How many catheters are used per year

The Foley catheter, introduced a Urethrally and b Suprapubically. In both cases, the bladder is shown to be draining continuously into a urine collection bag attached to the leg: this bag can be emptied when necessary by opening a valve. Alternatively, the bladder can be drained intermittently if a catheter valve is inserted into the drainage funnel of the catheter.

The normal practice is to use the smallest catheter compatible with good drainage [ 28 ]: 12—16 Fr is usually adequate and only rarely is a catheter larger than 18 Fr necessary.

The main problem with latex is its cytotoxicity: for instance, in the s, an epidemic of severe urethral strictures was recorded in patients as the result of using latex catheters.

The cause was traced to cellular toxicity due to eluates from rubber [ 29 ]. Latex catheters are now usually coated with silicone elastomer to reduce this risk [ 30 ]. Many modern catheters are made entirely of silicone elastomer and hydrophilic coatings are used to provide a slippery surface to reduce friction [ 31 ]. Silicone catheters are not only non-allergenic, but they also have superior resistance to kinking and better flow properties in comparison with latex catheters [ 32 ].

Emphasis has also been placed on the need for a smooth surface to the catheter and the drainage eyes [ 33 ]. Rough surfaces encourage the deposition of bacterial biofilm and sharp edges to the drainage eyes can cause bleeding from the urethral lining when the catheter is introduced or withdrawn.

Some catheter research over the last few years has focused on the development of antiseptic and antimicrobial coatings, with the aim of reducing the incidence of catheter-associated urinary tract infections [ 34 ], so far with negligible success [ 35 ] see also Section 6d. Thus, a randomized controlled trial performed to compare the ability and cost-effectiveness of an antiseptic- and antimicrobial-impregnated catheter vs a standard coated catheter to minimize the risk of catheter-associated urinary tract infection revealed no evidence of benefit [ 36 ].

Indeed, in an earlier randomized clinical trial, infection actually increased with a silver-impregnated catheter [ 37 ]. Some Foley catheters have a third channel, which can be used to infuse saline or other irrigating fluid into the bladder: this may be useful when there is a likelihood that blood clots may form in the bladder, perhaps as the result of post-operative bleeding.

There is also a commercially-available catheter that has two balloons at the end of the catheter. The balloon at the tip is intended to reduce the risk of trauma to the urothelium; the drainage eyes perforate a short section of catheter between the two balloons, the proximal of which serves as the retention device. A possible disadvantage of the dual-balloon catheter is that it may trap more urine in the bladder at the end of drainage, thus increasing the risk of bladder infection.

Kunin, published a comprehensive indictment of the Foley catheter, 51 years after its introduction into clinical practice [ 38 ]. Having acknowledged that the Foley catheter is indispensable in modern clinical practice to provide temporary relief of urinary retention, a dry environment for incontinent or comatose patients and an accurate measurement of urinary output in those who are seriously ill, his intervention added momentum to the publication of major contributions covering virtually every aspect of the subject.

For an adverse event to be considered to be serious , it should either: have led to a death; or have led to a serious deterioration in health that either resulted in life-threatening illness or injury or permanent impairment of a body structure or body function, or required in-patient hospitalization or prolongation of existing hospitalization or resulted in medical or surgical intervention to prevent life-threatening illness or injury or permanent impairment of a body structure or a body function; or led to foetal distress, foetal death or a congenital abnormality or birth defect [ 39 ].

The principal adverse events—some of which are serious—for which the Foley catheter is responsible are as follows:. The flow of urine through an indwelling catheter may be continuous or intermittent. The introduction of a Foley catheter without a valve results in continuous drainage and, thereby, suppresses the normal process by which the build-up of bacteria is inhibited by periodic flushing.

Periodic flushing is usually facilitated by a manually-operated pinch or rotary valve. By raising the height of the drainage tubing leading from the catheter to a few centimetres above the level of the bladder, the bladder fills to the corresponding hydrostatic pressure before a syphon is formed that empties the bladder, after which the cycle is repeated.

Although this is a marked improvement and urethral damage can be avoided by suprapubic catheterization [ 42 ], tidal drainage is seldom used nowadays, possibly because of the level of nursing care required.

Bacteria can invade the bladder by migrating along the inside and the outside of the catheter. Urinary tract infection necessitates the use of antibiotics, which are all too frequently untested against the specific bacteria and consequently often prove to be ineffective until the right one is found by a process of trial and error. This adds to the cost of clinical management, as well as being a burden for patients and carers. The use of antibiotics to control catheter-induced infections contributes significantly to the development of resistant strains, about which the World Health Organization WHO has expressed grave concern [ 43 ].

