Intermittent catheterisation in children September 2016 Chapter 3 Materials Catheters Catheters for intermittent catheterisation are available in various diameter sizes (Charrières) and lengths. They can have a variety of lubrication and/or coatings. There are also a variety of shaped tips and may come with or without integral drainage bags. Catheters can be specially designed for men, women, or children. For intermittent use, there are single-use catheters and reusable catheters available. Types of catheters may vary from country to country depending on local practice, availability and economics. Single use catheters are made of polyvinyl chloride (PVC) and are packed sterile and singly. They are usually discarded after use. There is an increasing demand for PVC-free materials in medical devices. The phthalate components in PVC can be harmful to the human body (REACH/EU chemical regulation).17 For some products, phthalate-free alternatives are available (the information can be found on suppliers websites). Intermittent catheters have no balloons, and are generally somewhat stiffer than indwelling catheters.18 When choosing which catheter to use, the following factors should be considered: medical safety, preference of patient/healthcare professional, physical disabilities and/or cognitive limitations, ease of use, and possible need for urine collection. In children, the length and Charrière size will depend partly on the child’s age but more importantly, the catheter should be long enough and large enough to provide easy, quick, and complete bladder-emptying, without damaging the urethra.19 Effective intermittent catheterisation is the result of compliance with both technique and frequency. It is therefore important that the patient is guided in selecting the best product. Sometimes it may be necessary to try a few different catheter types and systems.2,19,20 3.1 Types of Catheters Some single-use catheters require the addition of sterile lubricant. These lubricants are available with or without a local anaesthetic (lignocaine/lidocaine), and with or without chlorhexidine (antiseptic). These catheters may be reused in certain circumstances but this should only be in agreement with the child’s clinician. Only catheters without a coating should be used in this instance as coatings may cause catheters to stick as they dry out and cause trauma. There are also single-use catheters which contain gel either contained around the catheter or with a separate pack which requires activation to provide lubrication. In addition, there are catheters with a hydrophilic coating (liquid) within the catheter or in a package which again requires activating or filling with tap water. ‘Compact’ catheters are so called because the packaging is small and discreet. Some of the types of catheters mentioned above are also available as catheter sets, consisting of a catheter with an integrated drainage bag. These sets can be useful for wheelchair users, or if the toilet facilities are limited or unhygienic. These sets are designed for a ‘no-touch’ technique. Opening these catheter systems requires a certain level of hand function and manual dexterity and they are also more expensive. They are a useful additional aid but should be used only if indicated. Finally, there are catheters with Luer Lock connectors which will allow the administration of medication. Some female patients prefer to catheterize with a non-disposable metal catheter that can be used for years with daily cleaning 3.2 Drainage holes (eyes) The drainage holes (eyes) are positioned about 1 to 2 cm beneath the catheter tip. They allow the drainage of urine. It is therefore important that the catheter is placed far enough into the bladder (when urine starts to flow, the catheter should be advanced at least 1 cm further). There are usually two drainage eyes which are polished to avoid sharp edges. The size of the eyes increases with Charrière size (Fr). Catheter with additional eyes (3 to 4), and extra-large eyes which may be recommended to assist with mucous drainage (e.g. in an augmented bladder), and are available from Ch/Fr 8.
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