From the Guidelines
An intermittent catheter is a thin, flexible tube temporarily inserted into the bladder through the urethra to drain urine, then removed after the bladder is emptied, primarily used by people with neurogenic bladder or refractory bladder due to conditions like spinal cord injury, stroke, or multiple sclerosis. This procedure is meant to reduce catheter-associated UTIs and promote greater independence among people who have bladder emptying problems, as noted in a systematic review and cost-effectiveness analysis published in the BMJ 1. The most common indications for intermittent catheterisation include:
- Neurogenic bladder caused by spinal cord injury, stroke, Parkinson’s disease, multiple sclerosis, or diabetic neuropathy
- Refractory bladder caused by urethral obstruction due to infection, metastases, or congenital abnormalities
- Prostatic enlargement or procedures/medications that affect the contractility of the detrusor muscle The catheter may be made of different materials, including hydrophilic, gel reservoir, or non-coated, with hydrophilic and gel reservoir catheters being discarded after each use, while non-coated catheters may be discarded or washed and re-used for up to one week, as discussed in the study 1. Proper technique involves:
- Thorough handwashing
- Maintaining sterility of the catheter tip
- Cleaning the urethral opening before insertion This approach offers advantages over indwelling catheters by reducing infection risk and preserving bladder function, as the bladder can still fill and empty in cycles, although UTI remains the most common and serious complication of intermittent self catheterisation, as highlighted in the study 1. Users should monitor for signs of urinary tract infection such as cloudy urine, fever, or pain during urination, and seek medical attention if these occur.
From the Research
Definition of Intermittent Catheterization
- Intermittent catheterization is the insertion and removal of a catheter several times a day to empty the bladder 2
- It is used to drain urine from a bladder that is not emptying adequately or from a surgically created channel that connects the bladder with the abdominal surface 2
Indications for Intermittent Catheterization
- Intermittent catheterization is widely advocated as an effective bladder management strategy for patients with incomplete bladder emptying due to idiopathic or neurogenic bladder dysfunction 2
- It is recommended for bladder management after spinal cord injury since it has the lowest complication rate 3, 4
Techniques and Strategies
- Intermittent catheterization can be performed using aseptic or clean technique, with single-use or multiple-use catheters, and with coated or uncoated catheters 5
- The choice of technique and catheter type may depend on patient preference, clinical judgment, and cost-effectiveness 2, 5
Complications and Challenges
- Common complications of intermittent catheterization include urinary tract infections, urethral trauma, and discomfort during catheter use 5, 3
- Patients may experience difficulties with intermittent catheterization, such as carrying out the procedure in outdoor environments, dependence, and pain 3
- Intermittent catheterization may be under-used, and indwelling catheters may be more common due to various reasons, including inconvenience and urinary leakage 6, 4