If I Fail at Self Catheterization

Contents

• Ideal Patient
• Problem Patient
• Barriers to Self-Catherization
• Who Should Teach Patients
• Who Should Assistance Intermittent Catherter Insertion
• The Importance of Hygiene
• Catherization Positions & Environs
• How is a Catheter Inserted Into a Female?
• How is a Catheter Inserted Into a Male?
• How Often Should You Catheritize?
• Maintain a Record
• Resource

Introduction

I am Diane Newman. I'1000 an developed nurse practitioner and adjunct acquaintance professor of urology and surgery, enquiry investigator senior at the Perelman School of Medicine, Academy of Pennsylvania. I am besides co-manager of the Penn Centre for Continence and Pelvic Wellness, Partition of Urology at Penn.

This is a review of how to teach a patient how to cocky-catheterize (ISC). In my practice in urology, I've taught this for many, many years and it'south always a claiming, then I hope that this webcast volition requite y'all maybe some tips on helping you teach patients how to self-catheterize.

Ideal Patient

Well, who'southward the ideal successful patient? Well, of course you desire someone who has an unobstructed urethra, then it won't exist difficult to pass information technology. Someone who may have an enlarged prostate, take a stricture, it'south going to be a little fleck more of a trouble, especially to teach them initially.

The patient should take practiced vision. They have to be able to visualize the catheter, visualize the meatus, so this I recall is an important thing.

Good perinatal care. You want their hygiene to be really kind of top notch. Okay? Because they could introduce bacteria into the bladder, so you desire to review, again, soap and water. Yous don't want to take to utilise Betadine or anything to launder their genitalia, but they should be washing the area prior to catheterization.

They should be compliant, and this is important in children. Many times children under the age of say 15 even, may have to have their parent do it because they will non comply, and there's actually research on the fact that children are getting repeated urinary tract infections because they don't want to do the catheterization.

One of the hallmarks of knowing whether a patient tin can catheterize is can they perform self-care? So can they dress themselves and transfer? Those individuals who are more immobile, who have more other bug with ADLs is non going to be successful at performing cocky-catheterization.

Trouble Patient

At present, who is the problem patient?

Weight

Well, obesity, large intestinal girth. There'southward many times with men that I've had to teach them in front of a mirror because they cannot see over their girth. This is hard women, though, considering some of them may not be able to reach the perinatal expanse to insert that catheter into the meatus if they accept a large abdominal girth or obese, so this can exist a trouble. And then a woman with abductor spasms that she really cannot separate her legs to really access the meatus, insert the catheter, tin be a problem.

Tremors

The other ane that should be on this also is tremors. I've tried to teach patients say with Parkinson's disease who accept tremors, and sometimes the tremors are and so significant that they're not really able to pass the catheter. At the end of this slide deck I'll show y'all some aids that might aid someone like that who cannot grip the catheter.

Barriers to Self-Catheterization

What are barriers to performing self-catheterization? Well, fright. Everyone fears this. I had to spend quite a chip of time in many of my patients, male patients, because they fear the catheterization, especially younger. And what happens is those patients will not be compliant.

• They fear that they're not going to be able to perform information technology.
• They fear the hurting and they may non be able to do it.

So it'due south really helpful to really relay their fears, and I always say then information technology's the fright of the unknown. "Heed, let's try it." And sometimes you lot're successful, but there are times I oasis't been successful. The patient'due south had to come back.

Or I say, can you get a caregiver? I always endeavour to take someone else's significant other person in their lives to too be involved in the catheterization so if they can't do information technology on an individual day, and then that's really important. A spouse or someone would be helpful.

Patient Historic period

Historic period should not be a barrier. I've taught patients in their 90s, so age is non necessary a barrier, whereas obesity may be.

Perineal Sensation

If they accept decreased perineal sensation, considering with women I have them catheterize by bear on, and if they don't have the awareness of existence touched in sure areas so they can identify where's the vagina, where's the clitoris, they may not exist able to self-catheterize.

Leg Spasms, Defects, & Balance

Leg spasms, defects, decreased flexibility or balance. If yous're having a adult female catheterize themselves say over a toilet, or a man, and they're off balance, that may non exist the best. That may exist a barrier.

Dexterity

Decreased finger, hand dexterity. This is very important. They accept to exist able to experience that catheter and be able to manipulate it.

Children

Children as a whole is a bulwark, their historic period, they can be frustrated, angry over that they take to do it. They just may become noncompliant. So close parental supervision is really important in those children.

Who Should Teach?

