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Intermittent Catheterization: Indications, Technique, and Complications

Intermittent catheterization is the method of choice for bladder drainage in temporary or permanent voiding dysfunction due to neurogenic or myogenic causes. It is usually performed as intermittent self-catheterization (ISC). Compared with indwelling catheterization, intermittent catheterization reduces the risk of urinary tract infections (Lapides, 1972).

Indications and Contraindications for Intermittent Self-Catheterization

• Patient must be motivated and able to perform self-catheterization 4–6 times daily.
• No anatomical obstruction (e.g., urethral stricture)
• Low bladder storage pressures with a functional capacity of at least 400 ml
• Absence of polyuria

Technique of Intermittent Self-Catheterization

Catheter Material

Intermittent catheters are single-use catheters (without a balloon), usually made of inexpensive PVC. Intermittent catheters for women are typically short and have a Nelaton tip, while long intermittent catheters for men are available with either a Nelaton or Tiemann tip. Modern catheter sets provide atraumatic catheters with lubricant and hydrophilic coating. Packaging allows aseptic insertion without the need for gloves.

Procedure of intermittent self-catheterization

Perform hygienic hand disinfection, followed by disinfection of the urethral meatus. Gently advance the lubricated catheter, kept within its packaging, through the urethra until urine begins to flow. Depending on fluid intake and bladder capacity, the bladder should be emptied 4–6 times per day.

Complications

• Urethral injury with bleeding and risk for a urethral stricture
• Infections: 1–2 clinically significant urinary tract infections per year. Prevention includes aseptic technique, increased fluid intake (urine output >1.5 l/day), and urinary acidification with L-methionine or cranberry products.

References

Gambrill B, Pertusati F, Hughes SF, Shergill I, Prokopovich P. Materials-based incidence of urinary catheter associated urinary tract infections and the causative micro-organisms: systematic review and meta-analysis. BMC Urol. 2024 Aug 30;24(1):186. doi: 10.1186/s12894-024-01565-x.

Robinson J. Urethral catheter selection. Nurs Stand. 2001 Mar 7-13;15(25):39-42. doi: 10.7748/ns2001.03.15.25.39.c2993.

Sökeland, J., Brühl, P., Hertle, L., and Piechota, H. (2000). Katheterdrainage der Harnblase heute.
Dtsch Arztebl, 97(4):A167-A174.

  Deutsche Version: Indikationen und Komplikationen des intermittierenden Einmalkatheterismus

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