The WHO referred in particular to seven bacteria: the first of these, Escherichia coli , is strongly associated with urinary tract infections. The second bacterium in the list, Klebsiella pneumonia , which is also found in urinary tract infections, was similarly resistant.

In view of the increasingly serious threat to global public health identified by the WHO, the present pervasive lack of interest in research aimed at finding a better alternative to the Foley catheter is both disturbing and inexcusable. This sump of residual urine is likely to be infected, so that uninfected urine descending from the kidneys will also rapidly become infected, resulting in chronic infection of the bladder.

Invasion of the bladder by urease-producing bacteria, particularly Proteus mirabilis , results in the conversion of urea in the urine into ammonia [ 35 ]. The consequential increase in the alkalinity of the urine causes phosphates to nucleate out of solution, forming crystals of struvite magnesium ammonium phosphate and hydroxyapatite an hydroxylated form of calcium phosphate in which some of the phosphate groups are replaced by carbonate.

Increasing fluid intake with citrate-containing drinks increases the pH at which crystals form in the urine [ 45 ] and there is evidence [ 46 , 47 ] that this could be used to control the rate at which catheter encrustation occurs. The nucleation of struvite and hydroxyapatite crystals on the biofilm on the catheter resulting from the activity of the bacterial urease causes encrustation to form around and within the catheter, blocking the drainage eyes and the lumen and preventing the flow of urine Figure 6.

This is a medical emergency that not only can be excruciatingly painful for the patient, but that also and more importantly requires a rapid response usually the replacement of the blocked catheter if permanent damage to the bladder and the kidneys due to ureteric reflux caused by the high bladder pressure is to be avoided.

These problems are exacerbated if associated with bladder spasm [ 48 ]. Moreover, it is apparent that some patients are more likely to block their catheters than others [ 49 ] blockers tend to have urine that is more alkaline, which is consistent with other observations. A section through a Foley catheter that has become blocked during use by the formation of struvite.

The smaller patent lumen is the channel for the inflation and deflation of the retaining balloon. It has been reported that, in cases of Proteus mirabilis infection, the necessity for antibiotics might be avoided by adding the biocide triclosan to the sterile water used to inflate the balloon of the Foley catheter.

This appears to prevent the rise in urinary pH that drives biofilm formation and catheter blockage [ 50 ], presumably by leaching into the urine. It is disappointing, however, that exposure to triclosan has also been shown to encourage the development of resistant strains of Proteus mirabilis , so this does not hold out much promise as a long-term solution [ 51 ].

The crystals of struvite resulting from Proteus mirabilis infection act as nuclei for stone formation within the bladder [ 52 ]. Bladder stones entrap Proteus mirabilis bacteria and, thus, maintain the infection. Recurrent blockage of a catheter raises a high suspicion that bladder stones may be present. Endoscopic transurethral techniques are used to remove bladder stones: fragmentation by crushing litholapaxy , shock-wave ultrasound or laser probes may be required to break them into particles small enough to be washed out of the bladder through the urethra.

Insertion into the urethra of a hard unyielding catheter, with its balloon and its protruding tip perforated by drainage eyes, transforms the natural process of intermittent drainage. When the drainage valve at the distal end of the catheter is opened, the low viscous drag of the catheter allows the urine to flow rapidly, driven by both the collapsing bladder and the negative pressure of the hydrostatic column to the open end of the catheter.

Towards the end of the drainage process, when the bladder wall comes into what is frequently traumatic contact with the tip of the catheter, the mucosal lining can be sucked into the drainage eye [ 53 ]. This suction can result in the formation of haemorrhagic pseudopolyps, with cumulative damage [ 54 ].

The physical trauma caused by the catheter tip and the suction at the drainage eyes can damage the normally impermeable bacterial barrier provided by the urothelial lining of the bladder see Section 4. This provides direct access for bacteria into the bladder wall and the bloodstream bacteraemia , with a high risk of septicaemia.

Moreover, reflux of infected urine via the ureters can lead to renal infection pyelonephritis and septicaemia. If inadequately treated, septicaemia can prove to be fatal [ 55 ]. The process of inserting the catheter requires skill and practice, if urethral trauma is to be avoided [ 56 ]. One of the problems with indwelling catheters with silicone balloons is that, when the water is removed from the balloon with a syringe prior to catheter withdrawal, a phenomenon known as creep may cause the balloon to fail to collapse completely.

