Catheterization is a simple medical procedure performed to facilitate the flow of urine when the patient is unable to control the bladder movements or when the flow of urine is inhibited due to factors like a neurogenic bladder.

There are several different types of catheters, each available in different sizes and materials.

Usually, catheterization is performed in hospital settings wherein the doctor or a nurse chooses the right catheter for you based on certain factors and performs the procedure.

However, in most cases, patients may require catheter insertion outside of hospital settings such as when they are undergoing treatment at home. In such cases, it can be quite overwhelming for the patients to know which catheter would be the best for them.

If you have been advised to undergo catheterization or need to use a catheter due to your medical condition, keep reading to know the best ways to choose the right device. We will also discuss the indications for catheterization and how to care for a catheter.

What Is Urinary Catheterization?

The elimination of urine is one of the basic human functions that could be hampered or compromised due to surgery, acute or chronic illnesses, and other conditions.

Urinary catheterization is usually performed to support the urinary elimination in patients who have difficulty in voiding urine naturally.

Urinary catheterization is often required in the following cases:

•     Acute urinary retention

•     When the intake and output of urine need to be monitored to assess the kidney functions

•     To drain the bladder before, during, or after a surgical procedure

•     To drain the bladder during childbirth if the woman has been administered an epidural anesthesia

•     Enhance healing and repair of the tissues in incontinent patients having open perineal or sacral wounds

•     To deliver medications directly into the urinary bladder, such as during chemotherapy for the management of bladder cancer

•     Prolonged bed rest

•     Need for end-of-life care

What Is A Urinary Catheter?

 

A catheter is a partially flexible, hollow tube that can be used to empty or drain the urinary bladder and collect urine into the drainage bag.

The flexibility of the tube allows it to be passed through the urethra in men and women. It also supports the passage of urine from the bladder through the urethra to be collected in a drainage bag.

Urinary catheters come in different types and sizes. They are made of plastic (PVC), rubber, or silicone.

Catheters are usually necessary for patients who can not empty their bladder naturally. If the urinary bladder is not emptied, urine gets accumulated creating more pressure in the bladder as well as the kidneys. The rise in pressure may sometimes lead to renal failure. These complications can be life-threatening as they can lead to permanent damage to the tissues of the kidneys.

In some patients, catheters are necessary only until the patient regains the ability to urinate on his own. In these cases, the catheters are needed for a short period of time such as after surgery. Elderly people and patients with a severe illness or permanent injury might need to use a urinary catheter for a much longer period of time or even permanently.

Why Are Urinary Catheters Used?

You may need a urinary catheter if you cannot control the flow of urine resulting in the involuntary passage of urine or urinary retention.

The conditions that can reduce the ability of a person to urinate on his own include:

•     Obstruction to the flow of urine due to kidney or bladder stones, blood clots in urine, and enlargement of the prostate gland

•     Surgery in the genital area, like hysterectomy in women or a hip fracture repair in men and women

•     Surgery on the prostate gland

•     Spinal cord injury

•     Injury to the nerves in the urinary bladder

•     Medications that cause impairment of the strength or ability of the bladder muscles to contract or squeeze, causing urine to remain stuck in the bladder

•     Conditions that cause impairment of mental functions, like dementia or Alzheimer's disease

•     Spina bifida

 

Catheterization is usually performed by a doctor or a nurse. A urethral catheter is inserted through the urethra, which is a tube carrying urine out from the bladder. A suprapubic catheter is inserted through an opening made in the lower abdomen.

The tip of the catheter that stays in the urinary bladder, in both these types of catheters, has a small opening, which allows the urine to flow through it and pass into the drainage bag.

Depending on the type of catheter inserted and the indication for catheterization, it may be left in place for a few minutes or several days to weeks.

What Are The Different Types Of Urinary Catheters?

There are several different types of catheters, which are used or inserted in different ways.

Some of them include:

Intermittent urinary catheter

Just as the name suggests, intermittent urinary catheters are used when catheterization is needed more frequently. These catheters can be inserted into the bladder several times a day, each time for a short period, just enough to drain the bladder, and then removed gently.

You can learn how to insert these catheters yourself. An intermittent urinary catheter is usually passed into the bladder through the urethral opening.

