Urinary catheters are a complex and diverse group of medical products. While they all serve a similar ultimate purpose, the specific needs and demands of each individual patient can lead to some confusion as to which product is right for them.
Patients who are considering catheterization as a solution for urinary incontinence should exercise diligence in choosing the right urinary catheter for their lifestyle and health requirements. (Image above: Straight Catheter – Comfort Medical)
By far the most common type of catheter is the Intermittent (or Short Term) Catheter.
An intermittent catheter is inserted into the urethra on demand to empty the bladder, and then removed again as soon as the bladder is empty. Users are taught how to catheterize themselves, and it is a straightforward technique that can be performed by most people.
Even children as young as seven or eight years old can be taught how to catheterize, and by using aids, people with reduced hand function can practice it as well.
Catheterization is undertaken roughly at the same intervals as you would normally go to the toilet, about 4-6 times a day.
Medicare will cover up to 200 of these single-use, disposable catheters each month, allowing for frequent catheterization.
These are available in both straight tip and coude tip varieties. The straight tip is the most frequently used of these two, as Medicare requires patients demonstrate a medical necessity that specifies the use of a coude tipped Intermittent Catheter.
This need will arise from specific patient anatomy which makes straight tip catheter insertion difficult or impossible. This is especially true in men who have an enlarged prostate, where the curved coude tip catheter is the only choice for insertion into the bladder.
As insertion can be one of the main barriers to appropriate catheter use, it is usually recommended that patients use a hydrophilic catheter.
Hydrophilic catheters are lubricated with sterile water rather than gel, more closely mimicking our body’s own natural fluids. This produces greater ease of catheter insertion, helping encourage patients to catheterize whenever the need arises, leading to greater compliance with catheter treatment.
Indwelling (Foley) Catheters
Beyond simple intermittent catheters, there are also Indwelling, or Foley, Catheters. This type of catheter is replaced monthly, usually with the aid of a licensed medical professional.
As with Intermittent Catheters, these are available in both straight tip and coude tip varieties. Again, patients who can demonstrate a specific medical need will often opt for the curved coude tip version of a Foley Catheter as they tend to be easier to insert for many people.
The obvious advantage of Foley Catheters is that the frequent process of catheterization must be repeated much less often. For patients with a more active lifestyle that can make frequent catheter insertion difficult, Indwelling Catheters can be a good option.
This type of catheter is also frequently utilized for a preset period of time, such as after a surgery which can lead to urinary incontinence, since the catheter can be inserted by a doctor or nurse while the patient is already in their care. Foley Catheters are also available in a silicone version which enables patients with a documented latex allergy to avoid any unpleasant reactions to catheterization.
External (Condom) Catheters
For men, Condom Catheters are yet another option for urinary incontinence.
Rather than being inserted directly into the urethra as with Foley and Intermittent Catheters, a Condom Catheter is used externally on the penis.
Medicare provides for up to 30 of these catheters a month. As they can help avoid the sometimes difficult process of catheterization almost entirely, this can be a popular choice for men who have had difficulty with traditional Intermittent Catheters.
Closed System Catheter
While this system is more complex and thus expensive, it will significantly reduce the likelihood of urinary tract infections, by far the most common consequence of catheter use.
A closed system catheter is, at a quick glance, a self-contained, sterile, pre-lubricated catheter housed within a collection bag.
The collection bag eliminates the need to void the urine into a receptacle or toilet, and since it’s already self-containing, it also eliminates the need to hook up any other kind of bag or container. It’s basically ready to use once it has been opened.
These systems often include other features to help assist with the catheterization process and keep everything more sterile. As with all other types of catheters, its main function is to drain the bladder of all urine in a comfortable, smooth process while minimizing risk of bacterial infection of the urinary tract and/or bladder.
Conditions for Medicare Coverage of a Closed or Sterile Catheter:
Medicare will cover a Closed or Sterile Catheter System only for patients with very specific sets of medical criteria.
- If patients already on traditional Intermittent Catheters have had at least 2 urinary infections in the past 12 months, Medicare will cover a closed system.
- Patients in nursing homes, immunosuppressed patients, patients with vesico-uteral reflux, and spinal cord injured pregnant female patients can also qualify for this system.
10 Steps to Safe, Simple Self-Catheterization
1. Wash your hands thoroughly.
2. Set out all necessary supplies – these can include a mirror, the catheter, water, soap and/or a sterile wipe.
3. Position yourself in front of the toilet or in front of a collection container.
4. Wash or sterilize around the urethra. For women, wash from front to back, never re-using a wipe. For men, wash in a circular motion, starting at the urethra and working your way out.
5. Open the catheter. To keep the catheter as clean as possible, do not allow the catheter to touch anything once you pull it out of the wrapping.
6. Apply lubricant to the catheter if applicable.
7. For women, gently open the labia with your fingers. For men, hold penis straight out from the body and angled slightly upward toward your body and gently squeeze the head of the penis to very gently to open the urethra.
8. Insert the clean or sterile catheter until urine begins to flow. Gently push the catheter about 1 inch further into the bladder after urine begins to flow.
9. When the urine stops flowing, shift position a few times to ensure all urine is emptied, then slowly remove the catheter
10. Wipe the insertion site of any urine, throw away the catheter and wash your hands.