Patients who suffer urinary retention (inability to empty their bladder) must have their bladder emptied for them until their own ability to void to completion (empty their bladder) returns. There are three common methods used to empty the bladder:
Foley catheter - an indwelling catheter through the urethra
Suprapubic tube (SP tube) - a catheter through the abdominal wall into the bladder
CIC (Clean Intermittent catheterization) - placing a catheter through the urethra long enough to empty the bladder then removing the catheter. This is repeated daily or several times a day.
Clean Intermittent Catherization (CIC) provides the lowest risk of urinary tract infection, indwelling Foley has the highest risk of urinary tract infection, and an SP tube falls in between. CIC and SP tubes (when plugged or capped intermittently) allow your own bladder to cycle through filling and emptying. Using CIC or by plugging an SP tube the bladder can be allowed to fill and then the patient can void as completely as possible. After voiding as completely as possible CIC can then be performed (or the SP tube opened to drain the bladder). The amount of urine emptied from the bladder after voiding is called Post Void Residual (PVR). Measuring the PVR and allowing the bladder to cycle through filling and emptying are important advantages of CIC and an SP tube over using an indwelling Foley catheter.
Antibiotic Prophylaxis and Sterile Catherization When the urethra is instrumented antibiotic prophylaxis should be considered. We routinely use antibiotic prophylaxis when we have to instrument the urethra for cystoscopy (special telescope inspection of the bladder) or catheter placement. This prophylaxis reduces but does not eliminate the risk of urinary tract infection. This is no longer advantageous when catheterizing daily or when an SP tube or indwelling catheter have been in place for several days. Staying on antibiotics for prolonged periods can lead to infection with more dangerous bacteria resistant to common antibiotics.
Foley catheter Foleys can be used for a variety of reasons: for temporary or long-term treatment of urinary retention, to rest the bladder after surgery, to accurately measure the amount of urinary output, to instill medications, and to perform procedures. They are lubricated and inserted into the bladder using sterile technique.
Foley care
Foley catheters have an inflatable balloon at the end that keep them placed in the urinary bladder. The amount of sterile fluid that can be instilled into the balloon ranges from 5 to 30 cc. Smaller volumes (5-10 ml) are typically used; this helps prevent bladder spasms from pressure. Larger volumes are used in rare situations.
Foley catheters are sized on the "French" scale, abbreviated Fr. The higher the Fr number, the larger the catheter. Catheters range in size from single digit widths, used for children, to over 30 Fr. The smallest adult size is usually 14 Fr.
Unless otherwise contraindicated, patients with an indwelling catheter should increase their fluid intake. This will help preserve catheter patency and help to prevent infection. Preferred liquids are water, tea and juice. Carbonated beverages are discouraged, as they make the urine alkaline, predisposing to stone formation and bacterial growth.
Clean Intermittent Catheterization Clean intermittent catheterization (CIC) has a lower risk of infection than an SP tub or an indwelling Foley. Anyone can put in these catheters because it is a safe and a simple procedure to learn. Patients, family members, and/or caregivers who have the physical and mental abilities and who are motivated can be taught to perform CIC. Considerations for CIC are age, the physical ability of the person to perform catheterization, willingness, and self-discipline.
Definition: Intermittent catheterization involves the placement of a temporary catheter (tube) to remove urine from the body. This is usually done by placing the catheter through the urethra to empty the bladder and then removing the catheter once the bladder is empty.
Alternative Names: Self-catheterization; CIC; Intermittent catheterization
Information: To perform clean intermittent catheterization (CIC), the person must learn the basic location of the important urological landmarks.
Additionally, the person must have the physical ability to reach the urethra and must be able to manipulate the equipment. People who are unable to visualize the urethra may be taught how to feel for the proper location of the urethral meatus (opening).
Catheters that are used for CIC are slightly different from the catheters used for indwelling (long-term) catheterization. An indwelling catheter is held in place by a balloon; CIC catheters do not have this balloon or the side port for balloon inflation.
CIC catheters may be made of a clear plastic or a softer rubber material. These catheters also come in a variety of sizes.
Although catheters are intended to be disposable, they can be reused on a daily basis. How many times a catheter can be reused for CIC will depend on many factors, including the make and model of the catheter and the pH of your urine. In most situations a CIC catheter can last 2-4 weeks.
