View Poll Results: Do you use clean or sterile intermittent catheterization? I use

Voters
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  • Clean intermittent catheterization (new catheter)

    28 35.90%
  • Clean intermiettent catheterization (re-use silicone coat)

    16 20.51%
  • Clean intermittent catheterization (re-use hydrophilic coat)

    0 0%
  • Clean intermittent cathetherization (other type)

    2 2.56%
  • Sterile intermittent catheterization (hydrophilic coat)

    11 14.10%
  • Sterile intermittent catheterization (silicone coat)

    2 2.56%
  • Sterile intermittent cathetherization (other)

    6 7.69%
  • Indwelling urethral catheter (foley)

    5 6.41%
  • Indwelling suprapubic catheter (foley)

    4 5.13%
  • Mitrafanoff or other catheterization method

    2 2.56%
  • I don't use urinary catheters.

    2 2.56%
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Thread: Intermittent Catheterization: Clean versus Sterile?

  1. #21
    Quote Originally Posted by leschinsky
    Because that's where the nasty germs are. Santa Clara Valley Medical Center -one of the 13 Model Systems in the US- taught me CIC for the home, and thank god cause otherwise I'd be broke and the landfills would be much worse. I've been using CIC for almost 25 years now (actually my silver anniversity is today, yoohoo) using 8 caths a month and I have only had a handfull of UTI's, never pass blood, and never have insertion problems, there is no reason for me to switch to sterile.

    "They studied patients who had used disposable catheters with hydrogel coating. Although the number of infections seem quite high to me, the authors concluded that patients who used hydrophilic low friction catheters do as well or better than patients using conventional catheters with chlorhexidine jelly."

    Wholly molely Wise, I just saw the hydrophillic caths cost almost 10 times the amount of the Mentor siliconized ones I buy and use surigilube with. It doesn't sound like it's worth it for me to switch.
    Hi Leschinsky,

    I use a single Mentor siliconized catheter for 2-3 months so I got you beat by a long shot! You're SO wasteful. But my cathing procedure isn't condoned by the Nurses here so I guess I'm cheating.

    There are different brands and types of hydrophilic catheters and many different e-stores to buy them from so the prices vary. Some are packaged in sterile water (or whatever) so the hydrophilic agent doesn't need to be moistened prior to use.

    I used the Allegro Medical e-store since they're recommended by the Nurses here and tried to match up the Mentor siliconized catheters as fairly as I could with the Mentor hydrophilic catheters. The cheapest Mentor hydrophilic catheters need water added to them in order to activate the hydrophilic agent. Using this type of hydrophilic catheter they only cost 2.38 times more than its siliconized catheter counterpart. I imagine that you'd need to buy sterile water to go along with the "dry" hydrophilic catheters to prepare them for insertion so add some money there. That seems like a PITA to do plus you need a prescription from a doctor to buy sterile water. You can buy all the sterile aerosol saline solution that you want without a prescription but not so with plain ol' sterilized water. WT(F) heck?

    If we buy the pre-moistened hydrophilic catheter "kits" then we're talking 7.53 times more than our regular ol' dry Mentor siliconized catheters. If we buy the "similar" pre-moistened (lubricated) siliconized catheter kits they are 6.25 times more than the regular dry siliconized catheters that we use. Don't forget to add a few cents for a dab of Surgilube!

    Below are all 14Fr., 16 inches long.

    Mentor Self-Cath Straight Tipped -
    Box of 50 = $39.99
    $.78 each.

    Mentor Self-Cath Plus Hydrophilic Catheter
    Box of 30 = $55.95
    $1.86 each.

    Mentor Self-Cath Closed System Kit - Box of 50 = $244 $4.88 each.

    Mentor Self-Cath Hydrogel Kit
    Box of 50 = $294.00
    $5.88 each.

    The kits are very convenient to use especially when away from home and from a clean cathing environment but as is the case, the convenience comes dear, my dear. If used on a regular basis, say 6 hydrophilic caths a day at $5.88 a pop, that's $12,700 a year... just to pee. The mere concept seems so outrageous to me.

    If the Nevadian opposition to the Department of Energy's "Yucca Mountain Repository" for spent nuclear reactor fuel and other radioactive waste gets its way, maybe it can be used for storing all the waste material from the single-use catheters, catheter kits and packaging.



    North Portal of the Yucca Mountain Repository.

    You'd think I'd have something better to do with my time than this... but sadly, I don't.

