Intermittent Self-Catheterization
Create Medic Co.,Ltd.
Marketing Department Suzuki Masaru

If the bodily function “emptying bladder”, a physiological phenomenon in daily life, is impaired
due to some kind of disease, this natural function could turn into a serious problem. One of theproblems involved in urination trouble is incontinence of urine. Incontinence can be a big problem
because it can stand in the way of patients and even cause them to lose self-respect.
One of the treatment methods for urination trouble is intermittent self-catheterization, by which apatient or helper can discharge urine by using a catheter at regular intervals. It is regarded as a very
good method, because it prevents infection in the bladder, increases patient's self-reliance, andenhances QOL of patients.
Intermittent self-catheterization is less likely to cause complications such as urinary tract infection,cystolithiasis, and skin trouble than urethral catheter placement, and above all, it has an advantage
of maintaining patient's self-respect. It is also said that this method enables patients to urinate
without any artificial means very occasionally.
Catheters for intermittent self-catheterization vary from manufacturer to manufacturer in foldabilityof the catheter case, material of the outer casing, and shape of the cap, though the main structuresare same. Several manufacturers have also released inexpensive, disposable catheters, which are in
use in combination with reusable catheters in some patients.
This paper describes how to handle catheters for intermittent self-catheterization (reusable) andprecautions for use, by taking Self-Catheterization Set (Create Medic Co., Ltd.) as an example.
Types and materials of catheters for intermittent self-catheterization
Catheters for intermittent self-catheterization are available in the following types: For women, formen, for men (large sizes), for children, Tieman Balloon Catheter (for patients with urethralstricture), and CUR (bladder pouch) (Figure 1). If there is urethral stenosis, only Tieman catheters,
which are specially designed so that their tips pass through narrowed parts smoothly, are to be used,
and other catheters which may injure such parts should not be used.
Before use, it is important to select a catheter most suitable for each patient. Self-Catheterization
Set is available in various types and sizes (Table 1), which allows us to select one easily. The set
is also equipped with a catheter case and outer casing, which allow patients to carry the set withthem when they go out. Thus, the purpose of using a catheter for intermittent self-catheterization isto expand patient's field of activities for an improvement in the quality of life. It is recommended
that a product most suitable for each user should be selected.
c Because a catheter is made from 100% silicon, it is not irritating to living tissues and can be usedsafely.

Table 1 Types and sizes of the catheter
TypeFemale
Male
Male-L
Pediatric
Tieman
CUR

Size
10Fr
12Fr
14Fr
10Fr
12Fr
14Fr
12Fr
14Fr
9Fr
12Fr
14Fr
14Fr
16Fr
18Fr
20Fr

CatheterSide Holes

165mm

1 holeEvery 10mm between 10〜100mm from tip 60×117×15mm

300mm

1 holeEvery 10mm between 50〜200mm from tip 60×190×15mm

350mm
385mm
265mm

1 hole2 hole1 hole1 hole,Every 10mm between 50〜250mm from tip
60×232×15mm
Every 10mm between 50〜300mm from tip
Every 10mm between 10〜200mm from tip 60×190×15mm

300mm
395mm

w/Tieman Tip
5 hole, withnumeralDepth Marks

External case
Case size

LengthEvery 10mm between 50〜200mm from tip 60×190×15mm
Every 10mm between 100〜250mm from tip 60×232×15mm

markingd The central part of the catheter case can be accordion-folded, which allows compact storage.
e The hook attached to the catheter case allows the case to be hooked on a doorknob or something
when the catheter is used.
Indications for intermittent self-catheterization
Intermittent self-catheterization is indicated widely in patients with difficulty in urinating including
cases of urinary tract occlusion and incontinence of urine (Table 2). However, self-catheterization
should be managed by patients themselves. It is said that patients can keep up their motivation to do
self-catheterization over a long period of time only after they understand that they have to do it notbecause they are ordered to do so by doctors but because it is necessary for them.
Replacement of disinfectants and storage/management of catheters
Catheters for intermittent self-catheterization are disinfected in various ways. For the concentrationof a disinfectant to be used (Table 3), follow doctor’s directions.
1. Names of parts composing a catheter for intermittent self-catheterization
The names of parts composing a catheter for intermittent self-catheterization are as shown in Figure
2.
2. Disinfection and storage of cathetersc Unfold the catheter case, and put a disinfectant prescribed by the doctor in the case to the depth
shown in Figure 3.
d Mount a cap on the funnel of the catheter until it comes to the line of the cap (Figure 4).
e Unfold the catheter case, and put the catheter in it.
f Screw the cap in to fix it, then check that the disinfectant does not leak from the catheter case.
g Drain the urine.
Table 2 Indications

Indications①Underactive neurogenic bladder・Spinal cord injury
・Chronic urinary retention
・Diastematomyelia②Overactive neurogenic bladder・Escessive amount of residual urine
・Repeated urinary tract infection

Cases in whom it is not indicated・Catheter cannot be inserted
into the urethra
・Severe vesicoureteral reflux
・Contracted bladder

Table 3 Concentration of disinfectant
Drug name

Manufacturer nameBenzalkonium chloride solution (10W V%) Takeda Chemical Industries, Ltd.

0.05% to 0.1%(1/200 to 1/100)

Benzethonium chloride solution (10W V%) Sankyo Co., Ltd.

0.05% to 0.1%
(1/200 to 1/100)

Sankyo Co., Ltd.

0.05% to 0.1%
(1/200 to 1/100)

Benzethonium chloride solution T (10W V%)

・Incontinence that is difficult to control

・Urethral stricture
・Prostatic hypertrophy for which surgery

is contraindicated・Urinary disturbance of unknown etology

Reference
concentration

Isodine solution (100mg/ml of povidone iodine) Meiji Seika Kaisya, Ltd.

