catheter image

Intermittent self-catheterization is the temporary placement of a catheter (tube) to remove urine from the body. This is done by placing the catheter through the urethra (the tube that leads from the bladder to the outside opening) to empty the bladder.

Self-Catheterization for Adult Females

Self-Catheterization for Adult Adult Males

Supplies

  • Catheter
  • Lubricant (do not use petroleum jelly such as vaseline)
  • Clean towel & washcloths
  • Soap and water
  • Container for urine

Steps to self-catheterization

  1. Wash your hands well with soap and water; dry them completely.
  2. Wash the top of the penis with soap and water or an antiseptic.
  3. The end of the catheter is positioned so that urine can flow into a collection container (for convenience or if the measurement of output is required) or toilet.
  4. A lubricant is placed on the tip of the catheter.
  5. If the male client is not circumcised, have them pull back the foreskin and keep it back during the procedure.
  6. With the non-dominant hand, the penis is held straight up, so that its head is pointing away from the body.
  7. With the dominant hand, the catheter is then gently inserted into the urethra (the opening in the penis) until urine begins to flow or resistance is felt.
  8. Wait a few seconds, breathe easy.
  9. Slowly continue to insert the catheter approximately 2 inches farther into the penis.
  10. The catheter is removed when the urine stops flowing by gently pulling the catheter tube away from the body. – Pause whenever more urine continues to flow out.
  11. Replace the foreskin.
  12. Wipe the penis dry.
  13. Measure and record volume output if necessary.
  14. Wash hands.

Reuse of catheters

  1. Clean after each catheterization.
  2. Rinse under tap water right after using the catheter.
  3. Wash the catheter inside and out with warm water and soap – scrub the outside.
  4. Rinse the catheter completely and shake to dry, then air dry it on clean towel.
  5. Once dry, store the catheter in a dry ziplock bag.

Self-Catheterization Intervention for Occupational Therapists

Q&A for OTs

What is the role of occupational therapy in self-catheterization in the hospital?

Occupational therapists in physical rehabilitation settings (ARU, Med Surg), even other settings (SNF, home) frequently encounter clients with urinary incontinence or retention requiring catheterization. Urinary incontinence in the general population can be as much as 8.9%. The OT’s role is to enhance each client’s function and maintain their quality of life. For example, OTs may introduce adaptive equipment to help clients overcome impairments with voiding.

What are psychosocial considerations to self-catheterization in OT?

Many clients faced with learning to self-catheterization may have psychosocial challenges. The loss of urinary function can be stressful and embarrassing.

Intermittent self-catheterization can provide freedom from products such as collection bags and allow patients to enjoy their life with less restriction!

With multiple methods for urinary management, why is education in self-catheterization, specifically so important?

Multiple products for urinary incontinence management exist such as indwelling catheters, external catheters (recently the Purewick), absorbent products, and occlusive devices. Studies have shown intermittent catheterization to be the gold standard for bladder drainage for patients with urinary retention. Studies have shown this method to induce lower rates of bacteriuria and have fewer long-term urethral complications.

Considerations

  • Collaboration (Family members, MD, RN, CNA, SLP)
  • Sterile Technique (best practice – typically used in hospitals to prevent infection) vs. Clean Technique (typically used with our patients at home)
  • Self-catheterization with co-morbid precautions
  • Occupational profile
  • MMT – upper extremity, including fine motor control
  • Adaptive equipment (mirrors)
  • Voiding diary
  • Example goals

General requirements

  • Cognition: memory of steps, reading of steps (if forgotten), problem-solving
  • Habits and routines: keeping to a catheterization schedule (and use of assistive devices – such as phone reminders, if needed)
  • Range of motion to reach the perineum
  • Upper extremity coordination
  • Bilateral hand dexterity and strength – males require one hand to maintain penile position and the other hand to insert the catheter.
  • Proprioception or visual cues

Interventions

  • Improving muscle strength and control of upper extremities (before introduction of adaptive equipment)
  • Adaptive equipment selection, education, and teachback – may need to be simulated for hygiene purposes

Barriers

Depending on the policy of where OTs work, and the risk of infection, self-catheterization may need to be simulated. For example, you may encounter a client who is currently using a foley-catheter and the system must be “closed”, so you may not switch over to practicing intermittent self-catheterization. They may have a UTI. Work with your RN and MD to follow their specific protocol and recommendations. As always, follow standard and contact precautions.

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