    Bob.
    "Be kind, for everyone you meet is fighting a great battle." - Philo of Alexandria

  2. #22
    Quote Originally Posted by chak
    Dr. Young,

    Can you comment about nelaton catheter? Can it be use safely for intermittent cath? What are its negative effects? Thanks

    Chak
    chak,

    As far as I can tell, a Nelation catheter is made in China (brand name TRIUP) and is made of PVC (Source). PVC or polyvinylchloride is a kind of plastic. I don't think that it is a coated catheter, i.e. having a low-friction hydrophilic coating. If it is used with lubricant, that usually means that it does not have a hydrophilic coating. I haven't seen the pricing but I assume that Nelation catheters are inexpensive.

    For a long time, the suitability of PVC as a long-term catheter material was questioned because PVC contains potentially toxic plasticizers and because PCV does not undergo biodegradation in the environment. For intermittent use, however, I am not sure that the plasticizers would be that important. There are an awful lot of PVC being thrown away and it is a matter of making sure that it is thrown out in the proper recycle bins where the PVC would be properly dealt with.

    As I had pointed out, it is important that the tip be rounded and not present any sharp edges. If the catheter does not have a low-friction surface, it must be used with lubricants and is more likely to damage and irritate your urethra. I have not done a detailed comparison of catheters.

    Wise.

  3. #23

    Thanks Bob

    Thank you for the accurate info. Some people just throw numbers out that are not accurate. They do this so many times they start to beleive it. I think if you post hear especially a moderator you should verify your facts. Thanks agin Bob for correcting the info. There is a big difference between 10 and 2.3 times.

    SW

  4. #24

    Polished Eyes

    Wise Young is correct especially with the eyes of the catheter. If the eyes are not polihed(this is the manufacturing term, the eyes are really put under high temperatures from a special machine. The term polished came because some of the early catheters were made of glass and the eyes were too sharp. I would of hated to use those catheters. ) Unpolished eyes cause a lot of trauma. Mentor was the first to use this procedure.I would check the brand you use.Even lubrication does not overcome sharp eyes.

    SW

  5. #25
    Quote Originally Posted by Steve Winter
    If sterile is better in the hospital are you admitting that sterile is better than reusing? If so why would you not use the safer technique outside as well? There are just as bad of bugs outside the hospital as inside. Just call the CDC.

    SW
    Steve,

    Sterile is advised in the hospital settings for two reasons. First, there are the personnel there who can carry out sterile procedures properly. If you don't have trained personnel and try to do a "sterile procedure" yourself at home, the procedure is often not sterile, particularly for women. Second, bacteria in hospital are much nastier than those at home. As much as 70% of bacteria in some hospitals may be MRSA, for example. Therefore, sterile procedures are advisable in hospital.

    On the other hand, for the home setting, clean intermittent catheterization has been shown in numerous studies to be produce as few or fewer urinary tract infections than sterile intermittent catheterization. Now, regarding re-use of the catheters, I just have not seen any convincing data. I agree that it is probably not a good idea to re-use hydrophilic coated catheters unless it is clear that their coatings are certified to last and continue to be low-friction for repeated use. On the other hand, silicone-coated catheters (as some of the studies that I have cited) will remain relatively low-friction with re-use, although I am not certain how many times.

    In general, I think that the principles that you espouse are good. People should use the smoothest and least traumatic catheters. The procedure should be as clean or sterile as possible. I also agree with you that hydrogel coated catheters are not designed for reuse and should not be re-used. However, I don't think that the data and risk analyses currently supports regulatory prohibition of all catheter re-use and the requirement of sterile intermittent catheterization for all individuals.

    Wise.

  6. #26
    Quote Originally Posted by Steve Winter
    Thank you for the accurate info. Some people just throw numbers out that are not accurate. They do this so many times they start to beleive it. I think if you post hear especially a moderator you should verify your facts. Thanks agin Bob for correcting the info. There is a big difference between 10 and 2.3 times.

    SW
    Steve,

    Please stow the attacks. Thanks.

    Wise.

  7. #27
    In the posts that I have made so far, I have not discussed silver and antibiotic (nitrofurantoin) coated catheters. Silver is toxic to bacteria and was regarded to be very promising. However, several prospective randomized trials have not shown that silver-coated catheters significantly reduce urinary tract infections and cost savings are modest. The abstract of one such study is listed blow.

    Use of silver-hydrogel urinary catheters on the incidence of catheter-associated urinary tract infections in hospitalized patients.

