An article detailing the use of intermittent self-catheterisation for voiding dysfunction

Averbeck MA

Bermingham SL

Bickhaus JA

Collins L

Fumincelli L

Kobayashi M

Lapides J

Liberman D

Newman SB

Oliphant SS

Rognoni C

Seth JH

Thanagumtorn K.

Weynants L

Collins, Linda

Kingston University Research Repository

This document is the Accepted Manuscript version of a Published Work that appeared in final form in British Journal of Nursing, copyright © MA Healthcare, after peer review and technical editing by the publisher. To access the final edited and published work see https://doi.org/10.12968/bjon.2018.27.15.866   The use of intermittent self-catheterisation for voiding dysfunction.   Dr Linda Collins   In 1972, Dr Jack Lapides pioneered the use of clean intermittent catheterisation (CIC). The theoretical concept for CIC was to manage urinary retention symptoms in patients who had a neurogenic bladder, bladder abnormalities and to reduce the risk of these patients developing a urinary tract infection (UTI) (Lapides et al. 1972). Over four decades later, it is regarded as the gold standard for managing chronic urinary retention (Averbeck et al. 2018), it remains a clinical technique frequently performed by nurses to alleviate the symptoms of retention in acute and rehabilitation settings (Newman et al. 2003), and novel methods of CIC are being practised within the community setting (Rognoni et al. 2017).   Through the years, there have been variations of the name used for CIC such as clean intermittent self-catheterisation (CISC) (Weynants et al. 2017), intermittent self-catheterisation (ISC) (Bermingham et al. 2013) and intermittent urinary catheterisation (IUC) (Fumincelli et al. 2017). Despite the differing titles, the method remains the same, which is a periodic voiding method that assists the flow of urine (Fumincelli et al. 2017). It is performed by inserting the catheter which is a thin hollow tube with small eyelets at the peak, into the urethral orifice, along the urethra and into the bladder for urine drainage (Iggulden et al. 2009). Indications for using ISC  There are several reasons why ISC may be initiated. According to the European Association of Urology Nurses (Vahr et al, 2013), ISC should be performed when there is a residual urine in the bladder and accompanied with voiding symptoms or complications such as UTI, patient discomfort, voiding symptoms and incontinence. It should not be performed based upon a residual urine alone.   Various bladder treatments that reduce detrusor overactivity, can cause incomplete bladder emptying (Liberman et al. 2017), and ISC is often prescribed for this cause. ISC should be recommended for patients that have problematic voiding symptoms along with an elevated residual urine (Collins et al. 2017).   Patient assessment   A clinical assessment is an important initial step to determine whether a patient should commence on ISC. Performing a 3D portable ultrasound scan of the bladder, using a portable scanner, is a rapid and non-invasive method to determine a residual volume (Thanagumtorn 2016). Symptom assessment is also fundamental, the sensation of incomplete emptying, voiding small amounts and straining to void are all indications of voiding dysfunction (Kobayashi et al. 2018), and accompanied with a raised residual urine may indicate the need for ISC.   ISC insertion techniques  There are two main insertion techniques. According to Seth et al. (2014) the clean technique involves the use of reusable or single use catheters, following ordinary hand washing procedures, whereas the aseptic technique requires a sterile approach. Patients requiring ISC are often taught by nurses on how to insert the catheter and patients retain this skill for as long as it is required (Bickhaus et al. 2015).   Patients who undergo correctional surgery for urinary incontinence are often plagued with voiding failure anxieties however, use of an instructional video on how to self-catheterise has been reported to reduce the apprehensions towards performing the task (Oliphant et al. 2013). Optimally, good motor and sensory functions are the key skills required for patients to effectively perform ISC (Weynants et al. 2017).  