With so many infections abounding in the world this season, it is a good time to think about safety when catheterizing. These are not actions to slow down your process, but subtle changes in techniques that can help you protect yourself.
Handwashing Maintaining hand hygiene is so important to the care of your body, but an activity that is often overlooked. It can feel like you just washed your hands a minute ago, so does it really need to be done again? Well, the answer is yes. Washing your hands is essential to maintaining the cleanliness of your body.
Think about what you did in between washing your hands and starting to catheterize. Did you adjust your clothes, or push your chair from one location to another? It is these simple everyday moves that are often overlooked. You would notice if you accidentally got some food dripping from your hands as that can make a mess, but everyday moves, and touching dirty objects that do not leave a visible stain on your hands are often not noticed. Washing your hands just before touching a catheter is critical to prevent bacteria and viruses from entering the body.
Hand washing is essential when performing intermittent catheterization, when changing an indwelling catheter, suprapubic catheter, or ostomy bag. Even if you are wearing sterile gloves, you must wash your hands carefully before putting on your gloves. Or your caregiver needs to wash their hands prior to doing the change. It is easy to adjust clothing, gather supplies, and position your body before washing hands; however, these activities are woven into the catheterization process so often that hand washing is done too early.
If warm, flowing water and clean towels are not available, the use of hand sanitizer can be a substitute. Getting supplies, positioning, and removing clothing should all be done before washing your hands for catheterization.
Cleaning products can leave a residue in the urethral opening. They also tend to dry the delicate tissue at the inside of the opening of the urethra in both genders. Many urinary cleaning products contain alcohol which is very drying. Soap is also drying to internal tissue. Some soaps are pH balanced, which helps control drying.
The internal urethra is a mucous membrane which means it is constantly moist. It is critical that the cleaning process occurs at the opening of the urethra; however, it is just as important to remove the residue when catheterization is complete. A rinse with water can help preserve the moisture in your body. Hand sanitizer or other urethral cleaning products cannot be used as a rinse on the urethra as it contains alcohol which adds drying effects.
Lubricating the Catheter: Adding enough lubrication to a catheter is key to a successful insertion. The tissue in the urethra from the opening to the bladder is a moist mucous membrane. The tissue inside the body is not as hearty as our outer skin, which is used to the elements of life. It is always slightly damp but not moist enough for a catheter to slide easily through.
A lubricant is added to the catheter to help it glide through the urethra without causing minor tears, which can let in infection, or other significant injuries. Some individuals use lubricant sparingly, which is not helping your urethra. A thorough amount of lubricant should be used at the tip of the catheter as well as along the catheter. A drop at the tip of the catheter will not spread along the inserted catheter. It also helps with the withdrawal of the catheter. Men will need to lubricate the catheter six inches or more as their urethra is longer. Women will lubricate a catheter about 2-3 inches.
Pre-lubricated catheters are available for both men and women. This eliminates a lot of the ‘goopy-ness’ of application of the lubricant as well as ensures the entire catheter is well coated. If you have multiple urinary tract infections but have good technique, you may be able to use this as a justification for supplies of pre-lubricated catheters.
Angles When inserting catheters through the urethra, you need to think about taking the straightest route. In men, holding the penis straight up along the abdomen decreases the angle at the penile/scrotal junction internally. When the penis is pointed down, there is a severe angle that a catheter must traverse. When the penis is positioned up along the abdomen, this angle is almost non-existent.
While holding the penis up, you can place your little finger at the base between the penis and scrotum and feel the catheter pass under the skin. The area is quite close to the outer body. This is an area that is susceptible to breakdown, so holding the penis upright is important to avoid pressure injury from the inside of the body due to the trauma of passing the catheter.
Another issue with the penile/scrotal junction is the placement of external catheters. The roll at the top of the external catheter can rub against the penile/scrotal junction, which is why external catheters are secured lower along the penis rather than at the base.
Erosion of the penile/scrotal junction rarely occurs, but some men do have issues. Pressure injury in this location of the body is very difficult to heal which makes it a real challenge.
Further along the route to the bladder for men is the prostate. The catheter has to edge around the angle of the prostate gland. If it is difficult to maneuver the catheter around the prostate, a catheter with a coudé tip can be used. The coudé catheter tip is angled to help find the way around the prostate.