Catheterization at Home

CARE at HOME is a home healthcare service provider with a difference. The core purpose is to deliver 'Healthcare outside hospitals' in the right way. The main focus is on clinical excellence coupled with superior patient experience at an affordable cost.

Our team is highly competent to handle a wide range of services that require clinical expertise, hi-tech devices and complex multispecialty management. A commonly used device for drainage is the catheter, the procedure is called catheterization.

What is a catheter?

A catheter is a thin tube, often made of soft plastic material that can be inserted into the body. Catheters are a medical device and are prescribed by doctors to treat diseases or perform a surgical procedure.

Why is it needed?

A urinary catheter is used to drain the urinary bladder when it cannot be emptied normally. This process is called catheterization. It can become necessary after a surgery or during hospitalization.

What are urinary catheters?

A urinary catheter is a hollow, partially flexible tube that collects urine from the bladder and leads to a drainage bag. Urinary catheters come in many sizes and types. They can be made of:

• Rubber
• Plastic (PVC)
• Silicone

Types and sizes of catheters

Diameters:

• 5Fr, 6Fr, 8Fr, 10Fr, 12Fr, 14Fr, 16Fr, 18Fr, 20Fr, 22Fr, 24Fr, 26Fr
• The higher the number the larger the diameter of the catheter.
• 3Fr. = 1 mm (i.e., a 24Fr catheter is 8 mm in diameter)

Types:

• Straight-single use catheters
  • Have a single lumen with a small 1¼ cm opening

• 2-way Foley’s catheters (retention catheters)
  • Have an inflatable balloon that encircles the tip near the lumen or opening of the catheter

• Curved or coude
  • Catheters have a rounded curved tip (elbowed) used in older male patients with enlarged prostates, which partially obstruct the urethra

• 3-way Foley’s catheter
  • Often called a retention catheter, the Foley’s catheter has 2 or 3 lumens that encircle the body of the catheter. One lumen drains the urine through the catheter into a collection bag. The second lumen holds the sterile water when the catheter is inflated and is also used to deflate the balloon. The third lumen may be used to instill medications into the bladder or provide a route for continuous bladder irrigation.

Indications for urinary catheterization are:

• Intermittent catheterization 
• Collection of sterile urine sample
• Providing relief from discomfort due to bladder distention
• Decompression of the bladder
• Measure residual urine
• Management of patients with spinal cord injury, neuromuscular degeneration, or incompetent bladders
• Short-term indwelling catheterization
• Post-surgery and in critically ill patients to monitor urinary output
• Prevention of urethral obstruction from blood clots with continuous or intermittent bladder irrigations 
• Instillation of medication into the bladder 
• Surgical procedures involving pelvic or abdominal surgery repair of the bladder, urethra and surrounding structures
• Urinary obstruction (e.g., enlarged prostate), acute urinary retention
• Long-term indwelling catheterization
• Refractory bladder outlet obstruction and neurogenic bladder with urinary retention
• Prolonged and chronic urinary retention
• To promote healing of perineal ulcers where urine may cause further skin breakdown

Catheters are generally necessary when someone can’t empty their bladder. If the bladder isn’t emptied, urine can build up and lead to pressure in the kidneys. The pressure can lead to kidney failure, which can be dangerous and result in permanent damage to the kidneys.

Most catheters are necessary until one regains the ability to urinate on one’s own. Generally, they are used for a short period of time. Elderly persons and those with a permanent injury or severe illness may need to use urinary catheters for a longer time or even permanently.

Why are urinary catheters used?

A doctor may recommend a catheter if a person:

• can’t control when they urinate
• has urinary incontinence
• has urinary retention

The reasons why one may not be able to urinate on one’s own can include:

• Blocked urine flow due to bladder or kidney stones, blood clots in the urine, or severe enlargement of the prostate gland
• Surgeryon the prostate gland
• Surgery in the genital area, such as a hip fracture repair or hysterectomy
• Injury to the nerves of the bladder
• Spinal cord Injury
• A condition that impairs one’s mental function, such as dementia
• Medications that impair the ability of the bladder muscles to squeeze, which causes urine to remain stuck in the bladder
• Spina Bifida

What are the types of urinary catheters?

