Catheters: an essential guide

Urinary catheters come in many sizes and types, including rubber, silicone or latex. They’re typically used when patients are unable to urinate normally or to treat medical conditions such as:

  • Blocked flow of urine as a result of bladder stones, blood clots in the urine, or a narrowing of the urethra
  • Prostate surgery or surgery in the pelvic area, such as a hip fracture repair or hysterectomy
  • Injury to the nerves of the bladder caused by conditions such as Spinal Bifida, CVA , spinal cord injuries and childbirth
  • Medications that impair the ability of bladder muscles to squeeze such as antihistamines.

Most catheters are used for a short period of time until the patient regains the ability to urinate on their own. Elderly people and those with a permanent disability or severe illness may need to use urinary catheters for a longer period to avoid urine build up that – over time – can lead to infection, incontinence, nocturia and discomfort but also more severe complications such as permanent kidney damage, renal failure and septicaemia.

You could say, then, that catheterisation can be a life-saving therapy.

Here’s our essential guide to the different types of catheters, how and when to use them and how to help your patients avoid infection.

  1. Intermittent Catheterisation (IC) and Intermittent Self-Catheterisation (ISC). Intermittent catheterisation is a first choice therapy for short and long term continence management, because it reduces the complications more frequently seen with indwelling catheters – such as infections, bladder stones and catheter blockage.

    Patients with urinary dysfunction caused by neurological disease will often need intermittent self-catheterisation. The catheter is inserted into the bladder by the patient and, once the retained urine has drained, it’s removed and discarded immediately. A new catheter must be used for each catheterisation.

    Patients typically catheterise themselves from four to six times a day. Intermittent catheterisation allows normal bladder dynamics and is the most similar treatment to normal voiding. As a result, patients feel more in control of their bladder function, which leads to increased self confidence and independence. As the bladder is drained effectively and completely, urinary tract infections cease to be a problem (as they are with indwelling catheters), safeguarding the kidneys.

    Click here to view the intermittent catheters available.

  2. Single Urinary Catheterisation. This is generally a one-off catheterisation performed by a nurse in a hospital to empty a patient’s bladder or obtain a urine sample. A new catheter is used for each catheterisation.

  3. External Catheters (Condom Catheters). Placed over the penis, external catheters are typically used for men who may or may not have continence problem and are less invasive than a catheter.

    Rather than a tube placed inside the penis, a device that looks like a condom is placed over the penis head. A tube leads from the condom device to a drainage bag.

    These catheters are generally more comfortable and carry a lower risk of infection than indwelling catheters. Condom catheters need to be changed daily and personal hygiene attended.

    Click here to view the external catheters available.

  4. Urethral Indwelling Catheterisation. An indwelling catheter (sometimes called a Foley catheter) is an invasive procedure. The catheter is placed in through the urethra and remains in the patient’s bladder from anywhere between a few hours up to 12 weeks, creating a constant in/out flow.

    A balloon at the end of the catheter is inflated to prevent the tube from sliding out of the bladder. The balloon is deflated and the catheter is then removed. A new catheter is then inserted if its required on an ongoing basis. A medically trained health professional will generally insert the catheter in hospital or a clinic and change it every 6 to 12 weeks or as required.

    If your patient requires a catheter for the long-term, as with all catheters, the longer it is in situ the higher the risk of infection.

    Click here to view the indwelling catheters available.

  5. Suprapubic Urinary Catheterisation. Sometimes, an urologist will insert the catheter into the bladder through a tiny hole in the abdomen. This type of indwelling catheter is called a suprapubic catheter. The catheter is changed every 6 to 12 weeks or as required.

    Suprapubic catheters are only recommended for the management of medical conditions such as urethral obstruction and stricture. They are recommended for wheelchair bound patients as it reduces the risk of the catheter been pulled out when transferring.

What are the potential complications of urinary catheters?

The most common complication of all types of catheterisations is urinary tract infection (UTI). As the bladder is a sterile environment, introducing a catheter can increase the risk of bacterial contamination. However, urine retention has many more side effects than no catheter at all.

Indwelling urinary catheters are the leading cause of healthcare-associated urinary tract infections (UTIs) (van den Broek, et. al., 2011). It’s therefore crucial indwelling catheters are routinely cleaned to prevent infections. Symptoms of a UTI may include:

  • Fever
  • Chills
  • Headache
  • Burning of the urethra or genital area
  • Leaking of urine out of the catheter
  • Blood in the urine
  • Foul smelling urine
  • Low back pain and achiness.

Other urinary catheter complications can include:

  • Allergic reaction to the material used in the catheter, such as latex
  • Bladder stones
  • Blood in the urine
  • Injury to the urethra
  • Kidney damage (with long-term indwelling catheters)
  • Infection of the urinary tract, kidney, or blood (septicaemia).

Teaching your patients how to reduce the chance of infection

Maintaining personal hygiene is essential. Patients should be aware that both the catheter and the peri area should be cleaned with mild soap and warm water daily to maintain skin integrity and reduce the risk of a urinary tract infection (UTI). Patients should always wash their hands with warm water and soap before and after handling their catheter.

A fit and healthy lifestyle is important to maintaining optimal bladder health. Patients should drink plenty of fluid each day (at least 8 glasses) to help prevent infection. Exercise (low impact) and eating a diet high in fibre (30 grams a day) including fruit, vegetables and wholegrains can reduces the risk of constipation and maintains better continence.

For indwelling catheters, the drainage bag used to collect urine should be emptied when the bag is two thirds full. It should be cleaned using a plastic squirt bottle containing a mixture of 10% vinegar in water or plain soap and water. Ensure that the catheter is rinsed thoroughly afterwards.

To further reduce the chance of a UTI, patients should regularly check their catheter’s tubing for twists and kinks, and that their urine collection bag remains below the level of the bladder preventing the urine flowing back into the bladder.

Independence Australia carries a wide range of urinary catheters and catheter supplies, including intermittent catheters, indwelling catheters and external (condom) catheters.

Click here to view our full urology and continence range.