Catherisation

Created Feb 2022, Last edited 18 Sep 2023

Intermittent or Indwelling Catheter?

"Available clinical evidence supports the strategy to always consider intermittent catheterization as the first therapeutic choice, before considering the use of an indwelling catheter.
Has also been proposed that indwelling catheters are associated with bladder cancer. It is recommended to completely avoid or minimize use and duration of indwelling catheters.
Indwelling catheters involve more invasive placement and have a constant in and out flow (not true if outflow tap without bag is used) leaving a static bladder.
Intermittent catheterization is a type of continence management that allows normal bladder dynamics.
Although there is a consensus that intermittent catheterization is a better treatment option than an indwelling catheter, it is sometimes still discarded due to the perception that it is an added burden for patients."
https://www.wellspect.us/education/articles/intermittent-vs-indwelling-catheterization/

"indwelling catheter for treatment of urinary retention increased the risk for Deep Vein Thrombosis (DVT).
We would recommend the treatment of postoperative urinary retention with intermittent catheterization rather than indwelling catheters to decrease the risk"
https://www.sciencedirect.com/science/article/abs/pii/S0883540320302060

Indwelling Foley Catheter

The catheter has two tubes. A syringe is used to inject sterile water into one tube to inflate the balloon after it is certain the tip is in the bladder (liquid should emerge from main tube once tip is inside bladder). After inflation a gentle tug should ensure the balloon is seated properly at the bottom of the bladder.
A man was dispensed a female shorter catheter by mistake; if not noticed and inflated inside the urethra much damage can be caused.

The first diagram above shows a tap only setup using a catheter from 2011 era. The tube material (latex or silicon?) grips the tap bottom quite well even though it is conical shaped. The green and yellow safety clips were not used.
The righthandmost photo shows a 2023 catheter where the tubing is made of a different more rigid material (polythene?). The tap design hasn't changed. In use the catheter fell off the tap so this push on fit is not trusted.
Another commentator adds "I have a supply of these valves/taps and change it every week and find that as long as I push it on to the tube far enough it doesn’t come off"
However as push on joint separating has serious implications we add some safety devices

Points X and Y are joined together with non-water absorbent (for when user showers, swims or bathes) light cord.
Two plastic clips (bag clips) are snapped on.

If wanted a 2 L bag with 1 m long tube can be attached to the top of the tap (as depicted above, X end) again with push on fit. The top of the bag is strapped on below the knee but above the calf. Although not anticipated to fill much more than 500 mL, in case the strap slips with the weight/movement, a tensioned cord can be run up from the strap to a hidden belt. As the bag's tube is long it can be tucked up under the belt then come down again to fit onto the top, X end, of the parked tap.
The tap at the bottom of bag tap is then conveniently hidden just above hem of trousers.

Intermittent Self Catherisation

Comparison between Hollister old long 92144 & better Pocket 70144. The long one has no hydrophilic lubrication, instead one squeezed/burst a sac of gel/sterile water(?) - the blue part that has red cap on it.
Hydrophilic pre-lubrication as used on 70144 comprises sterile water vapour contained in the packaging.

Travelling

Here we look at travelling whilst using Hollister Advance 92144 Ch/Fr14 40 cm intermittent catheters to control PVR with UTI prevention in mind.

The contents of a box of 25 catheters (a packet) occupies a space of about 0.23m x 0.67m x 0.07m thick (0.01 m3)

Travelling away for 3 weeks using 3 catheters a day + 10% contingency needs say 69 catheters or 3 packets weighing 1.8 kg and occupying 0.03 m3

A 75 L rucksac has volume 0.075 m3. With the 3 week supply inside, 40% of the space becomes unavailable for other travel necessities.

Environmental Cost

The catheters under discussion are single use. Recycling of the used catheters and packaging under local council collected plastics is not feasible meaning this waste goes into general disposal. If put in landfill degradation can result in fine particles being produced that can wash into rivers and oceans.

Above are caps collected from Hollister catheters. These could be re-used after sterilisation instead of just being single use. The caps on the Hollister Pocket 70144 are smaller.

https://newatlas.com/environment/microplastics-blood-brain-barrier/

Mouse study shows microplastics infiltrate blood brain barrier.

Plastic waste can last for generations and with a large number of people discarding single use catheters and some fragments entering the food chain, a cost to health providers, like the UK NHS, could be foreseen for decades to come.
Their are also concerns about damage to non-human species.

Coudé Catheter

A coudé catheter is a curved tip or slightly angled catheter that is sometimes needed when a straight tip catheter is not easily inserted. It's named after the French word coudé, which means “bend”. This type of catheter is ideal for patients with enlarged prostates (BPH), urethral narrowing, blockages, or scar tissue.