There are three main types of catheters: indwelling catheters, external catheters and short-term catheters.

Indwelling catheters (urethral or suprapubic catheters)

An indwelling catheter is a catheter that resides in the bladder. It is also known as a Foley’s catheter. This type can be useful for short and long periods of time.

A nurse usually inserts an indwelling catheter into the bladder through the urethra. Sometimes, a healthcare provider will insert the catheter into the bladder through a tiny hole in the abdomen. This type of indwelling catheter is known as a suprapubic catheter.

A tiny balloon at the end of the catheter is inflated with water to prevent the tube from sliding out of the body. The balloon can then deflate when the catheter needs to be removed.

External catheters (condom catheters)

A condom catheter is a catheter placed outside the body. It’s typically necessary for men who don’t have urinary retention problems but have serious functional or mental disabilities, such as dementia. A device that looks like a condom covers 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 usually need to be changed daily, but some brands are designed for longer use. These cause less skin irritation than condom catheters that require daily removal and reapplication. A wound, ostomy and continence nurse can help make these recommendations.

Short-term catheters (intermittent catheters)

A person may only need a catheter for a short period of time after surgery until the bladder empties. After the bladder empties, it’s necessary to remove the short-term catheter. Healthcare providers refer to this as an in-and-out catheter.

In a home setting, people are trained to insert the catheter themselves or with the help of a caregiver. It can be done through the urethra or through a hole created in the lower abdomen for catheterization. 

What are the potential complications of urinary catheters?

Indwelling urinary catheters are the leading cause of healthcare-associated urinary tract infections (UTIs). Therefore, it’s important to routinely clean catheters to prevent infections.

The symptoms of a UTI may include:

• Fever
• Chills
• Headache
• Cloudy urine due to pus
• Burningof the urethra or genital area
• Leaking of urine out of the catheter
• Blood in the urine
• Foul-smelling urine
• Low back painand achiness

Other complications from using a urinary catheter include:

• Allergic reactionto 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)
• Septicemia or infection of the urinary tract, kidneys, or blood

What is a clean intermittent self-catheterization?

Each time one urinates one exercises the bladder muscles. However, some people’s bladder muscles don’t work as well as others. Then the doctor may recommend clean intermittent self-catheterization. This painless procedure helps one empty the bladder of urine at home.

What conditions require this treatment?

Clean intermittent self-catheterization is recommended when a patient has a condition that affects his ability to empty the bladder properly. “Clean” refers to the fact that the procedure requires clean techniques, such as washing one’s hands and skin before insertion to prevent infection.

Some people who may require clean intermittent self-catheterization include:

• Women who have had gynecological surgeries
• People with nervous system disorders
• People who can’t empty their bladders

If one can’t fully empty the bladder, they are at greater risk of urinary tract infections, which can ultimately damage the kidneys. The use of clean intermittent self-catheterization can help prevent a urinary tract infection.

How is the procedure performed?

While many types of catheters are intended to stay in for days or weeks, a catheter used for clean intermittent self-catheterization is used several times a day to empty the bladder. The catheter is attached to a plastic bag that can be used to measure the amount of urine. The process of clean intermittent self-catheterization for women is different from the process for men.

For women

First wash hands and the area around the urinary opening to prevent infection. You must be able to identify the urinary meatus (opening where urine flows). You need to lubricate the tip of the catheter and insert it into the urinary meatus.

When the catheter is properly inserted, urine will flow into the catheter’s bag. Allow all urine to drain. When the urine stops flowing, slowly and gently remove the catheter. Measure and record the amount of urine in the bag and then empty the bag.

Clean the catheter and urine collection device with mild soap and hot water immediately after use. Rinse the materials and air dry. Store the materials in a clean, dry container.

