Intermittent Self Catheterisation ISC

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Intermittent Self Catheterisation (ISC)

• PRESENTED BY
• Gill Nottidge
• Continence Specialist Nurse
• With thanks to
• Emma Lyles and Chris Bradley
• Also Continence Specialist Nurses

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Found at Pompei (not available on prescription!)
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Overview

• Where and when it all began
• Why the bladder sometimes doesnt empty properly
• What to consider when teaching ISC
• Choosing the right catheter
• Men and women whats the difference (if you dont
  know perhaps youre in the wrong job!)
• How to know how often to do it
• Advantages and disadvantages of ISC

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Where it all began

• Intermittent catheterisation is far from being a
  modern idea.

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Intermittent Self Catheterisation
The first mobile catheters were disguised in
walking sticks for discretion long before 1970.
now we disguise them as lipsticks which shows
that there is still a taboo surrounding
continence care. We more easily accept walking
sticks, spectacles, hearing aids, guide dogs etc.

• Lapides an American urologist pioneered the
  modern technique of ISC in the early 1970s.

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Some causes of incomplete bladder emptying

• Neurogenic
• Detrusor areflexia
• Hyporeflexia
• Detrusor-sphincter dyssynergia
• Detrusor hyperreflexia

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Other causes of incomplete emptying.

• Enlargement of the prostate
• Urethral stricture after an infection or trauma.
• Stenosis following surgery of the bladder neck.
• Surgical procedures eg. colposuspension or clam
  cystoplasty.
• Constipation
• Bladder diverticula and other abnormalities

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What professionals need to know

• ISC may only be part of an individuals total
  bladder management (ACA, 2003).
• A holistic assessment of the patient must be
  carried out before agreeing a management plan.
• Know the complicated stuff but dont miss the
  obvious.
• Consent

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Other considerations for ISC

• Residual volume gt10 0f bladder capacity
• Residual Volume gt1000mls!
• Good manual dexterity and eyesight
• Motivation
• Support from a regular carer/partner for some
• Appropriate follow up support available
• (Baron, 2000)

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Intermittent Self Catheterisation

• ISC is now much easier and safer because of new
  materials being available and possibly a change
  in our post Victorian social attitudes

Everything you need for self catheterisation
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Achieving success the ACA way

• Patient selection
• Patient discussion
• General discussion
• Health issues
• Observations (ACA, 2003)

Store your catheters carefully
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Indwelling

• Very high infection risk
• High irritation and trauma risk
• Professional and extra equipment usually required
  to change
• Can work well for up to 12 weeks
• Low level patient skills needed
• Unliked by some users associations with old age
  and infirmity
• Sometimes prone to blockages/encrustation

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Intermittent

• Fairly easy to use for many
• Fairly low infection risk
• Large amounts of supplies needed
• Needs doing regularly
• Allows easier sexual activity
• Imitates normal bladder function

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ISC Catheter Selection

• Main factor is patients personal preference
• Wide range of catheters currently on the market
• Come in a variety of sizes ranging from 8Ch to
  20Ch and are available in female or male length.
  
• The smallest size that will drain the urine at an
  acceptable speed should be used.

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ISC Catheter Selection

• Three main types
• Those requiring a water based lubricant prior to
  insertion. Usually reusable.
• Those needing immersion in water to activate the
  pre-lubricated surface.
• Those lubricated and sealed ready for use from
  the packet.

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Checklist

• Easy to open
• Easy to handle any special features
• Low friction low trauma
• Low support for bacterial growth
• Well lubricated
• Good information
• Smooth drainage eyes
• Cost

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Preparation

• Try to pass urine normally
• Wash hands with soap and water
• Have a container ready into which you can drain
  the urine. (especially if it needs measuring)
• Clean urethral meatus with mild soap or plain
  water or wash genital area from front to back
• Prepare catheter
• Open packet ready to use
• Lubricate if required
• Soak catheter to activate lubricant
• Wash hands again

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Positioning

• Choose a comfortable position
• for men standing, sitting or laying down if this
  is easiest, (penis will need to be held out from
  body)
• For women-squatting, sitting on toilet, standing
  with one foot on toilet seat or lying down with
  knees bent
• Over toilet if not using container

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MALES

• Pull back the foreskin
• Hold the penis up towards your stomach
• Guide the catheter into the urethra, taking care
  not to touch the part of the catheter entering
  your body
• If you experience a blockage near the bladder
  withdraw a little relax and try again
• A small cough and push will also often get past
  the bladder neck
• Wait until urine stops draining and slowly
  withdraw
• Dispose of safely or store if reusable
• Wash hands

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FEMALES

• With one hand spread the labia apart and find the
  urethral opening above the vagina.
• A mirror can be useful initially. With practice
  you should be able to find the urethral opening
  by touch.
• Slide the catheter slowly and smoothly into the
  urethra until urine starts to flow and drain the
  urine into the toilet or a container.
• Wait until urine stops draining and withdraw
• Dispose of safely or store if reusable
• Wash hands

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Frequency of ISC

• Depends on the patients needs.
• The urine passed plus residual should not total
  more than 500mls at each catheterisation
• Residuals over 100mls increase risk of UTIs
• If patients are wet between catheterisations they
  may need to increase the number of times they
  catheterise.

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Potential complications of ISC

• UTI- Asymptomatic bateriuria is common and is
  generally not treated unless it becomes
  symptomatic
• Recurrent UTIs review their technique
• Blood may be present at first catheterisation
• Pain/soreness- most patients can catheterise with
  minimal discomfort. On removal some experience
  pain or resistance, thought to be urethral spasm.
  Relaxing or a gentle cough can help.
• Give contact details and out of hours numbers

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THANK YOU
ENJOY YOUR LUNCH