Indwelling Urethral Catheters

Indwelling urinary catheters are those that are left in the bladder. They may be used for either short or long time periods. The indwelling catheter collects urine by connecting to a drainage bag. An indwelling catheter has a small balloon inflated on the end of it. This balloon prevents the catheter from sliding out of the body. When the catheter needs to be removed, the balloon is deflated.

2 Ways of insertion
There are two ways to insert the indwelling catheter into the bladder. The most frequent one is when the catheter is inserted through the urethra, which is the tube that carries urine from the bladder to the outside of the body. Other times, a clinician will provide a catheter into the bladder through a small hole in the belly. This may be done at a hospital or a clinician’s office.

Condom Catheters

Condom catheters are external male urinary incontinence devices.  The catheter is worn on the penis, just like a condom. The condom part is connected to the drainage bag, in which the urine is collected. Condom catheters are one-time use with a wear time of up to 24 hours. Condom catheters are generally considered to be easy to use, since they are simply rolled onto the penis. Before the condom is rolled on, the penis should be dry and the pubic hair should be trimmed to prevent any discomfort.

Size and design
Manufacturers design the drainage bags for condom catheters in different sizes to accommodate the activity level of the individual. For active men, there are small drainage bags available, that could be attached to the upper thigh with straps. This bag is usually quite discreet and it can be emptied easily. Larger bags are usually used at home and are placed on the floor beside the patient or attached to the bottom of the patient. 

Irritation
Occasionally, the adhesive used to attach the condom catheter may result in irritation to the penis shaft. In this case, the condom catheter should be removed until the irritation is completely gone. During this time, the individual may use urinary incontinence pads or underwear. To prevent urine irritation on the skin, these pads should be renewed on a regular basis.

Caregiving
Always clean the penis before wearing the catheter and taking it off. Examine your skin to prevent any signs of damage such as sores or cuts. The adhesive that attaches the condom around the penis may cause irritation.  Until the skin irritation is gone, the device should not be used.  To prevent urine irritation to the skin, regular cleaning of any urine leakage is important. Barrier creams are not recommended for usage on or near the penis as it may cause the condom to slip off or leak.

Intermittent Catheters

Intermittent Catheters are used to drain urine from a bladder that is not emptying adequately or from a surgically created that connects the bladder with the abdominal surface. The catheter is inserted and removed several times a day to empty the bladder. Intermittent catheters are highly recommended by physicians to patients who have inadequate bladder emptying functions due to idiopathic or neurogenic bladder dysfunction. Intermittent catherization has many advantages over indwelling catherization as with patients with spinal cord injury it preserves the renal function, reduces urinary incontinence, improves bladder emptying, and reduces the incidence of urinary tract infection, allowing the patient to lead a healthier and better quality life. Intermittent catheter is one of the most effective and commonly used methods of bladder management in patients with a neurogenic bladder, which is the common cause of spinal cord injury. By inserting the intermittent catheter several times a day, episodes of bladder over distention are avoided.

Complications
Even though intermittent catheters are the preferred method for catherization, there may be complications to it as well. If the patient is performing intermittent self-catherization for long-term, urethral, scrotal and bladder-related complications may occur. Among the bladder related complications, patient may have UTI, bleeding and stones.

Types
There are various types of catheters available for intermittent catherization: uncoated catheters come in latex-free and red rubber, hydrophilic or antibiotic coated cathethers . Closed systems come in gel, hyrdrophillic and antibacterial catheters.

Effect on the patient
Intermittent catherization could make a drastic physical and emotional impact on patients’ lives. While nurses worry about the medical complications caused by the intermittent catheter, the patient might be concerned about the discomfort, privacy issues, and the fear of catherization.  A well knowledgeable and experienced clinician could help ease this process by teaching the procedure to the patient. Many manufacturaers have visual guides or videos that help the patient follow the procedure and cover the caregiving portion of intermittent catherizaton.

Hydrophilic Catheters

A hydrophilic catheter is a catheter that is designed to be lubricated when moistened with water.  Hydrophilic catheters differ from conventional intermittent catheters in that they have a special surface that binds water to create a lubricant that reduces the amount of irritation and abrasion when the catheter in inserted into the urethra. This water-based lubricant allows for a smoother entry into the urethra with much less friction than conventional catheters, therefore causing less damage.

Benefits of Hydrophilic Catheters
One of the major benefits of using a hydrophilic catheter is the reduced abrasion to the urethra. The water lubricant sticks to the catheter better than lubricant on a conventional catheter, therefore, the catheter is still lubricated upon removal.  Because of the lubricated surface and reduction of damage to the urethra, users of hydrophilic catheters see a reduced incidence of urinary tract infections (UTIs).  Hydrophilic catheters can also be latex-free, so those with a latex allergy can use this type of catheter.

Caring for the Catheter
Urinary Tract Infections can often lead to more serious infections, such as a kidney infection, and can often cause severe harm to the catheter user.  Bacteria can enter the urethra from the user touching the catheter or by contaminating the catheter when it is opened.