This may result in a small rim that can make it difficult or impossible to to remove the catheter [ 57 ]. This presents a particular problem in the case of suprapubic catheters because these pass through a rigid fibrous track into the bladder, rather than through the urethra with its more elastic muscular walls.

Even more serious damage can occur if the catheter is deliberately pulled out when the balloon is still inflated, as can be done by disorientated or demented patients. In women with neurological conditions such as multiple sclerosis, the catheter can be expelled spontaneously by a sudden inappropriate contraction of the bladder. Under these circumstances, the urethra is dilated by the balloon and, if frequently repeated, the sphincter mechanism may become incompetent.

There is the risk that the catheter balloon may burst, either during insertion or withdrawal particularly by a demented or disorientated patient or when it is indwelling [ 58 ]. If this should happen, the fragments must be removed, usually with the aid of a cystoscope, as otherwise they can lead to stone formation or catheter blockage.

Several of these adverse events are demonstrated in a video presentation that can be accessed via the internet [ 59 ]. It is axiomatic that the incidence of catheter-associated urinary tract infections can be reduced by reducing unnecessary catheter use.

There have been numerous studies aimed at achieving this worthy objective. In reviews of these studies [ 60 , 61 ], two effective strategies have been identified. First, unnecessary placement of indwelling catheters should be avoided by imposing protocols including, for instance, a requirement to confirm by ultrasonic scanning that urine is being retained in the bladder [ 62 ]. There are semi-automated scanners designed for this purpose, but they are not without their shortcomings [ 63 ].

This simple expedient can have a significant impact. These strategies are already being implemented in many hospitals but, even if they were universally followed, the Foley catheter would still have to remain in widespread use. The number had risen to 2. The care of older and disabled people in an ageing population presents a major challenge: the management of bladder and bowel function is fundamental to the standard of care that they receive.

It is difficult or impossible for those affected to maintain a reasonable quality-of-life and urinary incontinence is a major reason for sufferers to seek residential care [ 65 ]. In this setting, catheterization is only recommended as a last resort, because of its high incidence of urinary tract infections.

Elderly patients are managed by using incontinence pads, but immobile patients lying on wet pads develop pressure sores. Choosing the lesser of two evils, the development of a pressure sore is accepted as an indication for catheterization.

It is a profoundly disturbing statistic that healthcare-associated urinary tract infections are estimated to have caused 13 deaths in hospitals in the US in [ 68 ]. The population of the US is 4. In a postal survey to determine the incidence and morbidity of long-term catheterization in a typical National Health Service setting [ 69 ], there were referrals from a cohort of patients over a 6-months period. Catheter-associated urinary tract infections not only place heavy demands on healthcare resources, but their treatment also raises profound concern regarding the development of antimicrobial resistance and they cause immense distress and social problems for the sufferers, their carers and their communities.

A rigorous analysis of economic costs of urinary retention, incontinence and catheterization is beyond the scope of this review. It may be helpful, however, to give some insight into the orders of magnitude involved, as follows:.

The costs of the relevant devices are, however, small in relation to those of the clinical and societal consequences of incontinence and retention and its management by long-term catheterization. The use of incontinence pads could be greatly reduced if there were a satisfactory alternative to the Foley catheter.

In addition to the fact that the use of pads is difficult or impossible to conceal, thus tending to make sufferers socially reclusive, there is the further problem of progressive deterioration of the condition of their skin. Unless pads are changed so frequently that the skin is kept dry, it tends to become macerated, leading to pressure sores and, with repeated drenching, the problem becomes chronic and unmanageable.

Until , the allocation was based on clinical need. Clearly it is impossible to make a simple and accurate calculation of the financial cost attributable to catheter-associated urinary tract infections. Data for show that infected patients, on average, incurred UK hospital costs 2. Between —, the UK consumer price index increased by a factor of 1. Admittedly this may not be a very good index of healthcare cost inflation, but no better measure seems to be available.

Prior to 1 October , hospitals in the US were able to recover additional payment to compensate for the extra cost of treatment of catheter-associated urinary tract infections.

Then the Medicare rule was changed and reimbursement for this was stopped [ 80 ]. Whether or not this was justified, the rationale was that catheter-associated urinary tract infection could reasonably be prevented through the application of evidence-based guidelines. Whatever the other effects of this change in the rule have been, however, it is perhaps surprising that it does not seem yet to have been seen as an incentive to develop a better catheter.