These sterile catheters are usually pre-lubricated to help you avoid the risk of discomfort during insertion. The outer end of the intermittent catheter is left open-ended to allow for the drainage of urine into a pan or the collection into a drainage bag. The other end of the catheter is guided through the urethra until it enters the bladder allowing the urine to flow out.

The catheter can be removed once the flow of urine stops. A new catheter needs to be used each time.

Indwelling urinary catheter

An indwelling catheter is inserted in the same manner as the intermittent catheter, though it is left in place for a few days to weeks.

Once the catheter is inserted into the bladder, it is held in place by a water-filled balloon that prevents it from coming out. These types of catheters are also called Foley catheters. These are suitable for patients who need prolonged catheterization.

The urine is drained through a tube connected to a drainage bag. The bag can be attached to a stand on the floor or strapped to the inside of your leg.

Indwelling catheters can also be fitted with a valve. The valve can be opened or closed, to allow the urine to be drained into the bag, or the bladder to fill with urine till emptying it is convenient, respectively. Most indwelling urinary catheters need to be changed once in 3 months.

Suprapubic catheters

This type of catheter is left in place for longer. Instead of being inserted through the urethra, a suprapubic catheter is inserted through a small hole in the wall of the abdomen and then, passed directly into the bladder. The procedure can be performed under general, local, or epidural anesthesia.

These catheters are used when the urethra is blocked or damaged, or when the patient is unable to use the intermittent catheters.

The catheter is secured to the side of the body and attached to a drainage bag strapped to the leg. Alternatively, a valve may be attached to the catheter. The valve opens allowing the urine to be drained into the bag and closes allowing the bladder to fill with urine till emptying is convenient.

These types of catheters need to be changed once every 4 to 10 weeks.

How To Choose The Right Catheter?

 

Given the large variety of catheters available to choose from, it can be quite overwhelming for patients to choose the right one.

You need to consider a few parameters such as the indication and the duration of use while choosing the most suitable catheter for managing your condition.

Here is a brief discussion about the parameters to consider while choosing a catheter.

Your specific medical condition

If you are suffering from a chronic condition that would need prolonged catheterization such as a stroke or paralysis, you can choose indwelling catheters that are designed to stay in place for several weeks to months.

Intermittent catheters are best suited to those who suffer from difficulty in passing urine due to the obstruction in the passage or the weakness of the bladder muscles. These catheters should preferably be used by those who can self-catheterize themselves as and when they have an urge to pass urine.

Length of the catheter

You should consider the length of the catheter and choose the right size. If the catheter is too short, it would not empty the bladder completely. On the other hand, if it is too long, it would be hard to manage.

Thickness of the catheter

The thickness of the catheter can also have an impact on how long it would take to empty the bladder and how it works in the urethra.

If the catheter is too thick, you may have difficulty in inserting it into the urethra. It may also cause damage to the delicate mucosal lining of the urethra if you try to force it through the urethral opening resulting in bleeding.

However, if the catheter is too thin, it may cause leakage from its sides allowing urine to flow out.

The tube width or thickness also affects the speed of bladder emptying. You may need to try one or more catheters to find the one with the most appropriate thickness.

Ease of use

It often takes a few days to weeks for patients to get used to having a catheter. Also, after a while, the need to use a catheter becomes a part of your everyday life, and hence, inserting a catheter or emptying the bladder should be as comfortable and easy as possible.

This is why; it is advisable to choose catheters that can be inserted or removed easily, especially if you are using intermittent catheters that have to be used several times a day.

Handling

Catheters that have handling aids for easier and steady grip or those that allow non-touch techniques during catheterizing can minimize bacterial contamination and hence, are considered safer.

Safety

Safety is one of the primary concerns you need to consider while choosing a catheter. You can choose a hydrophilic catheter, as it can keep the urethra as unaffected as possible, even in the long run.

Hydrophilic catheters use water as a lubricant. They are pre-coated to be slippery allowing you to pass them through the urethra smoothly and without much difficulty.

These catheters are also less messy and easier to handle compared to those that need you to use gel or lubrication during insertion.

Top 3 Urinary Catheters You Can Choose From

 

1.    Bard Medical StatLock Foley Device

These catheters are designed to reduce the Foley catheter movement and minimize accidental dislodgements. They provide maximum patient comfort by preventing circumferential compression and reducing traction.

Bard Medical StatLock Foley Device has a lock-tight design that can stabilize the catheter and inhibit pistoning.

