Important Matters Requiring Special Attention for Intermittent Catheterization

Intermittent Catheterization — Clinical Practice Guidelines

Intermittent catheterization refers to a technique in which a urinary catheter is inserted only as needed to empty the bladder, and is removed immediately after voiding is complete — the catheter is not left indwelling. This approach allows the bladder to expand and contract intermittently, which helps preserve bladder capacity and promote recovery of detrusor contractility. Intermittent catheterization is recommended by the International Continence Society (ICS) as the first-line method for managing neurogenic bladder dysfunction. Several important precautions must be observed during its application, as outlined below.

Timing of Catheterization

Catheterization should be performed on a scheduled basis. Patients should NOT wait until they experience urgency or discomfort before emptying the bladder.

Managing Resistance During Insertion

If resistance is encountered during catheterization, pause for 5–10 seconds and withdraw the catheter by approximately 3 cm, then re-advance slowly.

Managing Resistance During Withdrawal

If resistance is encountered upon catheter removal, it may be caused by urethral spasm. In such cases, wait 5–10 minutes before attempting withdrawal again.

Special Considerations for Female Patients

Vaginal packing may interfere with catheter insertion. Female patients should remove vaginal packing before catheterization. If the catheter is inadvertently inserted into the vagina during an attempt, discard the used catheter and use a new one to continue the procedure.

Insertion Technique — Gentle Manipulation

Catheter insertion should be performed with gentle, controlled movements, particularly in male patients. Special attention must be paid when the catheter passes through the following anatomical narrowing points: the external urethral meatus, the subpubic region, the inferior curvature of the urethra, and the internal urethral orifice. Instruct the patient to breathe slowly and deeply during these moments. Insert the catheter slowly and steadily — avoid rapid or forceful insertion, as this may cause urethral mucosal injury.

Maintaining Catheter Position Until Complete Emptying

Once catheterization is successful, the catheter should be left in place until urine flow has completely ceased. Do not remove the catheter immediately. During slow catheter withdrawal, gently rotate the catheter while instructing the patient to hold their breath and gently increase abdominal pressure (Valsalva maneuver). This ensures complete bladder emptying with no post-void residual urine.

Indications for Prompt Referral to a Medical Professional

The following clinical signs and symptoms require immediate consultation with a qualified medical professional:

① Hematuria (blood in urine)

② Failure to insert or withdraw the catheter

③ Significant worsening of pain or discomfort during catheter insertion

④ Signs of urinary tract infection or dysuria (painful urination)

⑤ Cloudy urine, presence of sediment or debris, or malodorous urine

⑥ Lower abdominal or back pain, or a burning sensation

Prerequisites for Intermittent Catheterization

Three key prerequisites must be met before intermittent catheterization can be safely performed:

① Adequate bladder capacity

② Low intravesical pressure (bladder pressure should remain below 40 cmH₂O)

③ Sufficient urethral resistance to maintain continence

Pre-Procedure Patient Education: Fluid Intake Management

Regardless of whether sterile or clean intermittent catheterization is used, patients should be instructed on planned fluid intake 1–2 days before beginning the catheterization regimen. Fluid intake should be distributed evenly throughout the day. Total daily fluid intake should be controlled at approximately 1,500–2,000 mL per 24 hours.

Reference Water Intake Schedule

Breakfast: 200–250 mL of water, fluids, or porridge

Between breakfast and lunch: 200–250 mL of water or fluids

Lunch: 200–250 mL of water, fluids, or porridge

Between lunch and dinner: 200–250 mL of water or fluids

Dinner: 200–250 mL of water, fluids, or porridge (if fruit or soup is consumed, reduce water intake accordingly)

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