Where do we get info to teach someone how to self cath?

[wen]

Do you have info on self cathing? Suggested caths? How to clean? How to sit if legs are flaccid?

Thanks,
Wendy

[SCI-Nurse]

Wendy, from your name I assume you are female. What is your level of injury?

Generally I suggest learning to cath first in bed, than practice on the toilet and in your chair. Most women who do self cath learn eventually to do it in their chair to avoid a transfer, and also so you can cath someplace where you can't get onto the toilet (the back of a van for example, or a friend's bedroom when visiting a home with an inaccessible bathroom).

Choice of catheters is personal preference. Most females use a plastic catheter. They make 6" female catheters, but unless you are always going to be cathing on the toilet, it is often easier to use the regular 14" ones used by males. Try both before you decide if you can. Get the type of catheters that have a funnel type end so that you can attach a leg bag to empty into when you are not on the toilet. Bard, Mentor, Rochester, Rusch etc. all make such catheters.

Use a mirror only to learn your own anatomy. It is best to learn a "touch, no mirror" technique so you are not dependent upon a mirror.

Here is the actual technique:

Position yourself in bed with pillows behind your shoulders. "Frog" your legs with pillows to support them too. Open your catheter. Either have a urinal handy to drain into, or attach a leg bag to the end of your catheter. Clean your perineum and your hands with a washcloth (or baby wipes). Lubricant is optional for females and not using it makes it easier to control your catheter. Using your non-dominant hand, separate your labia with your index and ring finger. Use your middle finger to feel for your urinary meatus (learn how this feels using the mirror first). Place the tip of your middle finger right on top of the meatus. Using your dominant hand, place the catheter on top of the tip of that middle finger, then slide the middle finger slightly forward (towards your front) and slip the catheter underneath. Insert until you get urine flow (about 2-3 inches).

If you get into your vagina by mistake, leave the catheter in place. Get a new catheter and try again. The catheter in the vagina will guide you were NOT to go. Some people do the same thing deliberately by inserting a q-tip or partially inserting a tampon into th vagina before cathing when they are still learning.

Once you have mastered this in bed, move to doing it on the toilet or your chair. It helps to have your pelvis tilted forward some, so in your chair slide forward and sit on your sacrum. It also helps to elevate one leg. On the toilet you can put one leg up onto your wheelchair or leg rest. In the chair, you can put your foot on the toilet (be careful it does not fall in!) or calf strap if you use one in your chair, or any other conventient place that is steady. When cathing in your chair use the leg bag technique so you have something to empty into.

When you are done cathing, wash your hands and the catheter in warm soapy water, rinse well, and shake off all the water. Place the catheter on a clean dry towel, and fold over to protect it. Do this with your catheters all day, fan-folding the towel. Let all the catheters dry at least 24 hours before reusing. It helps to have a "odd day" and "even day" set, so if you will be cathing 6X daily you need 12 catheters. Replace them as needed if they get cloudy, but you can easily use the same catheter for several months. Do not use chemicals to clean your catheters. Microwaving is possible as well, but not necessary.

When you need to cath away from home, put the cleaned catheter into a new brown paper lunch bag and put it in your wheelchair bag with a couple baby wipes (in a baggie) and your leg bag. After cathing away from home, keep the used catheter in the baggie until you get home and then clean as above.

(KLD)

[chipper]

SCI Nurse, I had all sorts of difficulty learning to cath from bed using the technique you described. I have no idea why, but as soon as my urologist's nurse showed me how to cath over the toilet by feel, I got the hang of everything. It took about 10 minutes maximum for me to able to cath by touch from a sitting position. Maybe I am just weird, but it was a huge difference for me. Yes, I do use the 6 inch catheters, which are easier to carry in my purse, as well as easier to use over the toilet. I thought you'd be interested in a different experience.b

[okeebryant]

SCI nurse--Do you have directions for males on self cathing?

[SCI-Nurse]

okeebryant -- Due to the anatomy of the male it is so much easier to do a self cath as compared to a female. Males can catheterize easily in a chair, in the bed, or sitting on a commode -- any place where you can easily get your trousers or shorts out of the way and have a little privacy.

Just as for the female, the technique you will use will be "clean-hand". This means you will use your bare hands that have been washed well with soap and water and use a reusable catheter that you will also wash well after each catheterization. As KLD mentioned, if you rotate your catheters (the odd day, even day approach) they may last for several weeks or more.

The actual technique involves the following:

1. Obtain all your needed supplies first: 12" catheter that is 12 french or 14 french in size, water soluble lubricant (like KY jelly), a urinal or leg bag to drain it in (unless you can drain it directly into the toilet), clean wash cloths and towels, and paper towels for drying the catheter after cleaning it.

2. First try to urinate on your own if possible.


3. If you are not near a sink for the actual procedure you may want to obtain four washcloths and a towel, two washcloths that are soapy and two that are moistened with water only (or disinfectant cloths or baby wipes if you have no access to a sink at all).

4. Wash your hands well with warm soap and water for at least 15-30 seconds. Rinse and dry them.

5. Wash your penis with soap and water (especially near the opening). Wash off the excess soap and pat it dry.

6. Attach the clean catheter you are going to use to a leg bag if you find difficulty draining it into a toilet or urinal. Lubricate the tip of the catheter well with water soluble jelly.

7. Hold your penis erect.

8. Gently insert the catheter into the penis (urinary meatus), advancing it slowly until the urine begins to flow and then gently advance it approximately 1" further.

