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Intermittent Catheter Types

The number of catheter types and designs has increased with the advancement of new technology. This has added complexity to the catheterization process for both the nurse and the patient.


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Catheter Length:

Catheter types are now gender specific, acknowledging the anatomical differences in urethral length between men and women.
  • Standard male catheter length is 16” (~40-45cm)
  • Female catheters range in length from 6-12 (20-26 cm)
  • Pediatric lengths are 6-10”.
Many women find that shorter length catheters are easier to grasp, manipulate and insert as it will not loop or kink.

Catheter Size:

A catheter used for intermittent catheterization has single lumen. The diameter is measured in the French catheter scale, French gauge (Fr or F), or Charriere (Ch), based on the cross sectional diameter of the catheter in millimeters, similar to the size of indwelling urinary catheters.  Sizes range from 6-12 French for children and 14-22 French for adults. The funnel end of the catheter is often color coded to allow for easier size identification. The funnel color of the shorter length catheters used by many women may not indicate the size and have been designed for ease of grasping the catheter.

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Catheter eyelets:

There are two eyelets of urinary catheters which may be placed laterally or opposing. Larger size catheters do not necessarily have larger eyelets in proportion.

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Catheter tip:

The tip of a catheter can be either straight (Nelaton) or curved (referred to as “Coudé or “Tiemann”). But all have a rounded tip allowing for smoother passage during insertion. There are catheters available to patients performing ISC that have an introducer tip that bypasses the part of the urethra that is colonized with bacteria during insertion. This prevents introducing bacteria into the bladder when catheterizing.

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“No-touch” or “Touchless” catheterization

A unique feature of most catheters is the ability to insert the catheter without touching the surface. To ensure a “touch-free” insertion some have a plastic sheath (sleeve) that covers the entire catheter, sliding down to the funnel during insertion. Many have an insertion aid, a special guide mechanism or “finger grip” that slides along the catheter while it is inserted. 

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Packaging

Catheters are available that have compact packaging. Some are sold individually packaged, and can be easily carried in a purse ., even lipstick-sized length, or pocket.  The packaging resembles cosmetic items that can be discreetly stored. These are more convenient and more discreet accommodating a person’s social and work life. 

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Intermittent Catheter Designs

There are two main designs of catheters used for intermittent bladder drainage: coated and uncoated. Catheter material and coatings are used for different types of catheters and are manufactured from latex, rubber, silicone, or polyvinylchloride (PVC). Catheter material or type influences rigidity.

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Uncoated/Non-coated

Uncoated/Non-coated catheters require separate or external gel for lubrication.  Lubricant may be packaged with the catheter.  These catheters are often part of straight catheter sets or kits used in hospital.  Uncoated red rubber latex catheters are uncoated catheters and are not appropriate for anyone with latex sensitivities and the flexibility of a red rubber catheter can make it difficult to insert.

Coated

Coated catheters are designed to improve catheter lubrication and ease insertion, which may reduce trauma and urinary tract infections. The most common coating is a hydrophilic coating as there is evidence supporting single-use HC catheters’ ability to prevent some of the most common catheter-associated complications, such as urethral trauma and CAUTIs.   
There are different types of coating:

  • Gel prelubricated catheters are safe, effective, and a comfortable option as results are significantly better compared to an uncoated catheter (Giannantoni et al., 2001; Sarica et al., 2010).
  • Hydrophilic coated catheters have been shown to cause less urethral trauma and catheter-associated UTIs than the uncoated catheter (Christison et al, 2018; DeFoor et al, 2017; Shamout et al, 2017; Prieto, et al, 2015, Cardenas et al., 2011). They have one of the following coating designs:
    • Surface hydrated with an integral lubricated surface and ready to use when opened
    • Surface not activated but includes a sachet of sterile water that activates the coating when pressed or
    • Surface activated when water added by the user
In addition, design changes include the integration of all needed equipment (such as catheters, water-based lubricants, and drainage bags) into a compact and user-friendly system (closed system). The health care provider who instructs the patient usually recommends the catheter choice, so knowledge of the different types of catheters is important.

March 2021
© 2021 Digital Science Press, Inc. and UroToday.com
Written by: Diane K. Newman, DNP, ANP-BC, FAAN
References:
  1. Chartier-Kastler E, Amarenco G, Lindbo L, et al. (2013). A prospective, randomized, crossover, multicenter study comparing quality of life using compact versus standard catheters for intermittent self-catheterization. J Urol. 190(3):942-947.
  2. Cardenas, D. D., Moore, K. N., Dannels-McClure, A., et al. (2011). Intermittent catheterization with a hydrophilic-coated catheter delays urinary tract infections in acute spinal injury: A prospective randomised, multicenter trial. Physical Medicine and Rehabilitation, 3(5), 408–417.
  3. Christnsen, J., Ostri, P., Frimodt-moller, C., et al. (1987). Intravesical pressure changes during bladder drainage in patients with acute urinary retention. Urologia Internationalis, 42(3), 181–184.
  4. Christison K, Walter M, Wyndaele JJM, et al. (2018). Intermittent catheterization: The devil is in the details. J Neurotrauma. Feb 1. doi: 10.1089/neu.2017.5413doi
  5. DeFoor W, Reddy P, Reed M, et al. (2017). Results of a prospective randomized control trial comparing hydrophilic to uncoated catheters in children with neurogenic bladder. J Pediatr Urol. Aug;13(4):373.e1-373.e5. doi: 10.1016/j.jpurol.2017.06.003. 
  6. Goetz LL, Droste L, Klausner AP, Newman DK. (2018). Intermittent catheterization. In: D.K. Newman, E.S. Rovner, A.J. Wein, (Eds). Clinical Application of Urologic Catheters and Products. (pp. 47-77) Switzerland: Springer International Publishing
  7. Håkansson MA. (2014). Reuse versus single-use catheters for intermittent catheterization: what is safe and preferred? Review of current status. Spinal Cord. 52(7):511-516.
  8. Newman, D.K., New, P.W., Heriseanu, R. Petronis, S., Håkansson, J., Håkansson, M.A., & Lee, B.B. (2020). Intermittent catheterization with single- or multiple-reuse catheters: clinical study on safety and impact on quality of life. Int Urol Nephrol. Aug;52(8):1443-1451. doi: 10.1007/s11255-020-02435-9. 
  9. Newman DK. (2017). Devices, products, catheters, and catheter-associated urinary tract infections. In: Newman DK, Wyman JF, Welch VW, editors. Core Curriculum for Urologic Nursing. 1st Pitman (NJ): Society of Urologic Nurses and Associates, Inc; 2017. p.439-66.
  10. Newman DK, Willson MM. (2011). Review of intermittent catheterization and current best practices. Urol Nurs. Jan-Feb;31(1):12-28, 48; quiz 29. PubMed PMID: 21542441
  11. Rognoni C, Tarricone R. (2017). Intermittent catheterization with hydrophilic and non-hydrophilic urinary catheters: systematic literature review and meta-analyses. BMC Urol. 17(1):4.
  12. Shamout S, Biardeau X, Corcos J, Campeau L. (2017). Outcome comparison of different approaches to self-intermittent catheterization in neurogenic patients: a systematic review. Spinal Cord. 55(7):629-643.
  13. Sun AJ, Comiter CV, Elliott CS. (2018). The cost of a catheter: An environmental perspective on single-use clean intermittent catheterization. Neurourol Urodyn. 37(7):2204-2208.