Intermittent self-catheterisation: Assessment

Intermittent catheterisation is an effective, alternative way of draining the bladder compared to an indwelling catheter. However, it is not always instigated by professionals for several reasons from not being aware of the benefits of the procedure, not understanding assessment of the individual who potentially is capable to undertake the skill and little awareness of equipment that is available. This article addresses some of these points and raises clinical awareness of the procedure.

Intermittent catheterisation is a procedure where a catheter is inserted into the bladder to drain the urine and immediately removed after the bladder is emptied (Lister et al, 2020). This procedure is deemed the gold standard of draining a bladder that cannot empty by itself (Royal College of Nursing (RCN), 2021). The catheters are known as nelaton catheters and are an alternative to indwelling urinary catheters for individuals who experience bladder emptying problems (Yates, 2017).

These individuals may need to undertake intermittent catheterisation for a number of reasons. This includes as a result of:

• neurogenic/detrusor hypo-contractility or failure – this occurs when the muscles of the bladder wall (destrusor muscle) fail to contract and expel urine. This can be as a result of, for example, spinal injuries and neurological disorders such as multiple sclerosis, spina bifida, cerebrovascular accident or late stage diabetes
• outflow obstruction – this is when the bladder

While there are many reasons to undertake intermittent catheterisation not all individuals will be suitable for or capable of it. Success depends on many factors including, willingness of the patient to undertake the procedure and how well they are given instructions (Leaver, 2023). Assessment requirements for intermittent catheterisation include:

• checking symptom severity profile, renal function, risk assessment, psychological and physical ability to undertake intermittent catheterisation
• checking post-void residual urine status (amount of urine left in bladder after urinating) via a bladder scan. The usual indicated amount varies between 100 and 150mls. This should be used in conjunction with other assessment requirements
• the patient should be physically able to store urine in their bladder
• the patient should be able to understand the technique for intermittent catheterisation (clean technique), rationale for its use and impact on symptoms
• the patient should have reasonable dexterity
• the patient should be able to position themselves into