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Clean Intermittent Self-Catheterisation is a technique which is used to empty the bladder at regular intervals. This is done by passing a catheter (small tube) into the bladder through the urethra (passage through which urine leaves the bladder). You should be taught how to do this by your continence nurse. It is not a sterile technique, but it is a clean one, so it is very important to have good hygiene standards when doing the procedure.
There are lots of catheters available. If the catheter is “self-lubricated”, it means that after it is soaked in water for a short time it becomes slippery enough to insert. Some catheters are pre-lubricated, which means they have a slippery coating on them. With others, you will need to use a lubricating jelly to ease insertion. Your continence nurse will tell you how to use each type of catheter.
Catheters are available on prescription from your doctor. Some chemists will have to order the catheters for you, so make sure you have enough catheters to last while waiting for your next order to come in. Many healthcare companies offer a home delivery service, whereby you send the prescription to the company and they send the catheters to your home. Ask the ASBAH Helpline for details.
Most catheters nowadays are “single use”. However, some people may need to use reusable catheters. A reusable catheter must be rinsed, dried, and stored in a clean paper bag immediately after each use. Change bags and catheter at least once a week.
Your doctor or continence nurse will tell you how many times a day you will need to catheterise yourself. It can vary from once a day for some people to 4-6 times a day for others.
If clean intermittent catheterisation is to be used on a child in school, make sure the school and person responsible for carrying out the catheterisation are properly trained to perform the procedure, and are quite clear about when and where it should be done. Furthermore, a school care plan must be in place. The continence adviser and school nurse will help with this.
Most people find it easiest to catheterise whilst sitting on the toilet.
Procedure
List of equipment
Catheter
Mirror – may be useful for females
Lubricating/anaesthetic jelly for males if used
Disposable tissues – or baby wipes
Unperfumed soap – the perfumed type may cause irritation
Towel – kept for this purpose only
Container for urine if not drained directly into the toilet
Floor protection
Very careful hygiene should be observed at all times.
Females
Collect everything you are going to need. Take off or loosen clothing as necessary. Gently wash genital area from front to back. Use disposable tissue and soap or baby wipes. Wash hands carefully, and dry them on a towel or disposable kitchen paper.
Part the labia and slide the catheter gently into the urethra, making sure not to handle the end which enters the bladder. The other end of the catheter should be pointing into the toilet or receptacle. When the urine has finished draining, slowly start to pull the catheter back out. If some more urine starts to flow, stop pulling the catheter and wait for the flow to stop. Continue doing this until the catheter is completely out.
Place the used catheter in a disposal bag and/or sanibin. If using a non–disposable catheter rinse it under a tap, dry on a paper towel and place in a clean paper bag for storage.
Males
Collect everything you are going to need. Take off or loosen clothes as necessary. Wash hands and then wash the penis, taking care to wash under the foreskin. Dry hands and penis carefully, using disposable paper.
Squeeze a little lubricating jelly onto a piece of paper and discard. Squeeze a little into the penis if using anaesthetic jelly or on to the tip of the catheter if lubricating jelly is used.
Gently pull back the foreskin and slowly insert the catheter, holding the penis upright. Do not touch the end of the catheter that is going into the bladder.
When the urine has finished draining, slowly start to pull the catheter back out. If some more urine starts to flow, stop pulling the catheter and wait for the flow to stop. Continue doing this until the catheter is completely out.
Place the used catheter in disposal bag and/or sanibin. If using a non–disposable catheter rinse it under the tap, dry on a paper towel and place in a clean paper bag for storage.
Tips
Try to avoid constipation because, if the bowel is empty, it makes it easier to drain the bladder properly. A high fibre diet can help and advice leaflets are available. If you become constipated, you may well begin wetting between catheterisations. Remember to drink at least 8 glasses of fluid a day as this helps to avoid constipation and urinary tract infections.
If you are going to go on holiday abroad, it is advisable to ask your GP if you can have a letter for the Customs Officials stating that you have catheters with you. If you are in doubt about the water in the country you are visiting, it would be best to use bottled water. Always remember to take enough supplies of catheters with you when going on holiday, either in this country or abroad. Remember to put them in your hand luggage if you are going on an aeroplane, as sometimes suitcases can get mislaid.
Potential problems
Urine infections
If your urine becomes cloudy and smelly, you may have a urinary tract infection. Other signs of infection could be generally feeling unwell, headaches, and a raised temperature. Sometimes, if you are wet between catheterisations, this may also indicate an infection.
Take a specimen of urine to your nurse/doctor who may give you some antibiotics to take. Drink plenty of fluid – at least one full glass every hour (preferably not coffee, coke or fizzy drinks). Cranberry juice can help to reduce the risk of urinary tract infections. However, cranberry juice is often contraindicated for people taking blood thinning medications (eg warfarin).
Do not stop catheterising!
Pain on catheterising
You may feel some pain when you first begin catheterising, but this does stop. However, pain can also be a sign of infection. If the pain persists and/or there is blood on the catheter when you take it out, seek medical advice.
Blood in the urine
If you sometimes see blood in your urine, don’t worry – it could be due to a slight irritation or infection and should clear within a few days. If it doesn’t, seek medical advice.
If you have any problems or questions always ask your continence nurse, doctor or ASBAH adviser.
Further information and resources
A ‘Need to Go’ card is available from ASBAH. The credit card size laminated card may help service users access toilet facilities when out and about. To find out more telephone the helpline or email helpline@asbah.org
Radar - The disability network offers a key scheme which allows people with disabilities access to locked public toilets. Visit www.radar.org.uk or telephone 0207 250 3222 to find out more.
Link Magazine
The essential magazine for people with hydrocephalus and spina bifida. Link is published quarterly (Winter, Spring, Summer and Autumn) and is packed with the latest news, events and issues for individuals, carers and people living with hydrocephalus and spina bifida. To subscribe contact ASBAH'S Helpline 0845 450 7755 email: helpline@asbah.org or click here.
Coloplast and ASBAH are working in partnership to campaign for an increased awareness of bladder and bowel health and to support ASBAH’s members and families in their efforts to live a full and satisfying life.
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This information has been produced by ASBAH’s medical advisers and approved by ASBAH’s Medical Advisory Committee of senior medical professionals.
