A straight catheter, also known as an intermittent catheter, is a flexible, hollow tube temporarily inserted into the bladder to drain urine. This procedure is performed on a schedule to ensure the bladder is completely emptied at regular intervals, a practice known as intermittent self-catheterization (ISC). The primary goal is to manage conditions that interfere with the body’s ability to empty the bladder naturally, such as urinary retention, spinal cord injury, or certain neurological disorders. Consistent bladder drainage prevents complications like urinary tract infections (UTIs) and potential kidney damage.
This technique should only be undertaken after thorough instruction and training from a qualified healthcare provider. Following proper technique and hygiene is necessary for the safety and success of the procedure.
Necessary Supplies and Preparation
Preparing the workspace and materials beforehand ensures a smooth and sanitary catheterization process. Supplies include the prescribed straight catheter, a sterile or clean collection container (if not using a toilet), and a water-soluble lubricating jelly. The lubricant must be water-soluble, as petroleum-based products can damage the catheter and irritate the urethra. Many individuals prefer pre-lubricated (hydrophilic) catheters, which eliminate the need for separate lubrication.
Begin by washing your hands thoroughly with soap and water for at least twenty seconds, or use an alcohol-based hand sanitizer. Position yourself comfortably, typically sitting on the toilet, standing, or lying down in a semi-reclined position, ensuring all supplies are within easy reach. Clean, non-sterile gloves may be worn, though they are not always required for clean intermittent catheterization.
Before proceeding, the tip of the penis, specifically the urethral opening (meatus), must be cleaned with mild soap and water or an antiseptic wipe. If uncircumcised, the foreskin should be gently retracted before cleansing to wash the area beneath. This hygiene step reduces the risk of introducing bacteria into the urethra and bladder.
Step-by-Step Guide to Intermittent Catheterization
If the catheter is not pre-lubricated, apply a generous amount of water-soluble lubricant to the tip and the first few inches. Proper lubrication minimizes friction and helps the catheter glide easily through the urethra, protecting the urethral lining from injury.
Hold the penis with your non-dominant hand, lifting it slightly upward and away from the body. This positioning straightens the natural curve of the male urethra, allowing the catheter to advance without resistance. Maintain this taut, straightened position throughout the insertion process.
With your dominant hand, gently insert the lubricated tip of the catheter into the urethral opening. Use slow, steady pressure to advance the catheter through the urethra. It is normal to encounter a brief point of resistance as the catheter reaches the external sphincter muscle.
When resistance is felt, pause the insertion and take several slow, deep breaths to help the surrounding muscles relax. Never force the catheter past this point, as it can cause trauma to the urethra. As the sphincter relaxes, continue applying gentle pressure, and the catheter should slide past the muscle.
Continue advancing the catheter until urine begins to flow, indicating the tip has entered the bladder. Once flow starts, insert the catheter an additional one to two inches to ensure the drainage eyes are fully within the bladder cavity. Allow the urine to drain completely into the toilet or collection container.
If the flow slows or stops, slightly repositioning or gently bearing down with abdominal muscles can help expel any remaining urine. Once the flow has stopped entirely, begin the slow, gentle removal of the catheter. If urine starts to flow again during removal, stop pulling the catheter out and wait until the flow ceases once more.
Preventing and Managing Insertion Difficulties
Difficulty advancing the catheter is a common experience, but the procedure must never involve forceful pushing. If the catheter meets firm resistance, stop and try to relax your muscles by taking several deep breaths, then attempt insertion again with gentle pressure. Resistance is often due to the external sphincter or an obstruction like an enlarged prostate or a urethral stricture.
If the straight catheter cannot be inserted after a second or third gentle attempt, a different type, such as a Coude tip catheter, may be necessary. The Coude tip is designed to navigate past obstructions. If the bladder is full and you are unable to insert the catheter at all, seek immediate medical attention.
Pain during the procedure is typically minimal, often described as pressure, but sharp or increasing pain is a sign to stop and consult a healthcare provider. A small amount of blood on the catheter upon removal (hematuria) may occur initially, but this should decrease over time. If you notice gross blood in the urine, persistent bleeding, fever, chills, or cloudy, foul-smelling urine, seek medical advice promptly, as these are signs of a potential urinary tract infection or trauma. Maintaining the prescribed catheterization schedule and practicing meticulous hygiene are the most effective strategies for preventing long-term complications.