How to Perform Self Intermittent (Straight) Catheterization
Patients should perform clean intermittent self-catheterization (CISC) using single-use hydrophilic or gel reservoir catheters 4-6 times daily, though clean non-coated catheters remain the most cost-effective option when resources are limited. 1, 2
Catheter Selection
Choose between hydrophilic or gel reservoir catheters as first-line options, as these are associated with fewer UTIs compared to sterile non-coated catheters (149-153 fewer UTIs per 1000 patients). 1 However, the evidence shows that catheter type makes relatively little difference in symptomatic UTI rates when measured over time, and the cost difference is substantial (>£54,350 per QALY gained for gel reservoir catheters). 1
Practical Catheter Considerations:
- Hydrophilic catheters: Pre-coated polymer surface, must be single-use
- Gel reservoir catheters: Packaged with water-based lubricant, must be single-use
- Non-coated catheters: Most cost-effective; can use clean technique with washing and reuse up to one week 1
Clean technique (washing and reusing catheters) is as safe as sterile single-use non-coated catheters, with no significant difference in UTI rates (12 fewer per 1000, not statistically significant). 1
Frequency and Technique
Catheterize 4-6 times daily to maintain adequate bladder emptying and prevent complications. 3 The goal is to prevent bladder overdistension while maintaining reasonable quality of life.
Step-by-Step Procedure:
For all patients:
- Wash hands thoroughly before beginning
- Position yourself comfortably (sitting on toilet, standing, or lying down depending on ability)
- Use adequate lubrication if using non-coated catheters
- Insert catheter gently until urine flows
- Allow bladder to drain completely
- Remove catheter slowly when drainage stops
- Wash hands after completion
Key anatomical landmarks:
- Women: Locate urethral opening between clitoris and vagina; may need mirror initially for visualization 4
- Men: Hold penis at 90-degree angle to body; insert catheter through entire length of urethra until urine flows
Critical Clinical Points
Intermittent catheterization is strongly preferred over indwelling catheters due to lower rates of UTI, urethral trauma, and bladder stones, with better quality of life outcomes. 2 When indwelling catheters are unavoidable, suprapubic placement is superior to urethral placement.
Common Pitfalls to Avoid:
- Insufficient catheterization frequency: Leads to bladder overdistension and increased UTI risk
- Inadequate drainage: Ensure bladder empties completely each time
- Poor hand hygiene: Primary source of contamination even with "clean" technique
- Forcing catheter insertion: If resistance encountered, stop and reposition; never force
Patient Education Priorities
Successful CISC requires comprehensive teaching by a knowledgeable nurse who can assess physical and psychological readiness. 5 Patients need to understand:
- Why catheterization is necessary (anatomy, physiology, disease process)
- How to recognize complications (UTI symptoms, bleeding, difficulty inserting)
- Importance of adequate fluid intake
- When to contact healthcare provider
Home training is highly effective and allows patients to learn in their actual environment, improving compliance and competency. 6 Offer patients a range of catheter options to try, considering their dexterity, physical ability, and living situation.
Monitoring and Follow-up
Watch for signs of complications:
- UTI symptoms: Fever, cloudy/foul-smelling urine, increased spasticity (in neurogenic patients)
- Urethral trauma: Bleeding, pain with insertion, difficulty passing catheter
- Autonomic dysreflexia: In spinal cord injury patients above T6 level
The evidence base for catheter selection remains limited, and additional data on urethral complications, patient compliance, and quality of life would strengthen recommendations. 1 Until better evidence emerges, patient preference and individual circumstances should guide catheter selection within the framework of these evidence-based principles.