In order to further reduce the incidence of UTIs, it is very important to use the hydrophilic catheter properly.  Though some catheters may be reusable, the hydrophilic catheter surface deteriorates after one use.  If the catheter is reused, the lack of lubricant will cause friction in the urethra and will increase the risk of UTIs and urethral damage.

Hydrophilic catheter users can lubricate the catheter with tap water or bottled water, if the tap water is unsafe.  When the catheter kit is opened, make sure the catheter does not come into contact with any unclean surfaces, in order to reduce the risk of contamination.

Suprapubic Catheters

Suprapubic catheters are used to drain urine in patients who have trouble urinating due to a medical condition. They consist of a sterile tube that is inserted through a small incision in the abdomen into the bladder. The term suprapubic means that it is inserted above the pubic bone. When in use, a small balloon filled with solution holds the catheter inside the bladder.

Infections related to the use of catheters are fairly common. In some cases, they can lead to serious injury or even death. These infections occur when bacteria gets inside the tube or drainage bag when the system is opened. Because infections can be very serious, it is important to care for the drainage system properly in order to reduce the likelihood of contamination.

How to Care for a Suprapubic Catheter
The most important step is always to use good hygiene. The hands must be kept as clean as possible. They should be washed before and after touching any part of the drainage system or the inserting site, and clean disposable gloves should always be worn. The drainage bag and tubing need to be positioned in a way that allows gravity drainage. The tubing must not be kinked or looped in anyway, and the bag needs to be placed below the waist but never on the floor.

To prevent pressure and pain on the insertion site due to an overfull bag, it needs to be emptied regularly. For most people, this means the bag should be emptied every three to six hours. When draining, make sure the drain spout does not come in contact with any surfaces, and clean it once the bag is completely empty. The drainage bag needs to be cleaned and changed as directed by a medical professional.

Caring for the Insertion Site
It is also important for suprapubic catheter users to keep the skin around the insertion site clean. It should be cleaned on a daily basis using warm water and soap that is free from lotions and perfumes. Before cleaning, the hands need to be thoroughly washed, and clean gloves should be worn. Using a clean washcloth or sterile gauze pad, clean the skin around the insertion site. The tube should also be cleaned to remove any blood or other material. Rinse thoroughly, and gently pat the area dry using a clean towel or sterile gauze.

Latex Allergy

A latex allergy is a reaction to the proteins found in natural rubber latex.  The body perceives the latex as a harmful substance and can therefore cause allergic reaction ranging from sneezing to anaphylaxis, which is a life-threatening condition. 

Mild symptoms of a latex allergy include itching, skin redness and hives or a rash, whereas more severe symptoms or reactions include sneezing, runny nose, itchy, watery eyes, scratchy throat, difficulty breathing, wheezing or coughing.  An anaphylactic response is the most severe allergic reaction and can often be fatal.  Anaphylactic responses occur immediately after exposure and can include the following symptoms: difficultly breathing, wheezing, drop in blood pressure, dizziness, loss of consciousness, confusion, and rapid or weak pulse. Emergency medical care should be sought immediately if any of these symptoms occur.

Spina Bifida and Latex Allergies
Latex allergies are extremely common amoung children with Spina Bifida, which is one of the most common birth defects in the United States.  Spina Bifida is caused by an incomplete closure of the neural tube and affects fetal development of the brain, spinal cord, and backbone.  Because so many children with Spina Bifida undergo frequent medical procedures as children, they often develop latex allergies.  Approximately 70% of children and adolescents with Spina Bifida are sensitive to Latex.

Latex Free Catheters
Latex catheters are soft and flexible catheters that are most widely used in catheter users.  Red rubber latex catheters are slightly stiffer and have an added ingredient of barium that reduces the likelihood that the catheter will kink.  Although latex catheters are more widely used by catheter patients, many patients with Spina Bifida have a latex allergy, and must use latex-free catheters when catheterizing.

Drainage bags

Drainage bags are used to collect urine in them and are attached to the catheter. There are two types of drainage bags available: leg bags and a bedside bag. Many people prefer using leg bags during the day or when they go out and bedside bags, at night. Since the leg bag is smaller in size, it does not limit the person’s movement. It can be hidden under pants, dresses and skirts. Hence, it must be emptied more frequently than the bedside bag. The drainage bag should be placed lower than the bladder at all times in order to make the urine drip into the bag. The bag should be emptied, when it is about 2/3 full.

Emptying leg bag
Emptying and changing a leg bag require detailed care and attention. When emptying the leg bag, it is important to be in a clean bathroom and not to let the bag or tube openings touch any of the bathroom surfaces. Wash hands well, keep the bag below your bladder and over the special container or the toilet. Once you open the spout at the bottom of the bag, it will start emptying the urine. When the bag is empty, rub alcohol on the spout with a cotton ball to clean it well and close the spout tightly. Attach the bag back to your leg again and wash your hands one more time.

Changing leg bag
Changing the leg bag could also become a detailed procedure. Here are the steps to follow to change the leg bag: after washing the hands carefully, disconnect the valve at the end of the tube near the bag. Do not let the end of the tube or bag touch anything, including your hands. Clean the end of the tube and the opening of the clean bag with alcohol. Attach the tube to the bag tightly, strap the bag to the leg tightly and wash your hands.