Now, teaching. Well, we're the ones that teach. I don't know in your practice, simply I've had very few of my urologists teach patients. Fifty-fifty the residents phone call us into the room and say, "Hey, could you help me with this?" So it'south really the nurses in the practice, whether information technology exist a registered nurse, a nurse practitioner or physician banana, is actually who's teaching the patient.

If the patient's unable to learn, you've got to call up about really their understanding, because later on I teach the patient, I give them handouts that are written. Can they read? That may be an outcome in your practice equally it is in mine in Philadelphia with certain cases. There are a lot of CDs that shows a patient catheterize themselves that the companies have available for educational activity, and I recommend that you lot get some of those.

Who Should Learn How to Insert the Catheter

Simply the indicate is call up about identifying someone else that can help that patient. They need to be available. It'south non someone that comes in once a twenty-four hours or once a week, and then commonly it's someone who'due south inside the business firm.

But sometimes I take mothers who will not let their children catheterize them. I had a case recently of a woman who the daughters have been catheterizing their female parent for over a year and the mother merely said no more. I don't want you doing it. Then that tin be a problem. So you need to think about the whole family unit dynamics effectually this.

Hygiene & Intermittent Catheters

You want to pay attention to the patient's personal hygiene. I hateful washing their easily earlier catheterization'southward of import, cleaning the ballocks, specially if they have fecal bug. If they take diarrhea or they take fecal incontinence you need to ask about that.

How do they handle the catheter prior to insertion? They may need a touchless system where they don't touch the catheter because you're concerned about the personal hygiene. At that place's another webcast that nosotros have here on the website that reviews different types of catheters, and then be familiar with all the catheters available because it really is individualized which catheter y'all option for which patient.

You want to really teach the patient, hey, you lot have to accept good hygiene to avoid UTIs. They don't have to scrub the perineum. They don't accept to use Betadine or whatever. Soap and water'due south fine. And you want to teach them the signs and symptoms of a UTI so that they're aware of it and if they feel they're developing one, they come up in to come across y'all immediately.

Identify a Position That Works in the Patients Surroundings

Now I'm going to show you lot a couple illustrations that I had drawn for my textbook I did on urinary incontinence, and I accept these on my patient education tools and y'all tin can find them likewise on the website urotoday.com.

Once you can run into, and probably none of your patients, including mine, are kind of dainty and thin and easy admission every bit this woman, only what I want to show here was the different places where that patient could catheterize. Yoga style, and they're using a self-contained organization. This adult female here is sitting on the bathtub. This adult female'southward using a mirror. I think this is hard, but there is a mirror that can attach to the toilet bowl that they tin can see.

This is the only mirror I would use considering if you're going to use a mirror, where's the third hand? Because you want one hand separating the labia, identifying the clitoris, the other hand inserting the catheter. Well at that place's no mitt to really hold a mirror. So this blazon of thing would be nice. Men. Men tend to just stand up in front end of a toilet. That's fine. But women can crouch or stand over a toilet and that may be the position. And so these are all the different positions that can work.

I think it'south important when you lot teach someone to self-catheterize, you endeavour to work with them on identifying position, the one that works for them. That's difficult to do in the clinical setting in an office do where I'g sure you, like I, have them on an test table. Well they don't have an test table at home.

So most of my patients, I hook them upwardly with a habitation care nurse and I have a lot of proficient relationships with our home intendance agencies in the Philadelphia expanse. They know to call me and I tell them what I'd like them to effort so that they go in the abode and run across, appraise that environment in the domicile. What'due south the best mode for that patient to catheterize? And also to have them demonstrate catheterization in their home to make sure the technique is skilful and is risk-free.

How is a Catheter Inserted Into a Female?

As far equally cocky-catheterization, I usually do it by impact. Basically divide the labia, identify the meatus. I e'er have them feel the vagina, the opening. You don't desire to go there. The clitoris is above the meatus, and take them try to feel the meatus, and then I guide them into passing the catheter.

Ordinarily they can, if they accept skillful perineal sensation, they'll experience that catheter being passed. And so considering our urethras are and then short, urine drains actually quickly, and they insert the catheter into the urine begins to bleed. Once it's drained they slowly pull information technology out.

How is a Catheter Inserted Into a Male?

Men, yous desire to make sure that yous have them straighten out the curves. Remember a male urethra has two curves and sometimes that curve makes it hard for that human to pass that catheter. So y'all want them to hold their penis kind of upright, to straighten out the shape of that male person urethra so to pass the catheter.