    Major Articles
    AJIC: American Journal of Infection Control. 30(4):221-225, June 2002.
    Lai, Kwan Kew DMD, MD a; Fontecchio, Sally A. RN, BSN, CIC b

    Abstract:
    Background: Urinary tract infections (UTIs) account for 40% of all nosocomial infections, and about 80% of these are associated with the use of urinary catheters. They not only contribute to excess morbidity and mortality, but they also significantly add to the cost of hospitalization. Clinical trials with silver-coated urinary catheters have shown conflicting results. However, recent trials with silver-hydrogel urinary catheters have shown a reduction in nosocomial UTIs, and these catheters appear to offer cost savings.

    Method: The University of Massachusetts Medical Center is a teaching, tertiary hospital with 18% of its beds in intensive care units. The silver-hydrogel urinary catheters were introduced in October 1997. The rate of catheter-associated UTIs with silver-hydrogel urinary catheter use was compared with a historical baseline UTI rate that was established for January 1996 and January 1997 with the standard, noncoated catheters. The cost of a nosocomial catheter-associated UTI was estimated by calculating the hospital charges resulting from all urinary catheter-associated UTIs in 1 month. A cost-analysis of silver-hydrogel urinary catheter use was performed.

    Results: The rate of catheter-associated UTIs for noncoated catheters was 4.9/1000 patient-days compared with 2.7/1000 patient-days for the silver-hydrogel catheters, a reduction of 45% (P = .1). The average cost (calculated with hospital charges) of a catheter-associated UTI at our institution was estimated to be $1214.42, with a median of $613.72. The estimated cost-saving ranged from $12,563.52 to $142,314.72.

    Conclusions: The use of silver-hydrogel urinary catheters resulted in a nonsignificant reduction in catheter-associated UTIs and a modest cost-saving. (Am J Infect Control 2002;30:221-5.)

    Copyright (C) 2002 by the Association for Professionals in Infection Control and Epidemiology, Inc.
    Nitrofurantoin-coated catheters show greater activity than the silver-coated catheter against multi-drug resistant bacteria (see attached study). Note that indwelling catheters even for short times should always be done sterilely. Several studies suggest that the presence of any meatal bacteria usually will lead to symptomatic urinary tract infections within a few days when indwelling systems are considered (Source).

  8. #28

    Sterile is easier than clean

    I, and thousands of patients perform sterile cathing everyday .It is easy .Why are people saying it needs to be in the hospital with a healthcare professional. The closed systems which are sterile can be done in cars, planes etc.I can teach someone to do it in 5 minutes. Also can you name the EXACT studies you are referring to that show reuse has less infections and could you give me the EXACT cleaning instructions that they reccomend. If someone makes a statement that is completely false why can't we challenge it? Thank you for the time you are putting into this topic.

    SW

  9. #29
    Senior Member Scorpion's Avatar
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    Quote Originally Posted by Steve Winter
    I, and thousands of patients perform sterile cathing everyday .It is easy .Why are people saying it needs to be in the hospital with a healthcare professional. The closed systems which are sterile can be done in cars, planes etc.I can teach someone to do it in 5 minutes. Also can you name the EXACT studies you are referring to that show reuse has less infections and could you give me the EXACT cleaning instructions that they reccomend. If someone makes a statement that is completely false why can't we challenge it? Thank you for the time you are putting into this topic.

    SW
    Steve, the studies are posted or at least linked in other threads here on CC already. Instead of demanding stuff, you might try doing a quick search of the site to find the answers you want.

    Clean cathing works fine for many, many people. If you think you need to do sterile cathing, then do it. No need try to disprove the effectiveness of clean cathing for others in order to justify sterile cathing for yourself.
    Last edited by Scorpion; 10-25-2007 at 03:19 PM.

  10. #30
    Quote Originally Posted by Steve Winter
    I, and thousands of patients perform sterile cathing everyday .It is easy .Why are people saying it needs to be in the hospital with a healthcare professional. The closed systems which are sterile can be done in cars, planes etc.I can teach someone to do it in 5 minutes. Also can you name the EXACT studies you are referring to that show reuse has less infections and could you give me the EXACT cleaning instructions that they reccomend. If someone makes a statement that is completely false why can't we challenge it? Thank you for the time you are putting into this topic.

    SW
    You can disagree with what people say but not attack anybody on these forums. You started here by attacking people and you are getting into the same attack mode. Moderators are members like any and everybody else. If you expect to be treated respectfully, you must treat others respectfully. Implying that moderators cannot be trusted is not the way to do it.

    Regarding clean versus sterile, I have posted many references that came to the conclusion that CIC does not significantly increase the risk of UTI compared to SIC. I even included the abstracts of the references so that people can look them up. Is there a specific study that you have a problem with? How about citing some papers that support what you say?

    Wise.

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