Today, the "golden standard" is intermittend catheterisation, which imitates the "natural" rhythm of bladder emptying.
KNOWLEDGE CENTRE
CONTINENCE CARE
INTRODUCTION TO THE PROCEDURE OF SELF-CATHETERISATION
HOW TO SUCCESSFULLY SELF-CATHETERISE
Urinary catheterisation is a method of emptying the bladder using a catheter. It is a process with a long history, which has undergone many stages of improvement.
Today, the “golden standard” is intermittent catheterisation, which mimics the “natural” rhythm of bladder discharge.
Preconditions for a successful self-catheterisation
What is required for intermittent self-catheterisation is first and foremost education. Health professionals are responsible for your familiarisation with this technique.
You also need to have good control over your hands, good vision, and a willingness to perform self-catheterisation.
Self-catheterisation and intermittent catheters
In addition to being familiar with the technique, the procedure requires an intermittent catheter, of which today there are different types. They are often divided into coated and uncoated intermittent catheters.
For catheters without coating, an external lubricating source for the tube is required, while the coated ones are already covered with lubricating substances, for example catheters with hydrophilic layers.
The hydrophilic layer is activated in contact with water, evenly lubricating the tube and forming a “soft coating” around it that facilitates the insertion of the catheter and reduces the risk of irritation of the urethra.
Hydrophilic catheters usually come with a sachet with sterile water used to activate the hydrophilic layer, which is why the user does not depend on an external source of water for the self-catheterisation process. You will determine the specific type, length and diameter of the catheter you will use with your doctor.
For a proper catheterisation procedure, you will also need some hand washing agent such as soap. In addition, it is necessary to have a clean space that allows you privacy during the self-catheterisation process. Women can also use a mirror to help them find the entrance to the urethra.
Finally, a toilet or a urine bag is needed to drain urine into it during the catheterisation process.
Why are female and male catheters different?
Due to the differences in anatomy between women and men, female and male catheters differ. The key is the difference in the length of the urethra. In men it is 18 – 20 cm long, while in women it is significantly shorter, only 3-4 cm.
Therefore, male catheters are longer than females, which is why the catheterisation process is somewhat different. There are also paediatric catheters that come in the size which is appropriate for children.
How is intermittent self-catheterisation performed?
The details of the specific self-catheterisation process depend on the type of catheter used. However, general instructions are mostly the same. To begin with, it is necessary to wash your hands thoroughly and to dry them well.
Then put the equipment needed for catheterisation in a clean place within hand’s reach.
It is important to wash the part around the opening of the urethra, i.e. the glans penis. For women, the direction of washing is very important, which must always go from the urethra to the anus.
This prevents the contamination of the urethra with microorganisms found in the human intestine.
The catheter is removed from the package and then gently introduced into the urethra until urine starts to drain. Both hands are used for the insertion.
Women need to spread their labia with one hand, using the index finger and the middle finger, while inserting the tube with the other hand. Similarly, men need to hold their penis with one hand while inserting the tube with the other one.
It is very important for men to hold the catheter only by using the insertion grip throughout the entire procedure – this protects the tube against contamination, which reduces the risk of urinary infections. In order to achieve a more complete discharge, the catheter tube can be slowly rotated/turned towards the end. When the discharge is complete, the catheter tube is gently drawn out from the urethra.
In pregnant women, there may be difficulties in conducting intermittent catheterisation. The solution is to try out different catheters and positions for the self-catheterisation process.
More detailed self-catheterisation instructions are available on our YouTube channel.
Why is fluid intake important for intermittent self-cateterisation?
Insufficient amounts of fluid can lead to urinary infections. Also, excessive fluid intake into the body can cause bladder distension, i.e. its excessive stretching.
To prevent this, it is important that there is no more than 500 ml of urine in the bladder.
A general rule is that the bladder should be emptied when there is about 400 ml of urine in it. For this reason, fluid intake is aligned with the rhythm of intermittent catheterisation.
For example, if you have entered 500 ml of fluid into the body since the last catheterisation, then it is likely the right time to self-catheterise and empty your bladder. It is worth noting that this amount of fluid varies from person to person and that it is smaller in children.
The level of appropriate fluid intake into the body depends on several specific factors such as age, gender and body weight. Therefore, you should consult a doctor to determine the optimal quantity in your case.
