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The following article appears in the December 1997 issue of Outspoken and is reprinted here with permission from The Robson Clinic and The Canadian Paraplegic Association of Ontario. A spotlight on the Charles J. Robson Clinic, Lyndhurst Spinal Cord Centre

Intermittent Catheterization - How to Reduce the Risk of Infection

Intermittent catheterization (IC) is one of the best methods of emptying the bladder if you have urinary retention and a low bladder pressure (determined through urodynamic studies). All methods of bladder management however, including indwelling catheter, condom drainage, and IC, can contribute to urinary tract infections. So what can be done to minimize the risk?

Adequate Hydration

One approach of reducing UTI is to drink sufficient amounts of water. This helps to "flush" out lingering bacteria. For individuals that are on IC however, a balance must be found between drinking sufficiently to reduce infections, but not exceeding a volume of 500 ml with each IC, which could cause the urine to back up into the kidneys. Generally, an intake of fluid totaling about 2000 mL to 3000 mL is recommended if you are on IC, and it is best if you can distribute this as evenly as possible throughout the day.
 

Cleanliness ... next to godliness!

Hands should always be washed before and after the IC. The genital area should also be cleansed before insertion of the catheter. Soap and water, or if away from home commercially prepared wet towels (baby wipes) can be used. Make sure that the wet towels that you purchase do not contain alcohol.
 

Reuse & Recycle ...

There are so many cleaning methods for reusing plastic catheters that it is difficult to say which is best. If you are not getting infections, and you are content with your bladder routine, then likely your method is okay! If you are having problems however, here are a few ideas to keep in mind. Studies have shown that rinsing with tap water, is itself a very effective way of reducing surface bacteria on a plastic catheter. In addition to this, it is recommended that a dry catheter be used since moisture can also harbor bacteria. The nursing staff at Lyndhurst Hospital teach their clients before they go home, to use 2 catheters, and alternate them between IC allowing them to dry between use. After each IC, the catheter exterior is washed with soap and water and then rinsed for 5 - 10 seconds under running tap water. Make sure that the water is allowed to run through the catheter. Place the catheter on a clean paper towel and cover with a second clean paper towel. Allow to dry. If you are going out, place the catheter in a clean paper towel in a clean ziplock bag. Catheters must be discarded if they are discolored, or the surface appears damaged. The results from a recent research study conducted through the Robson Clinic, have indicated that a microwave may be used for sterilizing catheters. Currently the data from the study is being analyzed, however it looks like 5 minutes on high may be a good time recommendation. A minimum of 250 mL of cold water (in a deep container) must be placed in the microwave, to act as a "heat sink". To microwave after they have been washed / rinsed as described above, the catheters are placed on a clean paper towel in the oven beside the water.
 

Natural Preventatives

Cranberry capsules. We have had so many individuals comment on how the cranberry capsules have helped them reduce the incidence of infection. Some people have combined the cranberry capsules with garlic pills for a winning success story too! We generally suggest that you start with four cranberry capsules per day (Cranex or CranActin) if you have had recurring problems. Most individuals take 2 in the AM and 2 in the PM. You could try to reduced the number of capsules taken after a month or so. Garlic pills can be taken according to the recommendations on the bottle. These methods don't work for everyone, but they have been helpful for many who have tried it!
 

Investigation

Lastly, if you have been troubled for months with recurring infections, and have not had an investigation in a while, you should have a urodynamic test, renal (kidney) ultrasound, and a cystoscopy to rule out specific causes for the infections.
 

Questions? Comments? Please call the Robson Clinic at 416 597-3422 ext. 6218.
 
 

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