Intermittent catheterisation in children September 2016 3.6 Catheters for non-touch technique There are currently an increasing number of systems available whereby the catheter can be inserted with the help of an applicator. This prevents the catheter from being touched. There is evidence that using the notouch technique reduces the risk of UTIs especially in patients with an increased risk of UTIs.22 The literature however indicates that some patients have difficulty handling the applicators, packaging and slippery surfaces of coated intermittent catheters. These factors should be considered when selecting the most appropriate catheters for each individual 3.7 Catheterisation Aids There are a variety of aids and devices to enable easier insertion for children with limited dexterity or a physical disability. For example, there are mirrors for girls to obtain a good view of the urethral orifice. Some can be attached to the leg and some can help to fix the legs in a position that keeps them apart leaving both hands free to catheterize. It can be difficult however to direct the mirror correctly and sometimes for the child to manage with the reversed image in a mirror. They are less compact, and therefore not very convenient to carry. Some of these mirrors also come with a light as an accessory product but these can be relatively expensive and are not usually provided free of charge in the majority of countries. There are special grips or handles available to help hold the catheter. These may be useful if the abdomen is large, the arms are too short, or a firmer grip of the catheter is needed. There are also ‘clothing holders’ to help keep clothes are out of the way. In addition to catheters and aids educational support materials are available in many countries. These include dolls to practise catheterisation, DVD`s with instructions to catheterize and discussions about children’s experiences with self-catheterisation, kits containing show-and-tell items for holding talks in school and card games etc.23-25 When transurethral catheterisation is too complicated construction of a catheterisable stoma in the umbilicus or lower abdomen may be recommended 3.8 Continence containment products Some children suffer from leakage of urine and/or faeces in between catheterisations and may require additional advice on appropriate containment products. There are disposable and washable products available depending on the volume of leakage. The types of products available will vary from country to country. For boys drainage systems such as sheaths (male external urinary collection systems) may also be a useful option if available. It is important to take into account the children’s lifestyle, cognitive abilities and independence when selecting the most appropriate aid or product for each individual case. In order to ensure children and families can make informed choices and get the best available products for their individual needs it is important that healthcare professionals keep informed of existing and new developments. They must also consider the financial implications and discuss these with the child / family. Consideration of further the factors around containment products is outside the remit of this guideline. 3.9 Use of catheters in poor financial circumstances In many countries cost of catheters for long term use can be an issue as single use catheters can be very expensive. Overall studies currently do not provide sufficient evidence to recommend or to contradict the use and reuse of non-coated catheters over single use /coated catheters. There is evidence that non coated catheters can be reused indefinitely with daily cleansing without extra risk for recurrent urinary tract infections.2 Female patients can also use reusable metal catheters.
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