12 Chapter 3 Materials Catheters Catheters for intermittent catheterisation are available in various diameter sizes (Charrières) and lengths. They can have a variety of lubrication and/or coatings. There are also a variety of shaped tips that may come with or without integral drainage bags. Catheters can be specially designed for men, women, or children. For intermittent use, single-use catheters and reusable catheters are available. Types of catheters may vary from country to country depending on local practice, availability and economics. Single-use catheters are often made of polyvinyl chloride (PVC) and are packed in sterile and single packs.17 They are usually discarded after use. There is an increasing demand for PVC-free materials in medical devices. The phthalate components in PVC can be harmful to the human body (REACH/EU chemical regulation). More and more phthalate-free alternatives are available (the information can be found on suppliers’ websites). Intermittent catheters have no balloons and are generally somewhat stiffer than indwelling catheters. When choosing which catheter to use, the following factors should be considered: medical safety, preference of patient/healthcare professional, physical disabilities and/or cognitive limitations, ease of use, and possible need for urine collection. In children, the length and Charrière size will depend partly on the child’s age. Still, more importantly, the catheter should be long enough and large enough to provide easy, quick, and complete bladder-emptying without damaging the urethra.18 Effective intermittent catheterisation is the result of compliance with both technique and frequency. It is, therefore, important that the patient is guided in selecting the best product. Sometimes, it may be necessary to try a few different catheter types and systems. 19 3.1 Types of Catheters Some single-use catheters require the addition of sterile lubricant. These lubricants are available with or without a local anaesthetic (lignocaine/lidocaine) and with or without chlorhexidine (antiseptic). These catheters may be reused in certain circumstances, but this should only be in agreement with the child’s clinician. Only catheters without a coating should be used in this instance, as coatings may cause catheters to stick as they dry out and cause trauma. There are also single-use catheters that contain gel either contained around the catheter or in a separate pack, which requires activation to provide lubrication. In addition, there are catheters with a hydrophilic coating (liquid) within the catheter or in a package, which again requires activation or filling with tap water. ‘Compact’ catheters are so-called because the packaging is small and discreet. Some types of catheters mentioned above are also available as catheter sets, consisting of a catheter with an integrated drainage bag. These sets can be useful for wheelchair users or if the toilet facilities are limited or unhygienic. They are designed for a ‘no-touch’ technique. Opening these catheter systems requires a certain level of hand function and manual dexterity, and they are also more expensive. They are a valuable additional aid but should be used only if indicated. Finally, there are catheters with Luer Lock connectors that allow the administration of medication. Some female patients prefer to catheterise with a non-disposable metal catheter that can be used for years with daily cleaning.
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