Conclusion  The purpose of ISC is to alleviate bothersome voiding symptoms. It remains a common clinical procedure which can be performed in a clinical or community setting. Adequate clinical assessment is fundamental and the indications for ISC should be determined prior to insertion. Nurses are key instructors when teaching patients to self-catheterise and have a significant role when assessing patient proficiencies in the case of urinary voiding dysfunction.   References  Averbeck MA, Krassioukov A, Thiruchelvam N, Madersbacher H, Bogelund M and Igawa Y (2018) The impact of different scenarios for intermittent bladder catheterization on health state utilities: results from an internet-based time trade-off survey. J Med Econ 1-8. Bermingham SL, Hodgkinson S, Wright S, Hayter E, Spinks J and Pellowe C (2013) Intermittent self catheterisation with hydrophilic, gel reservoir, and non-coated catheters: a systematic review and cost effectiveness analysis. Bmj 346. Bickhaus JA, Drobnis EZ, Critchlow WA, Occhino JA and Foster RT, Sr. (2015) The Feasibility of Clean Intermittent Self-Catheterization Teaching in an Outpatient Setting. Female Pelvic Med Reconstr Surg 21 (4) 220-224. Collins L, Sathiananthamoorthy S, Fader M and Malone-Lee J (2017) Intermittent catheterisation after botulinum toxin injections: the time to reassess our practice. Int Urogynecol J 28 (9) 1351-1356. Fumincelli L, Mazzo A, Martins JCA, Henriques FMD and Orlandin L (2017) Quality of life of patients using intermittent urinary catheterization. Rev Lat Am Enfermagem 25. Iggulden H, MacDonald C and Staniland K (2009) Clinical skills: the essence of caring. Berkshire: Open University Press. Kobayashi M, Tokura Y, Kambara T, Nukui A and Kamai T (2018) Feeling of incomplete emptying with little post-void residual in patients with lower urinary tract symptoms: Clinical implications and treatment outcomes. Low Urin Tract Symptoms. Lapides J, Diokno AC, Silber SJ and Lowe BS (1972) Clean, intermittent self-catheterization in the treatment of urinary tract disease. J Urol 107 (3) 458-461. Liberman D, Milhouse O, Johnson-Mitchell M and Siegel SW (2017) Real-World Retention Rates After Intravesical OnabotulinumtoxinA for Idiopathic Overactive Bladder. Female Pelvic Med Reconstr Surg. Newman SB, Nelson MB, Gaydos CA and Friedman HB (2003) Female prisoners' preferences of collection methods for testing for Chlamydia trachomatis and Neisseria gonorrhoeae infection. Sexually Transmitted Diseases 30 (4) 306-309. Oliphant SS, Lowder JL, Ghetti C and Zyczynski HM (2013) Effect of a preoperative self-catheterization video on anxiety: a randomized controlled trial. Int Urogynecol J 24 (3) 419-424. Rognoni C, Tarricone R and Fizzotti G (2017) Healthcare resource consumption for intermittent urinary catheterisation: cost-effectiveness of hydrophilic catheters and budget impact analyses. BMJ Open 7 (1). Seth JH, Haslam C and Panicker JN (2014) Ensuring patient adherence to clean intermittent self-catheterization. Patient Prefer Adherence (8) 191-198. Thanagumtorn K (2016) Accuracy of Post-Void Residual Urine Volume Measurement Using an Ultrasound Bladder Scanner among Postoperative Radical Hysterectomy Patients. J Med Assoc Thai 99 (10) 1061-1066. Vahr, S, Corbussen-Boekhorst, H, Eikenboom, J et al (2013) The European Association of Urology Nurses. Evidencebased guidelines for best practice in urological health care. Catheterisation urethral intermittent in adults. Dilatation urethral intermittent in adults.  Weynants L, Hervé F, Decalf V, Kumps C, Pieters R, de Troyer B and Everaert K (2017) Clean Intermittent Self-Catheterization as a Treatment Modality for Urinary Retention: Perceptions of Urologists. Int Neurourol J 21 (3) 189-196.  

Use of intermittent self-catheterisation for voiding dysfunction

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Use of intermittent self-catheterisation for voiding dysfunction

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