Furthermore, over deaths would probably be avoided each year in the UK and over in the US. In order to meet this challenge, an alternative indwelling catheter system must be developed. Taking into account the data presented in this review, as well as other analyses [ 82—84 ], the following research agenda can be proposed:.

The catheter should be easy to insert and withdraw. This means that the catheter should be flexible and experience minimal friction with the urethra, possibly by the application of durable, lubricious, antibacterial and hydrophilic coating [ 85 ]. The catheter should be retained within the bladder. The mechanism of retention is arguably the pivotal aspect of design development.

The balloon of the Foley catheter provides a retention force between 9—41 N, depending on the balloon inflation volume [ 86 ], which normally provides satisfactory retention, but it is associated with many problems mainly incomplete urinary drainage, bladder and urethral damage , so a novel approach is essential.

The catheter should allow the bladder to fill at low pressure and to empty completely, mimicking the natural physiology and without damage to the urothelial lining of the bladder or the urethra.

For instance, an alternative to the balloon of the Foley catheter as a retention device should minimize the retained volume of urine. A catheter with numerous drainage eyes, extending from a suprapubic port to the urethral opening, could be retained suprapubically, with negligible volume within the bladder.

A collapsible section in the catheter close to the end of the urethra or the suprapubic port could serve to restrict the rate of flow towards the end of drainage and, thus, to reduce the suction which otherwise could lead to pseudopolyps and other complications at the drainage eyes of the catheter.

The catheter system should be able to minimize any increase in bladder pressure such as that due to muscle spasm , to avoid damage to the kidneys. One possibility might be to provide an external reservoir to compensate for the reduction in the functional capacity of the bladder when it contracts during a spasm, with the urine flowing back into the bladder as it subsequently relaxes.

Such a reservoir could also compensate for the reduction in the structural capacity of the bladder due to long-standing inflammation. Catheter blockage is primarily the result of urinary infection and so the catheter should be resistant to encrustation by crystalline bacterial biofilm. Attempts to prevent catheter encrustation by impregnating the catheter surface with antimicrobial agents such as silver see Section 3 have failed because of a lack of understanding of the encrustation process.

Thus, it has been shown that, in patients infected with Proteus mirabilis , crystals generated in the alkaline urine rapidly cover the silver surface, protected from the underlying antibacterial agent [ 87 , 88 ]. The lesson here is clear: if antimicrobials are to be incorporated into catheters to prevent encrustation, they must diffuse from the catheter into the urine and, thus, prevent the bacteria from elevating the urinary pH.

As a precautionary measure, a sensor might be used to predict imminent encrustation. Moreover, the incidence and severity of catheter encrustation and blockage could be expected to be reduced if the normal periodic drainage of the bladder were to be restored. There should be an effective method for the safe insertion of the catheter by the suprapubic route.

Ultrasonic guidance is satisfactory, but only when used by a trained practitioner [ 90 ], so this needs to be deskilled. An alternative is to construct a permanent continent suprapubic port by the Mitrofanoff [ 91 ] procedure, which involves the transplantation of the vermiform appendix and major surgery.

In this context, there has been an attempt to use a plastic gastrostomy button as an alternative port [ 92 ]. Neither of these approaches is completely satisfactory; research into biomaterials with tissue-integrating surfaces or scaffolds must be worth exploring, aimed at developing a prosthetic suprapubic port suitable for intermittent or indwelling catheterization. The catheter should have control mechanisms appropriate for all users, including those with loss of manual or cognitive abilities.

A valve is needed to mimic the normal cyclical filling and emptying of the bladder. For users with manual dexterity and cognitive ability, this valve can be a simple tap, although a pinch valve is preferable because it eliminates the possibility of bacterial ingress. For people who cannot use a manual valve, an electrically-actuated valve is necessary, with pre-set timing for those for whom that is required: a prototype device already exists [ 93 ].

The intellectual property in the design of the catheter should be protected, as this will be the catalyst for its commercial manufacture, without which it cannot be introduced into clinical practice. The performance of the catheter will need to be tested in clinical trials and it will need to be shown to comply with the relevant medical device regulations.

Rigorous cost-benefit analysis will also be needed to generate the data to justify the inevitably higher cost than that of the Foley catheter. Figure 7 illustrates how some of these concepts, several of which are the subjects of patent applications [ 94—96 ], could be incorporated in a catheter system designed to meet the specifications of the research agenda.