How to Perform CIC (Women):
- Assemble all equipment: catheter, lubricant, drainage receptacle.
- Wash your hands and clean the vulva and urethral opening. Wipe from front to back to prevent contaminating the area with fecal contents.
- Lubricate the catheter.
- Locate the urethral opening (meatus). The meatus is located below the clitoris and above the vagina. A mirror can be very helpful in locating the opening.
- Spread the labia with the second and fourth finger, while using the middle finger to feel for the meatus.
- Begin to gently insert the catheter into the meatus, in an upward direction toward your belly button.
- Once the catheter has been inserted about 2 to 3 inches past the meatus, urine will begin to flow. Advance another 1 inch and wait for the urine to stop.
- Withdraw the catheter in small increments to empty the lower bladder.
- Record the amount of urine obtained, if instructed..
- A small amount of blood staining is sometimes seen on the catheter or in the urine. This is normal. Frank bleeding is not normal.
- Most patients tend to reuse their catheters, which is perfectly acceptable. A catheter may be re-used for 2 to 4 weeks. A zip-lock bag or a Tupperware container is a good place to store/transport them.
- Throw away catheters that have become hard, deformed, discolored, or cracked.
- Use water based lubricants such as KY Jelly. Oil based products like Vaseline will damage the catheter.
- Catheterization should be done often enough to keep the bladder from overfilling, you may need to catheterize more often if you are getting more than 300-500cc or milliliters (10-16 ounces) each time you catheterize.
How to Perform CIC (Men):
- Assemble all equipment: catheter, lubricant, drainage receptacle.
- Wash your hands thoroughly with soap and water and clean the penis and urethral opening.
- Lubricate the catheter.
- Hold the penis on the sides, perpendicular to the body.
- Begin to gently insert and advance the catheter.
- You will meet resistance when you reach the level of the prostate. Try to relax by deep breathing, and continue to advance the catheter.
- Once the urine flow starts, continue to advance the catheter another 1 inch and hold it in place until the urine flow stops and the bladder is empty.
- Withdraw the catheter in small increments to make sure the entire bladder empties.
- Wash the catheter with soap and water. If the catheter is disposable, discard it right away. If it is reusable, rinse the catheter completely and dry the outside. Store the catheter in a clean, dry, secure location.
- Record the amount of urine obtained.
Suprapubic Tube
A suprapubic catheter or SP tube is basically an indwelling catheter that is placed directly into the bladder through the abdomen. The catheter is inserted above the pubic bone. This catheter must be placed by a doctor during an outpatient surgery or office procedure or in conjunction with other surgeries. The insertion site (opening on the abdomen) and the tube should be cleansed daily with soap and water.
These catheters usually are changed by qualified medical personnel such as a nurse, a medical technician, a physician’s assistant or a doctor. The catheter may be attached to the drainage bags. A suprapubic catheter may be recommended in people who require long term catheterization, after some bladder or prostate surgeries, and in people with urethral injury or obstruction.
A suprapubic catheter is a catheter which is inserted through a small incision (cut) made in the wall of your lower abdomen just above your pubic bone and below your belly button. A doctor inserts the catheter during a short surgical procedure. It is used for a short time after surgery on the bladder, prostate or for some gynecologic procedures.
A suprapubic may be used in persons who need to have a catheter placed for a long period of time because it has less risk of infection than an indwelling urethral catheter. It may be more comfortable, less prone to infection and it is a less likely to fall out or leak. An SP tube needs to be changed just like an indwelling Foley catheter approximately every four weeks.
Changing a suprapubic tube that has been in place for over a week is as simple or even easier than changing an indwelling Foley catheter. However, for the first week after placement if the tube falls out a new SP tube may be difficult to place. For that reason a suture is usually used to hold the catheter in place during the first week. If the catheter becomes displaced during the first week despite placement of a temporary suture then you should notify your urologist immediately. The more quickly a replacement catheter can be put into the SP tube site the less likely you are to have difficulties from the catheter. The temporary holding suture usually needs to be removed after one week.
Supplies for Suprapubic tubes, Foley Catheters, and CIC supplies can be obtained from:
Home Wellness, Inc.
700 Route 130 North
Suite 201
Cinnaminson, NJ 08077
(800)949-4445