0.05% to 0.1%
(1/200 to 1/100)

Figire 2 : Names of the components

Figure 3 : Reference Amount of disinfectant

External Case
CapCatheter

FunnelCatheterh After use, wash the catheter with tap water, and put it in the catheter case again by repeatingprocedures 2 to 4 above.
i Fold the catheter case in half, and fix it with a hook. Then, put it in the outer casing.
* Follow doctor’s directions as to how to drain the urine.
3. Points to remember when storing a catheter
c When a catheter is not to be used for a long time, unfold the catheter case before storing it.
d Do not expose the catheter, catheter case, and other parts to a strongly acidic or basic drug andorganic solvent.
e Replace the disinfectant in the catheter case with a new one, preferably once a week, and replace
the catheter with a new one, preferably once a month.
Figure : 4 Cap attachment to the funnel

Procedure of self-catheterization
1. Supplies
c Catheterd Lubricant
e Sterilized cottonLine

2. For menc Sit down on a chair or lavatory, and spread the legs apart. (For corpulent persons, it may bebetter to perform catheterization while standing.)
d Wipe the tip of the penis with sterilized cotton.
e Hold up the tip of the penis with the left hand, and hold the catheter with the right hand in theway you hold a pen. Then, gently insert the catheter into the urethral opening. (If you feel painor have difficulty in inserting it, lubricate the tip of the catheter with the lubricant.)f Advance the catheter about 15 cm. Once the urine flow starts, continue to advance the catheter
another 2 to 3 cm.
g After draining the urine, withdraw the catheter 2 to 3 cm to make sure the entire bladder empties.
h Remove the catheter from the urethra, wash it with tap water, and replace it in the catheter casecontaining a disinfectant.
3. For womenc Sit on the edge of a chair or lavatory, or squat in a Japanese toilet or bathroom, for easiercatheterization.
d Spread the labia with the left hand, and wipe them with sterilized cotton with the right hand.
e Locate the vaginal opening with the left hand, and hold the catheter with the right hand. Locate
the urethral opening while using fingers to trace the vaginal opening. Gently insert the catheterinto the urethral opening. (If necessary, lubricate the catheter.)f When the catheter has been inserted about 5 to 6 cm past the opening, urine flow starts.
Continue to advance the catheter another 2 cm to drain the urine.
g After draining the urine, withdraw the catheter about 2 cm to make sure the entire bladderempties.
h Remove the catheter from the urethra, wash it with tap water, and replace it in the catheter casecontaining a disinfectant.
Points to remember when inserting or removing a catheterc Insert or remove a catheter gently, because it may injure tissues. Be sure not to insert or remove
it forcedly. Lubricate it if necessary. If it is difficult to insert or remove it even after lubrication,
discontinue the use of the catheter and consult a doctor.
d If you feel abnormality before or during use, discontinue the use of the catheter right away andconsult a doctor.
e Do not pull or fold it forcedly. Handle it very carefully.
Troubles and countermeasuresc If you feel pain when inserting a catheter- Lubricate it before insertion.
- Consult a doctor to check whether the catheter is suitable for you. If it is too large, use a smallerone.
- If you still have pain, you may have inflammation of the urethra. Discontinue the catheterizationand consult a doctor.
d If you cannot drain the urine- The depth of the catheter insertion may be too shallow. Gently advance the catheter further.
- If you still cannot drain the urine, consult a doctor right away.
Other points to remember
c Before use, be sure to check that there is no abnormality in each part.
d Do not make alterations to catheters in any way. If an alteration such as a side hole is made, thecatheter may be cut off at that point.
e Do not pinch a catheter forcefully with forceps etc. Doing so could result in a breakage of thecatheter or occlusion of the lumen.
f If the package is broken or there is abnormality in the product such as a breakage, do not use it.
g After the package is opened, use the product in an appropriate way. If it is replaced with a newone, discard the used one in a safe manner.
⑥ For storage of a catheter, avoid direct sunlight, high temperature, high umidity, low temperature below 10℃,and UV rays such as germicidal lamp.

Tips and hints
Intermittent self-catheterization is a symptomatic therapy that increases patient's self-reliance andenhances QOL of patients. It is also more advantageous than indwelling bladder catheters with asmaller possibility of causing infection. Patients will be better off if they drain the urine byself-catheterization. In Japan, however, many patients use indwelling bladder catheters even if they
are not indicated in, there are only a small number of patients who perform self-catheterization.
Under the circumstances, nurses should think that self-catheterization usually comes first andindwelling bladder catheters should not be used without much thought.
One of the problems nurses should wrestle with is how to instruct patients about self-catheterization.
In particular, there are quite a few patients who do not perform self-catheterization at given
intervals just because they think they cannot keep their hands and catheters clean, saying that
“There is no place to wash hands” or “There is no disinfectant.” It is important to teach them
politely that retention of urine in the bladder can cause infection and passing urine helps prevent
infection due to self-cleaning functions. Instruct them to empty the bladder rather than caring forhygiene. In fact, in the United States, self-catheterization has become so common that nurses
instruct patients to carry around a catheter with them in their socks. It is said that there is no need tostrictly manage a catheter as long as it is thoroughly washed with tap water etc. after use. In the caseof patients with dementia, it may be difficult to instruct when to perform catheterization. It isnecessary to tailor instructions to patient’s individual needs. First of all, let’s think about whathinders them from performing self-catheterization.
(Member of editorial board, Secom Medical System, Chief of the Nursing Department, WOCN,
Miyuki Numata)