Understanding the 3 Types of Urinary Catheters
Understanding the 3 Types of Urinary Catheters
Urinary catheters are divided into three main types: External, Intermittent, and Indwelling. Depending on the patient, and application, picking the best catheter requires an understanding of the variations and benefits provided by each.
External catheters are designed for men, and often are also called condom catheters or Texas catheters. External catheters are made from silicone, consist of an outer sheath that covers the penis, and has an opening at the tip to allow urine to flow into a collection device.
Rochester Medical is a manufacturer that has been producing external catheters for over 30 years and has pioneered an adhesion process that keeps the catheter in place for long periods of time. They are known for the development of the WideBand brand of condom catheters that utilize an adhesive inside the entire sheath wall of the catheter. This process ensures that urine does not migrate from the tip compromising the adhesive and requiring catheter replacement.
Ambulatory patients can use external catheters, along with a leg bag collection device, as an alternative to wearing an adult brief. Male quadriplegics may also use external catheters as they may not have the dexterity to self catheterize using an intermittent catheter. The external catheter may be left in place all day and accommodate active lifestyles.
Intermittent catheters are inserted into the urethrae to immediately drain urine from the bladder and are designed for one-time use. Both men and women use the intermittent catheter which are typically the best choice for an active wheelchair user or someone with a postoperative bladder or prostate challenge.
Intermittent Catheter Tip Types
Different tips and connection ends are available on intermittent catheters. Tips are either straight or curved (also called a Coudé-tipped). Depending on the patient’s condition, insertion may be easier with a curved tip over a straight tip1. The Olive Tip is another variation of the curved tip catheter designed to facilitate easier insertion for female catheter users.
Intermittent Catheter Material
Intermittent catheters are packaged individually in a sterile container. Most are made from Polyvinyl Chloride or PVC and coated with a hydrophilic material to ease insertion. The application of a hydrophilic polymer, mainly polyvinyl-pyrrolidone (PVP) to the exterior of the catheter creates a super slick surface when mixed with water. This makes insertion and extraction easy and lessens the risk of UTIs and urethral complications2. The alternative to hydrophilic coated catheters is the use of a sterile lubricant gel-like Surgilube.
Closed / Sterile Systems
A closed system intermittent catheter combines an intermittent catheter in a self-contained drainage bag. The catheter is typically hydrophilic coated or pre-lubricated and also features an introducer tip – a plastic tip that shields the catheter from bacteria as it’s passed through the distal urethrae. The distal urethra is the first few centimeters of the urethrae and is considered a location where harmful bacteria reside which may result in UTIs3 during catheterization. The outer bag of the closed system also provides a way to hold the catheter without risking contamination by touching it directly during the insertion process.
Indwelling catheters are also called Foley catheters or balloon catheters. Foley catheters are designed to be inserted into the bladder by a health care professional and remain in place for longer periods. The Foley catheter has a connection end that can be attached to a drain bag, leg bag, or collection bag and a small balloon at the insertion end. The balloon is inflated after the Foley is inserted into the bladder allowing it to remain in place. To remove the Foley catheter, the balloon is deflated and the catheter can be extracted. Foley catheters are typically made from rubber or silicone material.
Foley catheters are most often used in a medical setting, for patients undergoing surgical procedures, or those who are bedbound for long periods of time.
Understanding the three types of urological catheters will ensure the best patient application. From external, intermittent, or Foley, choosing the right catheter may reduce the risk of UTIs, enhance patient mobility and create greater independence.
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1) Review of Intermittent Catheterization and Current Best Practices, Diane K. Newman, MSN, ANP-BC, CRNP, FAAN, BCIA-PMDB, Margaret M. Willson, MSN, RN CWOCN, http://www.medscape.com/viewarticle/745908_8
2) Clean Intermittent Catheterization in Spinal Cord Injury Patients: Long-Term Follow-up of a Hydrophilic Low Friction Technique, Waller, Jonsson, Norlen, Sullivan, Journal of Urology, February 1995
3) The 'no-touch' method of intermittent urinary catheter insertion: can it reduce the risk of bacteria entering the bladder? Hudson E, Murahata RI. http://www.ncbi.nlm.nih.gov/pubmed/15852058