Intermittent Clean Catheterization: An Alternative Approach

                             Many patients with urinary issues such as incontinence, frequent urination, or incomplete emptying often undergo medication or surgery for treatment. However, these interventions may not always yield satisfactory results, leaving patients with a permanent catheter as their only option. In some cases, even surgical creation of an artificial bladder through abdominal opening becomes necessary, leading to complications and substantial costs.

Intermittent Clean Catheterization (ICC)

             Intermittent clean catheterization (ICC), also known as clean intermittent self-catheterization, offers an alternative solution. This approach is particularly beneficial for patients who experience difficulties in urinary function but want to avoid long-term catheterization. ICC involves periodic insertion and removal of a catheter, helping to empty the bladder and maintain normal urine flow.

Common Causes of Urinary Catheterization Dependency:

           1. Brain disorders such as brain trauma, tumors, cerebral atrophy, or encephalitis.

           2. Spinal cord conditions like spinal cord injuries, tumors, infections, or parasites.

           3. Peripheral nerve disorders affecting bladder control, including diabetes.

           4. Damage to bladder nerves due to pelvic surgery.

           5. Conditions affecting bladder muscle function or excessive bladder stretching leading to loss of urinary sensation.

Preventing Long-Term Catheter Placement:

           Prolonged placement of a catheter in the urethra or through the abdominal wall may solve some urinary problems but can lead to numerous complications. Patients may need to replace the catheter every month or earlier if clogging occurs. Pain, bladder stones, bleeding, and frequent infections are common issues. Men may experience urethral discharge, swollen testicles, or fistulas. Additionally, carrying around the catheter and urine collection bag can be burdensome. Given these drawbacks, the medical community now emphasizes avoiding long-term catheterization whenever possible. Clean intermittent catheterization has emerged as a superior alternative.

Types of Intermittent Clean Catheterization:

             1. Manual catheterization performed independently by the patient.

             2. Assisted catheterization performed by another individual if self-catheterization is not feasible.

Benefits of Intermittent Clean Catheterization:

             1. Reduces the risk of urinary tract infections and kidney deterioration.

             2. Restores normal bladder function more rapidly in certain cases.

             3. Minimizes complications associated with long-term catheter use.

             4. Enhances patients' quality of life, allowing for social engagement without inconvenience to others.

             5. Empowers patients to be self-reliant and less dependent on others.

Challenges of Intermittent Clean Catheterization:

             1. Self-catheterization can be challenging, particularly for women.

             2. Assistance from others is required for patients who are unable to perform the procedure independently. In the case of children, parents or caregivers may assist until the child can self-catheterize. However, adults may encounter  difficulties and should consult a doctor.

             3. Lower urinary tract obstruction can hinder the catheterization process.

Urinary Catheterization Supplies:

            1. Catheter hose

            2. Saflon antiseptic solution (or yellow soap) for cleaning (Mix 5 cc of antiseptic solution with 500 ml of boiled water)

            3. 1 bottle of boiled water

            4. Clean cotton wool

            5. Lubricating jelly for catheter insertion

            6. 2 containers (small for disinfection solution, large for collecting urine)

            7. Mirror (optional for self-catheterization)

Preparation and Equipment Maintenance:

            1. Wash all catheterization equipment with soapy water and rinse with clean water. Dry them thoroughly.

            2. Soak the cleaned catheter in a disinfectant solution contained in a plastic tube. Fill the tube with the disinfectant solution and insert the catheter, allowing the solution to flow through it. Remove the cap to open the end of the          catheter and cover the plastic tube.

  Note: Each time the catheter is soaked, remove the end cap to ensure easy removal of the catheter from the tube for the next use.

Urinary Catheterization Procedure:

            1. Wash hands with soap thoroughly, paying attention to short nails and avoiding wearing jewelry.

            2. Prepare the catheterization equipment, including the catheter and lubricated catheter taken from the disinfectant solution. Rinse the lubricant with boiled water before inserting it into the catheter.

            3. Self-catheterization or have someone assist you.

                       For women: Squat, spread the legs or lie down with legs apart, or stand with one foot on a chair. A mirror can be used to view the urethra or feel it with fingers.

                       For men: Stand, lie down, or sit.

            4. Clean the urethral opening with antiseptic solution. If outside the home, soap can be used to wash the genital and urethral areas.

            5. Hold the catheter approximately 1 inch from the end. Apply lubricating jelly to the end of the catheter to reduce irritation. Insert the catheter into the urethra: in women, about 3 inches deep, and in men, all the way until urine starts to flow into a container or toilet.

            6. When urine flow from the catheter stops, use one hand to hold the catheter and press over the pubic area to encourage additional urine flow. Once the urine flow stops, gradually pull the catheter while pressing over the pubic area.                  Repeat this process until you are confident that the bladder is empty before removing the catheter from the urethra.

            7. Rinse the genital area and urethra with clean water or use a damp cloth to dry the area after completing the catheterization.

Additional Notes:

            1. The frequency of catheterization should be determined by a doctor.

            2. Adhere to the specified catheterization schedule regardless of cleanliness or environment. Avoiding prolonged urine retention in the bladder helps prevent infections.

            3. This type of catheterization is clean but not sterile, unlike in a hospital. This should not discourage the intention to perform it.

            4. Do not hesitate to consult a doctor and seek immediate medical attention if any problems arise from catheterization.

            5. Maintaining a positive attitude towards clean urinary catheterization promotes correct and consistent adherence, enabling patients to live happily and confidently in society.

Provided by: Dr. Chaiyasit Majchariyakul, Urological Surgeon