A urinary catheter is a small hollow tube that you pass into your bladder to empty urine. You may need this because the bladder is blocked, such as in men with a large prostate or BPH. Or, you may need a catheter because the bladder no longer can empty on its own because of a neurological disorder.

In either case, the catheter is inserted through the body via the urethral opening. The urethra connects the bladder to the urinary opening in the genitalia.

Intermittent Catheterization

In some people, rather than keep a catheter in place all the time, a catheter is inserted to drain urine when it is needed and then removed right away. When this is done periodically, it is called intermittent catheterization.

Most people can learn to do this on their own. Doing it yourself is called “self-catheterization.”

A “Clean” Procedure

When you “cath” yourself at home, you should follow a clean procedure. This means you should keep everything, from your hands to your genitalia, as clean as possible. You do not need to sterilize the catheter by boiling, microwaving or using any chemicals.

Items You Need

Below is a list of the items you will need:

• 2 clean washcloths or cleansing pads.
• Soap and water
• A lubricant that is water soluble. Do not use petroleum-based lubricants like Vaseline® or oils.
• The appropriate catheter, as prescribed by your doctor. 
• A urinal or pan to collect the urine; or alternatively, you can drain the urine into the toilet
• A dry pad or towel

How to Use the Catheter (MEN)

1. Gather all of the supplies you need.
2. Wash your hands well with soap and water.
3. Get into a comfortable position. Place a towel or waterproof pad under you.
4. Wash the tip of the penis with soap and water or a cleaning cloth. If you are uncircumcised, first pull back the foreskin.
5. Rinse with the second washcloth.
6. Put lubricant on the tip of the catheter.
7. Hold your penis parallel to your body with urethra pointed upwards towards the ceiling.
8. Look at the opening. If you are uncircumcised, the foreskin should be pulled back far enough to easily see the opening.
9. On the other hand, push the catheter into the opening until the urine flows. If there is resistance, try taking a deep breath and relaxing. Use firm and consistent but gentle pressure.
10. Never force the catheter. If you have sharp pain or notice blood, STOP.
11. Allow all of the urine to flow out.
12. After the urine has stopped flowing wait a few seconds, then slowly remove the catheter. If more urine flows out at one spot, stop there to let it drain.
13. Pinch the catheter as you remove it to avoid getting wet.

How to Use the Catheter (WOMEN)

1. Gather all of the supplies you need.
2. Wash your hands well with soap and water.
3. Get into a comfortable position. Place a towel or waterproof pad under you.
4. Wash your genital area. Wipe from front to back.
5. Lubricate the tip of the catheter to about two inches from the tip.
6. Spread your labia (the outer lips) using one hand.
7. Find your urethra by feel or by using a mirror.
8. Hold the catheter a few inches from the tip, away from the lubricant. Gently insert it into your urethra.
9. Never force the catheter. If you have sharp pain or notice blood, STOP.
10. Direct it upwards into your bladder until urine flows.
11. Allow all of the urine to flow out.
12. After the urine has stopped flowing wait a few seconds, then slowly remove the catheter. If more urine flows out at one spot, stop there to let it drain.
13. Pinch the catheter as you remove it to avoid getting wet.

Body Positioning When Inserting A Catheter

Many men stand while many women sit with their back recline to a 30-60 degree angle. Others sit completely upright or lay flat on their back.

There is no one way that works for everyone. Try different ways to see what works best for you.  

After You Remove the Catheter

After you pull out the catheter, follow your doctor’s instructions.

• If you are just starting to use the catheter or if something has changed, you may keep a urine journal and record how much urine you make with each catheterization.
• Always, check to see if the urine is cloudy, bloody or has changed in any way.

If you were told to re-use the catheter:

1. Wash the catheter with soap and warm water. Rinse well.
2. Air-dry the catheter by placing it on a clean paper towel.
3. Use a new catheter weekly or more often if it is damaged or soiled.
4. Do not soak the catheter in disinfectant.
5. Never microwave it.
6. Do not store it in a plastic bag.  Moisture in a sealed bag can cause bacteria to grow and increase your risk of urine infection.

To Dispose of Catheters

Dispose of used catheters and soiled pads in a plastic bag, such as a grocery store bag. Tie it closed, and place it in your household trash

How Often should you catheterize?

• Generally most people catheterize every 3-4 hours, however, this is individualized and there is a wide range.
• Many people are able to sleep through the night or catheterize once overnight.
• A general rule of thumb is if your outputs are consistently more than 500ml at each catheterization, you should do it more often.
• Follow your doctor’s instructions for catheterization frequency. 
• However, if you feel uncomfortable or have a strong urge to urinate, you may catheterize yourself more often. Let your doctor know if this persists as it could be a sign of changing bladder function.

Additional Points

Try to drink at 8-10 eight-ounce glasses of water daily (unless you have a medical condition that prevents this).

Try limiting water and other drink about 2-3 hours before bedtime. Many people who do this can stay dry and avoid overfilling the bladder. This may allow you to go through the night without catheterizing.

Reasons to call your doctor or healthcare provider:

• Cloudy or dark-colored urine that does not resolve when you drink more water.
• Bloody urine, especially if it is painless
• Blood from the urethra. You can tell the blood is from the urethra if you notice blood immediately after you finish catheterizing or the blood comes out around (not through) the catheter.
• Persistent temperature greater than 100.5° F by mouth, especially if you have belly and back pain.
• Persistent pain with catheterizing or difficulty catheterizing.
• Persistent pain in the urethra or bladder

Catheter-Related UTIs

Unfortunately, bladder infections and catheter use go hand in hand. Whether you are tending to somebody with a catheter or self-catheterize, here are important things to remember:

If a catheter is a temporary measure, check in with the hospital internist regularly on updates when it’s time to remove the catheter. Each day could increase the chances of the patient to contract a UTI by 3-7%. The longer it stays in place, the higher chances for a UTI and increased risk for bloodstream infections that could be lethal.

Sure, the nurses know what they are doing but ask the internist what is the minimum required time to keep the catheter and then check-in again when the time comes.

Here are the best practice guidelines that reduce catheter-related UTI that you should know:

• Using only the silicon type of foleys catheter
• Aseptic insertion
• Daily renewal of a catheter
• Emptying bag three-fourth via closed circuit
• Choosing the appropriate catheter sizes,
• Secure the draining tube on the thigh
• Keep catheter bag below a patient’s bladder level and not touching the floor
• Removing the catheter as soon as possible.