spinal cord injury: systematic review and meta-analysis of randomized controlled trials. Archives of physical medicine and rehabilitation, 94(4), 782-787. Available online at https://www.archives-pmr.org/article/S0003-9993(12)01111-2/pdf

 

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