A catheter incorporating some of the concepts in the research agenda. The catheter is retained by wings which spring open after insertion through the suprapubic tract to the bladder: this traps less urine than the balloon of a Foley catheter and the catheter can be withdrawn transurethrally after cutting through it at the external suprapubic port.

Multiple drainage eyes in the section of the catheter within the bladder minimize the risk of the formation of pseudopolyps, and this risk is further reduced by a collapsible section shown stippled of the catheter situated close to the external meatus of the urethra. The elastic reservoir at the suprapubic end of the catheter and strapped to the abdominal wall expands to accommodate urine from the bladder during spasmodic bladder contraction and returns it to the bladder when it relaxes after the spasm, thus minimizing the possibility of kidney damage.

Periodic drainage of the bladder into a leg bag is actuated by a pinch valve beyond the collapsible section of the catheter, under manual or timed automatic control. Perhaps the scientific community has not realized that there are significant interdisciplinary research challenges to be solved. The commercial companies probably see no reason to upset their business models with disruptive new technologies. Institutional review board approval was received at each participating facility.

All participants provided written informed consent. Each weekday morning Monday through Friday from August 26, , to August 18, , research staff identified patients on selected inpatient units who, during the previous 3 days, had placement of a urethral catheter.

After identifying potentially eligible patients by using data from the electronic medical record system, study staff conducted bedside visits to begin the recruitment process. After confirming eligibility, patients were invited to participate regardless of whether the urethral catheter was still in place at the time of recruitment. Once they were recruited, patient follow-up continued for 30 days from the initial date of catheter insertion. Participants received a souvenir magnet as a thank-you gift for their participation.

Information about patient characteristics as well as infectious and noninfectious complications associated with the urethral catheter were collected directly from patients.

After providing written consent, an initial in-person patient interview was conducted that included questions about why the urethral catheter was placed. The follow-up assessments, which asked patients about their symptoms and experiences during the previous 2 weeks, were conducted in person if the patient was still hospitalized.

After discharge, a study team member contacted the patient by telephone. Indeed, patient assessments may be the only way to identify complications that occur after hospital discharge, particularly complications that do not lead to a medical visit or require intervention.

Questions were primarily closed ended, except for a concluding question that allowed patients to discuss other possible complications. Primary outcomes were infectious and noninfectious complication events associated with the urethral catheter. Infectious complications for participants included being told that they had a urinary tract infection or a positive endorsement of any of the following symptoms in the previous 2 weeks: fever, chills, burning with urination, urinary frequency, urinary urgency, or other symptoms suggestive of an infection that required the patient to see a physician.

Noninfectious complications for participants whose catheters had been removed included a sense of urgency or bladder spasms, blood in the urine, leaking urine, and difficulty with starting or stopping the urine stream. For those with a catheter still in place, noninfectious complications included pain or discomfort, a sense of urgency or bladder spasms, blood in the urine, and trauma to the skin associated with catheter placement or securement.

A full list of complications by category is provided in eTable 1 in the Supplement. Secondary outcomes of interest focused on patient perspectives about their catheters, such as their effect on activities of daily living, social activities, and the general level of comfort. The primary outcome was the percentage of patients experiencing a complication from a urethral catheter at any time, which was calculated for select individual complications as well as by group infectious vs noninfectious.

The frequency of complications at each site was also assessed. To test whether differences between the sexes persisted after accounting for age, AUA symptom index score, reason for placement, and catheter duration, we used multivariable Poisson regression with robust SEs. All analyses were performed using SAS, version 9. Of eligible patients at 4 study sites, The majority of patients of [ Participants who were missing a baseline assessment or both follow-up assessments were excluded of patients [6.

Patients were recorded in both the group with a catheter in place and the group with the catheter removed if they had an indwelling catheter at 1 follow-up evaluation, but not at the other follow-up evaluation.

Table 1 describes the patient demographics. Only patients Urethral catheters were initially placed before surgical procedures in of participants Most catheters were placed for short durations, with patients Only patients 7.

A significantly lower percentage of patients 33 of [2. In addition, of patients During the 30 days after a urethral catheter was inserted, of patients As shown in Table 2 , noninfectious complications were 5 times as prevalent as infectious complications noninfectious, Women were more likely than men to report an infectious complication 92 of women [ Table 2 shows the percentage of specific patient-reported complications during the month after urethral catheter insertion.