For men

First wash your hands and cleanse the area around the top of your penis to reduce bacteria and risk for infection. Lubricate the first several inches of the catheter tip. Insert the catheter into the urinary opening of your penis until 8 or 9 inches of the catheter have been inserted. You may feel some resistance after inserting 6 inches of the catheter. This is not uncommon, as this is the location of the urinary sphincter muscles. Take a few deep breaths and increase the pressure while continuing to insert the catheter.

Make sure the urine has stopped flowing and you’ve completely emptied your bladder. Then slowly remove the catheter. Measure and record the amount of urine in the bag and then empty the bag.

Clean the catheter and urine collection device with mild soap and hot water immediately after use. Rinse the materials and air dry. Store the materials in a clean, dry container.

General information

Each time you’re finished using the catheter, always wash it with soap and hot water; let it air dry, then store in a clean, dry container. You should replace your catheter every two to four weeks, according to the National Institutes of Health (NIH). If your catheter becomes hardened, discolored, brittle or too soft for insertion, discard it.

Your doctor will recommend how often you should perform clean intermittent self-catheterization. A typical schedule is every six hours and just before you go to bed. If you’re urinating more than 400 mL at a time with clean intermittent self-catheterization, you may need to increase the frequency to prevent infection.

How is the procedure monitored?

The doctor usually asks you to keep a record of your daily liquid intake and output while performing clean intermittent self-catheterization. Intake includes anything you drink, such as water, juice, tea, soft drinks, alcohol, tea and coffee. Be sure to drink between 2,000 mL and 2,500 mL (or 8.5 to 10.5 cups) of fluid, preferably water, per day.

If your kidneys are working properly, you should flush out the same amount of fluid as you take in over the course of the day. If your recorded output doesn’t match your intake, notify your doctor.

Specific considerations

Pediatric catheterization:

• Size: 5, 6, 8, 10Fr or smaller depending on the size of the urethra and age of child
• Rarely are catheters left indwelling; typically, they are intermittent and are used to obtain sterile urine sample to rule out infection.
• In children <2 years of age, a 5Fr feeding tube can be used if a small diameter catheter is not available.
• Using feeding tubes can cause urethral trauma.
• A second pair of hands for assistance is recommended for very young children.

Male catheterization:

• 16Fr or 18Fr catheter is typically used for most men, as they are more rigid and often easier to insert past the prostate.
• In males it is helpful to use a Urojet (syringe with lidocaine jelly) to minimize the discomfort of the catheterization.
• Males who present with gross hematuria require 3-way Foley’s catheters with the largest diameter that can be safely inserted (22Fr, 24Fr).
• Catheters should be attached to the inner upper thigh with a Cath Secure. This will minimize discomfort and prevent the catheter from being pulled on/out.
• When the foreskin is retracted for the purpose of catheterization, put it back in its original place.
• If resistance is met while inserting the catheter, due care is used not to damage the enlarged prostate. Never inflate the balloon until urine has been visualized and is draining.

Female catheterization:

• A 12Fr, 14Fr or 16Fr catheter is typically used.
• Positioning is important to properly visualize the urethra in females.
• If you are unable to visualize the urethra, raise the pelvis with a pillow. blanket or inverted bed pan.
• If you insert the catheter into the vagina leave it in place as a landmark and start again with another sterile catheter.
• Never inflate the balloon until you see urine.
• If a patient presents with gross hematuria a larger 3-way catheter needs to inserted.

Equipment

• Catheterization tray consists of: disposable sterile gloves, drapes, one fenestrated, lubricant, cotton balls with container, forceps (2), prefilled 10cc syringe with sterile water to inflate the balloon and sterile specimen container for urine sample collection
• Sterile catheter, latex (rubber) or silicone: 2 way or 3 way (where possible, select a non-latex catheter)
• Chlorhexidine 2% aqueous solution
• Sterile water
• Catheter-secure device or adhesive tape
• Urinary drainage bag
• Medicated lubricant (Urojet)