14 There are a variety of catheters available with different tips. Nelaton This is the standard tip. The catheter is straight and has a rounded tip. Tiemann The tip is slightly curved. This catheter is sometimes recommended in case of an obstruction near the prostate, after specific surgery (sling), or a high bladder neck. The curved tip should be inserted with the tip pointed upward. Pointed tip/olive tip). The pointed tip has a bendy part and ends in a ball. It can be recommended for obstruction or pain in the sphincter region. Flexible tip This catheter has a tip that is somewhat narrower than the rest of the catheter. It can be recommended for a narrow meatus or a stricture. 3.6 Catheters for non-touch technique There are currently an increasing number of systems available whereby the catheter can be inserted with the help of an applicator. This prevents the catheter from being touched. There is evidence that using the no-touch technique reduces the risk of UTIs especially in patients with an increased risk of UTIs. The literature, however, indicates that some patients have difficulty handling the applicators, packaging, and slippery surfaces of coated intermittent catheters. These factors should be considered when selecting the most appropriate catheters for each individual. 3.7 Catheterisation Aids There are a variety of aids and devices to enable easier insertion for children with limited dexterity or a physical disability. For example, there are mirrors for girls to obtain a good view of the urethral orifice. Some can be attached to the leg, and some can help to fix the legs in a position that keeps them apart, leaving both hands free to catheterise. It can be difficult, however, to direct the mirror correctly and sometimes for the child to manage the reversed image in a mirror. They are less compact and, therefore, not very convenient to carry. Some of these mirrors also come with a light as an accessory product but these can be relatively expensive and are not usually provided free of charge in the majority of countries. There are special grips or handles available to help hold the catheter. These may be useful if the abdomen is large, the arms are too short, or a firmer grip of the catheter is needed. There are also ‘clothing holders’ to help keep clothes out of the way. In addition to catheters and aids, educational support materials are available in many countries. These include dolls to practice catheterisation, animations, DVDs or apps, often designed by catheter firms. These items contain instructions to catheterise and discussions about children’s experiences with self-catheterisation, kits containing show-and-tell items for holding talks in school and card games, etc.23-25 When transurethral catheterisation is too complicated, the construction of a catheterised stoma in the umbilicus or lower abdomen may be recommended. 3.8 Continence containment products Some children suffer from leakage of urine and/or faces in between catheterisations and may require additional advice on appropriate containment products. There are disposable and washable products available depending on the volume of leakage. The types of products available will vary from country to country. For boys, drainage systems such as sheaths (male external catheter / MEC systems) may also be useful if they are available. It is important to consider the children’s lifestyle, cognitive abilities and independence when selecting the most appropriate aid or product for each individual case. To ensure children and families can make informed choices and get the best available products for their individual needs, it is important that healthcare professionals keep informed of existing and new developments and products that leave the market. They must also consider the financial implications
RkJQdWJsaXNoZXIy NjM1NTk=