Both infectious and noninfectious complications were reported more frequently by patients who still had their catheter. For patients who had had their catheter removed, the most frequently cited noninfectious complications were leaking urine of patients [ The most common noninfectious complication cited by the patients who still had a catheter in place was pain or discomfort 67 of patients [ In addition to infectious and noninfectious complications, many of the patients who still had a catheter reported activities of daily living restrictions 49 of [ Of the patients, 16 Sexual problems were reported by 99 of patients 4.

Select clinical characteristics associated with patient-reported infectious and noninfectious complications are shown in Table 3. For example, a higher percentage of patients with a baseline AUA symptom index score in the severe range reported both infectious complications 37 of patients [ Longer duration of urethral catheter use was also associated with more reported infectious and noninfectious complications.

Medical or surgical indication for catheter placement was not significantly associated with infectious complications. Noninfectious complications, however, were reported by a higher percentage of patients with a catheter inserted due to urinary retention or bladder obstruction. In a multivariable analysis adjusting for demographic and clinical characteristics eTable 3 in the Supplement , the sex-related difference remained significant only for infectious complications incident rate ratio [IRR] for female patients, 2.

Moderate and severe AUA symptom index scores and urinary catheter duration of more than 3 days remained significantly associated with both infectious and noninfectious complications eTable 3 in the Supplement. This prospective cohort study of urethral catheter—associated complications conducted at 4 US medical centers in 2 states has 3 key findings. First, the overall patient-reported complication rate of indwelling urethral catheter use was found to be However, women were almost twice as likely to report an infectious complication Finally, more than one-third of patients with catheters in place reported restrictions in activities of daily living These findings are novel, relevant to patient safety, and could not have been uncovered without direct follow-up in our study of patients who had been catheterized.

Other investigators have also evaluated the noninfectious complications of urethral catheters, albeit without the direct patient perspective. For example, Leuck et al 7 prospectively reviewed the medical records at a single Veterans Affairs hospital to evaluate both the infectious and traumatic complications associated with the use of an indwelling urethral catheter. These investigators noted that several of the lawsuits involved a spouse who claimed loss of consortium deprivation of the benefits of a family relationship because of injuries caused by the tort.

Finally, Davis and colleagues 16 followed up patients at 2 tertiary care hospitals in Ireland for 6 months and reported an incidence of traumatic urethral catheterization of 6.

Our findings confirm the importance of noninfectious complications based on reports of a diverse group of patients who received care at 4 different medical centers. We also received patient-reported accounts about their experience with the use of the catheter. Many patients complained about the indwelling catheter.

Hurts like hell! We prospectively followed up a large cohort to identify complications that resulted from urethral catheterization and were described by patients rather than relying on information that may be documented in the medical record or may be available through secondary data sources.

This information provided a unique and important perspective on potential complications that may concern patients and may occur outside the hospital setting.

For example, urine leaking from the catheter when the device was in place or from the urethra after it had been removed was an issue for many patients. Our study extended understanding of urethral catheter—associated complications by also identifying lifestyle issues—such as sexual problems—that are important to patients.

The analysis also identified sex-related differences in reported complications, which makes some sense given the anatomical differences of the genitourinary tracts. Women are at higher risk for catheter-associated urinary tract infections than men because they have shorter urethras and closer proximity of perineal bacterial colonization to the insertion site of the indwelling catheter.

Although male sex was no longer an independent risk factor for noninfectious complications when assessed in a multivariable model including the AUA symptom index score, this is likely linked to collinearity with the AUA symptom index score.

Our findings have clinical implications. This allows you to wear the bag under your clothes. An indwelling catheter may be inserted into the bladder in 2 ways:. An indwelling catheter has a small balloon inflated on the end of it. This prevents the catheter from sliding out of your body. When the catheter needs to be removed, the balloon is deflated. Condom catheters can be used by men with incontinence.

There is no tube placed inside the penis. Instead, a condom-like device is placed over the penis. A tube leads from this device to a drainage bag. The condom catheter must be changed every day. You would use an intermittent catheter when you only need to use a catheter sometimes or you do not want to wear a bag. You or your caregiver will insert the catheter to drain the bladder and then remove it.

This can be done only once or several times a day. The frequency will depend on the reason you need to use this method or how much urine needs to be drained from the bladder. Keep the drainage bag lower than your bladder so that urine does not flow back up into your bladder. Empty the drainage device when it is about one half full and at bedtime.

Always wash your hands with soap and water before emptying the bag. To care for an indwelling catheter, clean the area where the catheter exits your body and the catheter itself with soap and water every day. Also clean the area after every bowel movement to prevent infection. If you have a suprapubic catheter, clean the opening in your belly and the tube with soap and water every day.