The innovative Swivel design can allow smoother catheter movements without the need to exert a pull force on the device. It has a releasable design that can allow for easy cleaning.

2.    Teleflex Medical Urethral Catheter

It is a hydrophilic coated catheter with a straight tip designed to support easier insertion. You can choose these catheters, if you have a tendency for repeated urinary infections. Using a hydrophilic coated catheter would protect you against the risk of contamination during insertion and prevent infections.

These are disposable catheters specifically designed for women.

3.    Bard Medical Foley Catheter

 

Bard Medical Foley Catheter is a 2-way standard tip catheter with a 5-cc balloon. It is a silicone-coated latex catheter designed to support ease of use and higher convenience. It is specifically suited for patients who need long-term catheterization and prefer to change the catheter less frequently due to conditions that cause prolonged immobility.

Urinary Catheterization: Frequently Asked Questions

What are the risks and potential complications linked to catheterization?

The most common complications caused by catheters are infections in the bladder, urethra, and rarely, the kidneys. These infections are called urinary tract infections. They can be easily treated with antibiotics.

The symptoms of urinary tract infections linked to using a catheter include:

•     Pain in the lower abdomen or around the groin

•     Feeling shivery or too cold

•     A high temperature

•     Confusion

 

Catheters may sometimes lead to other problems, like bladder spasms, blockages, leakages, and damage to the urethra.

Some rare problems linked to the catheter usage include:

•     Injury to the urethra when the catheter is inserted or removed

•     Injury to the bladder due to the incorrect insertion of the catheter

•     Narrowing of the urethra due to the formation of scar tissues caused by the repeated or prolonged catheter usage

How to prevent the risk of urinary tract infections?

•     Clean the skin in and around the area where the catheter enters the urethra, using mild soap and water once every day

•     Wash your hands with warm water and soap before and after touching the catheter equipment

•     Drink enough fluids to stay well-hydrated

•     Avoid constipation by eating high-fiber foods like fruits, vegetables, and whole grains

•     Make sure there are no bends or kinks in the catheter

•     Always keep the urine collection bag below the level of the bladder

How does catheterization affect your regular activities?

Having a urinary catheter may cause discomfort and inconvenience in the initial few days. However, over a period, most patients are able to adjust to having a catheter and continue with their routine activities without much difficulty.

Having a catheter usually does not pose difficulties in performing routine activities. However, certain activities like swimming and strenuous exercise may have to be avoided to prevent exerting strain on the bladder and catheter.

When to get medical advice?

 

The procedure of catheterization or having a catheter may pose a few risks. It is important to be aware of the early warning signs of complications that can occur due to a catheter.

It is advisable to contact your doctor if you develop the following symptoms:

•     Severe or continuous bladder spasms

•     Leakage of urine along the edges of the catheter

•     Blockage in the catheter preventing the passage of urine

•     Passage of bright red blood instead of urine

•     Persistently blood-stained urine

•     Presence of blood clots in urine

•     Falling out of the indwelling catheter

•     Having symptoms of urinary tract infections like lower abdominal pain, fever, and chills

Common catheterization concerns and suggested solutions.

Urine leakage

The catheter may be too thin or not be inserted far enough. It may also be blocked or the bladder could be having a spasm.

Absence of urine flow after catheterization

The catheter may not be inserted far enough or the person may not be drinking enough fluids. The catheter could also be blocked.

Blood in the Catheter

It indicates a mild urethral or bladder irritation that usually resolves by itself. If blood persists, contact your doctor.

This complication can also be prevented by avoiding the forceful entry of a catheter through the urethra. Lubricating the catheter can also help to reduce urethral trauma and prevent bleeding.

Conclusion

Catheterization may be required for a short term or a long term depending on the cause of the inability to pass urine. Choosing the right catheter is the key to avoiding inconvenience and discomfort and preventing the complications like bleeding and pain.

Being aware of the ways to care for a catheter is also essential for protecting yourself against the common risks and carrying on with your routine activities with better ease.

References

https://www.nhs.uk/conditions/urinary-catheters/

https://medlineplus.gov/ency/article/003981.htm

https://www.mayoclinic.org/tests-procedures/cardiac-catheterization/about/pac-20384695

https://www.ncbi.nlm.nih.gov/books/NBK560748/

https://www.health.harvard.edu/medical-tests-and-procedures/urinary-catheterization-a-to-z