Intermittent self-catheterisation: Procedure
Intermittent catheterisation is an effective, alternative way of draining the bladder compared to an indwelling catheter. This article is a part two of Intermittent self-catheterisation: Assessment.
Article by Ann Yates
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Equipment
When teaching intermittent catheterisation it is important to choose the right catheter. It needs to be the correct length, width and type. There are three main types of intermittent catheters:
Although catheters are available in several materials most intermittent catheters are made from polyvinyl chloride which is a commonly used
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Procedure
If the procedure is carried out in hospital by a health professional, an aseptic technique must be used (RCN, 2021). A clean technique is used in the patient’s home (Vahr et al, 2013). As with all procedures informed consent should be obtained and documented.
All equipment should be assembled including:
- personal protective equipment
- lubricating gel if required
- appropriate sized catheter
- access to toilet or receptacle for urine drainage if required
- mirror if required
Step-by-step procedure
- Patients should identify a position that is comfortable for them to undertake intermittent self-catheterisation, for example:
-
- sitting on the toilet
- standing over the toilet
- sitting on a chair or side of the bath
- one leg slightly elevated on a stool
- sitting in a wheelchair
- lying on one side in bed
- Patients with a large abdomen may find it easier to stand in front of a mirror so they can see what they are
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Risks and complications
While intermittent catheterisation is the gold standard for bladder drainage it still has associated risks and complications (Table 1).
| Table 1. Common problems and solutions associated with intermittent catheterisation | ||
| Problem | Cause | Solution |
| Bleeding or blood on catheter tip | Traumatic insertion or scratching of catheter on lining of urethra |
- reassure that bleeding is common in initial phase. If it persists, rule out urinary tract infection. - if it is heavy or clots appear advise to seek medical help. - check the catheter used - advise lubrication or lubricated catheter - check technique |
| Insertion and/or removal difficulties |
May be caused by the prostate in men or anatomical changes i.e. prolapse in women Associated pain: - on insertion - on removal |
- check the size of the catheter. The change in size will depend on the cause of the problem - provide more lubrication - check tip of catheter as a specialist |
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Evaluation
The evaluation and review of intermittent catheterisation should be identified on an individual basis as some patients will need more support and input than others. Initially this may be frequent, either face to face or by telephone contact. Being informed that a patient needs to carry out intermittent catheterisation is daunting and for many embarrassing. Professionals should be aware of the eight determinants for an individual’s compliance to intermittent catheterisation. These are:
- knowledge of condition
- the steps and skills required for procedure
- checking any impaired bodily functions
- fears and misconceptions associated with the procedure and the catheter entering the bladder, where it goes, increased risk of infection and fear of pain
- feelings of shame and/or stigma
- the patient’s level of motivation
- timing of instructions given to the patient
- availability of materials or products. Individuals should be informed that there are various ways to obtain products in the community. They can
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Conclusion
Intermittent catheterisation is a safe and effective alternative to indwelling catheters for managing bladder problems. It is currently under recommended by professionals because of a lack of training in the procedure, lack of awareness in assessment of potential individuals who may be appropriate for its use and little knowledge of equipment available.
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Resources
Continence Product Advisor. ISC catheters. 2023. https://www.continenceproductadvisor.org/catheters (accessed 1 March 2023)
Leaver R. Intermittent self-catheterisation. Urology & Continence Care Today. 2023. https://www.ucc-today.com/journals/issue/launch-edition/article/intermittent-self-catheterisation-ucct (accessed 1 March 2023)
Lister S, Hofland J, Grafton H. The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Oxford: Wiley-Blackwell; 2020
Royal College of Nursing. Catheter Care: Guidance for Health Care Professionals. 2021. https://www.rcn.org.uk/Professional-Development/publications/catheter-care-guidance-for-health-care-professionals-uk-pub-009-915 (accessed 1 March 2023)
Vahr S, Cobussen-Boekhorst H, Eikenboom J et al. Catheterisation: Urethral intermittent in Adults. 2013. https://nurses.uroweb.org/guideline/catheterisation-urethral-intermittent-in-adults/ (accessed 1 March 2023)
van Achterberg T, Holleman G, Cobussen-Boekhorst H, Arts R, Heesakkers J. Adherence to clean intermittent self-catheterization procedures: determinants explored. J Clin Nurs. 2008;17(3):394-402. https://doi.org/10.1111/j.1365-2702.2006.01893.x
Yates A. Teaching intermittent catheterisation: barriers. Nursing Times. 2013;109(44):22-25
Yates A. Urinary catheters 4: teaching intermittent self-catheterisation. Nursing Times (online). 2017;113(4):49 – 51
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