How to support your patients when choosing a catheter

Patient choice is vital to supporting safe and effective use of catheters. But have you and your team ever reviewed the options that you give patients who are starting to use intermittent self-catheterisation, to make sure that you are giving them a range of choices with different properties? As well as this, it is worth thinking about how you review this when they are comfortable catheterising, as there may be products or accessories that can further improve their quality of life, and the individual’s ability to use the catheter may change over time.

This article briefly outlines some of the different properties that you should consider and discuss with your patient before prescribing them a catheter, and those that you should think about once they are settled into catheterising.

Type of catheter

There are three types of intermittent self-catheter :

First generation (un-coated)
Second generation (PVP-based hydrophilic coatings)
Third generation (integrated hydrophilic properties).

Deciding which type to use is a matter largely for personal preference (including comfort and cost) and availability. This choice may be influenced by material factors including the material the catheter is made of, whether it is pre-lubricated and whether the coating contains PVP, as well as how compact and discreet the catheter is to fit in with people’s lifestyles, so make sure you bear these factors in mind when selecting the catheter.

Catheter length

This varies for men and for women – male catheters are usually up to 40cm long whereas female catheters are more like 20cm long. Women who use a wheelchair or who have a larger body mass index may find that a longer catheter works better for them. Compact catheters are available – while those used by women can be as short as 7cm long and work well, those for men just provide more compact packaging rather than a shorter catheter. Once the patient has got used to catheterising, it is worth discussing whether they might like to also try a compact catheter for use outside the home to increase their independence.

Catheter size

Catheter size relates to the thickness or external diameter of the catheter and is measured in French Gauge (FG or FR) or Charrière (Ch). A Ch equals 1/3 of a millimetre, so the external diameter of a 12Ch catheter is 4 mm. Most people use a 10–14Ch catheter. Discuss with the patient the balance between using a smaller size for comfort and urine flow (a larger size is quicker to drain the bladder).

Patients usually use the smallest size that allows them to maintain good drainage and reduces the risk of urethral and bladder neck trauma.

Products that make catheterising easier

Depending on your patient’s needs and abilities, you may wish to discuss the use of catheter sets for use out of the house, specially designed catheters, handles or penis holders for those with reduced dexterity, mirrors for women who find it difficult to locate the urethral opening, or leg spreaders to help hold the legs apart during catheterisation.

As well as physical products, a patient support system like Me+ (https://www.convatec.com/en-gb/continence-care/meplus-support/) can be immensely helpful for patients who have started catheterising, as they have access to expert information and support when and where they need it.

Reviewing with the patient

Don’t forget to give the patient contact details for urgent queries (while encouraging them to try each type for a reasonable period of time so they can get used to using it) and book in an appointment to review this while they are there.

Material – is the catheter comfortable to insert and remove? If not, would they benefit from a third generation catheter rather than one with a PVP-based hydrophilic coating. Traditional hydrophilic catheters have PVP coatings that make them slippery on the way in, but they can become sticky when removed (Pollard et al, 2022). Third generation catheters have the slippery hydrophilic properties integrated inside the catheter itself so they do not stick, protecting the delicate urethra?
Length – once the patient is comfortable catheterising, might they benefit from having access to a compact catheter for use outside the home. This can help them maintain their independence.
Size – once the patient has got used to using a catheter, you could ask them if they wanted to try a larger size as this would allow them to drain their bladder more quickly..

Resources such as Continence Product Adviser (https://www.continenceproductadvisor.org/catheters) can be useful for both patients and healthcare professionals as a source of independent product information.