This is really important and this is why I always have patients demonstrate to me how they're going to catheterize. Men volition just kind of be pushing down on their penis as they try and insert the catheter. That doesn't work. Then they really need to pull their penis up and out as they pass the catheter and exercise it slowly.

They need to pass the catheter most the entire length, because that male urethra is very long and they want to make sure that they pass information technology the entire length and not to simply stop when they get urine, to make sure they're in there and then just slowly pull it out so they go all that urine, especially hither at the base of operations of the bladder.

This is just some examples of, okay, what are the steps? First, patients should wash their easily. Here they're wiping them with Betadine. I put this slide in here because I don't recommend that. Betadine can be very drying, so you really practice non desire them to use it. Soap and water's fine. And this guy, just accept him wash tip of his penis hither.

Here they're using a type of hydrophilic catheter that has actually h2o in the packaging, so you tin see that he's catheterizing himself standing and into a trivial container, so that may be an pick.

There are unlike types of catheter holders. And remember nosotros talked almost peradventure patients who don't have proficient dexterity, maybe utilizing this kind of a grip, and you can find these on the internet. I've actually ordered some of these for patients. This is equally far as keeping the penis, because they may not be able to do that. This one kind of to directly and hold the penis, considering they may not be able to grasp that thinness of the catheter, and then this. And sometimes with spinal cord injury patients, and hither'southward the ones that have some problems with their contracted or whatever, with their dexterity, this may be something that y'all recommend.

So a lot of aids out in that location. I suggest that you look for them. I find them all on the cyberspace and a lot of rehab centers will have them also.

How Often Should You Cathertize?

Now, how oft do you catheterize? This is a common question I go from nurses. Well, it'due south really based on the urine book. There's no such thing equally they must catheterize five times a day or they must catheterize six. It's really on how much urine they're producing, and of course that depends on intake.

The rule of pollex is that the catheterization volume should not exceed 400 milliliters, so normally that comes out to about 4 to half dozen times a solar day.

I recommend that they catheterize:

• Before they become to slumber.
• When they awaken in the morning.

At nighttime is going to be the largest catheterization volume because the kidneys produce most urine at nighttime, especially with crumbling patients, with the adult, older adult. So that's what patients volition do.

I have some older adults who accept some center failure that they actually need to wake upwards at dark to catheterize, or they may have incontinence during the night. So the existent fun though is before they go to bed and when they wake up in the morning.

Maintain a Tape

I do have them record and I have them do this for a period of fourth dimension. So this is our catheterization record, and you'll detect this on the UroToday website. And basically I ask them delight put downwards the date, the time, I desire you to attempt to void if they're able to void prior to catheterization, because I desire the catheterization volume to be a post void, and in some cases who they accept temporary retention, say, that will resolve, you want them to initiate voiding so just catheterize what's left in the bladder. So it'southward really a PDR catheterization.

The indicate is though that y'all hope whenever they come up back in, I want to see these volumes below 400 mls, and so I go over with them are their voider volumes increasing, and then they maybe need to catheterize less or do they have to catheterize more than ofttimes? This is very important. All of our staff employ this and I scan this into their medical record so I take a record of what they've washed.

Resources

I showed you some of the aids and in that location are pictures, at that place'south videos, similar I said. Videos can exist very helpful. Virtually of the companies have them.

There are mirrors. This mirror here can be used as a patient'due south catheterizing even on the toilet. They can prop it. There is a leg spreader with mirror attached that rehab centers have. You can detect that on the internet and it cost, I call up, nigh 29.99, and then that helps keep a patient who is not able to separate their legs. They fall in. Sometimes MS patients who have weakness of their lower extremities, this will keep those legs autonomously.

So children. There'south dolls, there's coloring books, instructional models, so there'southward a lot of aids out there to help parents or help children learn how to catheterize.

So I want to end this webcast with the fact that ane of the well-nigh important things is the frequency and the fact that you really need to follow up on patients.

Whenever I teach a patient how to catheterize, I take them come dorsum usually inside two weeks with their catheterization record and I accept them demonstrate for me how they're catheterizing so I can selection upwardly any problems that they're having. I become over with them, once more, frequency.

And why I think this is important and why I want you to run across this slide once again is that catheterizing to go on those volumes low will preclude urinary track infections, will forestall issues, and that's the almost important thing to teach patients. So they need to really proceed catheterization on a schedule and you demand to really follow up with them on a consistent basis.

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Source: https://www.urotoday.com/urinary-catheters-home/intermittent-catheters/evidence-based-clinical/ic-clinical-and-research-publications/114455-intermittent-catheters-teaching-self-catheterization.html

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