9. When the urine begins to stop flowing, you may try to gently crede or push down over the bladder area to squeeze out any excess urine. Check with your MD to make sure this is not contraindicated.

10. Begin to slowly withdraw the catheter until the urine flow stops, pausing at any point when the urine begins to flow until the flow stops. Place the catheter on paper towels while you clean off any excess urine on your penis or surrounding areas.

Note: Store the catheter in a zip lock bag if you are not able to clean it right away -- folding it over in a paper towel to absorb any excess urine is a good idea until you can clean it properly.

11. As soon as you can, rinse and then wash your catheter with warm soapy water. Rinse again. Drain the water from the catheter and pat it dry with clean paper towels. After it is dried, store it inside a clean paper bag or another zip lock bag. It will be important to make sure all of the moisture on the catheter is absorbed before putting it into a zip lock bag so as not to harbor more organisms.

12. Catheters should be discarded if they become rough, hard, or damaged. Some folks will reuse the same catheter over a 7 day period. Others will rotate catheters to make them last longer. Most insurance companies will only cover 4 catheters a month at home so you will have to find out what cleaning system works best for you.

PLG

[1heart4u]

Originally Posted by SCI-Nurse

Wendy, from your name I assume you are female. What is your level of injury?

Generally I suggest learning to cath first in bed, than practice on the toilet and in your chair. Most women who do self cath learn eventually to do it in their chair to avoid a transfer, and also so you can cath someplace where you can't get onto the toilet (the back of a van for example, or a friend's bedroom when visiting a home with an inaccessible bathroom).

Choice of catheters is personal preference. Most females use a plastic catheter. They make 6" female catheters, but unless you are always going to be cathing on the toilet, it is often easier to use the regular 14" ones used by males. Try both before you decide if you can. Get the type of catheters that have a funnel type end so that you can attach a leg bag to empty into when you are not on the toilet. Bard, Mentor, Rochester, Rusch etc. all make such catheters.

Use a mirror only to learn your own anatomy. It is best to learn a "touch, no mirror" technique so you are not dependent upon a mirror.

Here is the actual technique:

Position yourself in bed with pillows behind your shoulders. "Frog" your legs with pillows to support them too. Open your catheter. Either have a urinal handy to drain into, or attach a leg bag to the end of your catheter. Clean your perineum and your hands with a washcloth (or baby wipes). Lubricant is optional for females and not using it makes it easier to control your catheter. Using your non-dominant hand, separate your labia with your index and ring finger. Use your middle finger to feel for your urinary meatus (learn how this feels using the mirror first). Place the tip of your middle finger right on top of the meatus. Using your dominant hand, place the catheter on top of the tip of that middle finger, then slide the middle finger slightly forward (towards your front) and slip the catheter underneath. Insert until you get urine flow (about 2-3 inches).

If you get into your vagina by mistake, leave the catheter in place. Get a new catheter and try again. The catheter in the vagina will guide you were NOT to go. Some people do the same thing deliberately by inserting a q-tip or partially inserting a tampon into th vagina before cathing when they are still learning.

Once you have mastered this in bed, move to doing it on the toilet or your chair. It helps to have your pelvis tilted forward some, so in your chair slide forward and sit on your sacrum. It also helps to elevate one leg. On the toilet you can put one leg up onto your wheelchair or leg rest. In the chair, you can put your foot on the toilet (be careful it does not fall in!) or calf strap if you use one in your chair, or any other conventient place that is steady. When cathing in your chair use the leg bag technique so you have something to empty into.

When you are done cathing, wash your hands and the catheter in warm soapy water, rinse well, and shake off all the water. Place the catheter on a clean dry towel, and fold over to protect it. Do this with your catheters all day, fan-folding the towel. Let all the catheters dry at least 24 hours before reusing. It helps to have a "odd day" and "even day" set, so if you will be cathing 6X daily you need 12 catheters. Replace them as needed if they get cloudy, but you can easily use the same catheter for several months. Do not use chemicals to clean your catheters. Microwaving is possible as well, but not necessary.

When you need to cath away from home, put the cleaned catheter into a new brown paper lunch bag and put it in your wheelchair bag with a couple baby wipes (in a baggie) and your leg bag. After cathing away from home, keep the used catheter in the baggie until you get home and then clean as above.

(KLD)

There is no mention of knee spreaders, with mirrors. I am T10 complete. I have spasms in my legs. My knees lock together. It is difficult to get them apart. The inside of my knees are almost always bruised trying to get the knee spreader between them. Any suggestions on how to get my legs apart, aside from taking baclofen or something else?
Thank you
K

[adi chicago]

paras cannot cath?what can i do as a quad [my fingers are dead].
try harder and you will do it .i cannot yet ...i am not lazy ...simply i cannot.

[SCI-Nurse]

1heart, wow, this is a really old post.

As you note, we do not teach a mirror technique, other than to learn your landmarks. We don't use knee spreaders either, as anything that touches the inside of your thighs is just likely to trigger more adductor spasm. A touch technique is much more functional and you can use it in bed or in your chair. If your adductor spasms are that bad, I really recommend considering taking antispasticity meds. Spasticity that interferes with function or hygiene is noxious spasticty that needs treatment. Have you considered discussing Botox with your physician?

Adi, if you have any tenodesis, you should be able to cath with practice. Do you have an OT you can work with to learn how to use this? For those with tetraplegia, I recommend a somewhat stiffer catheter such as one made of PVC, and of course clean technique.

(KLD)

[sjean423]

1heart,

I was given one of those mirrors in rehab, but just use the plastic plart to balance the mirror. (Was only given it for that.)

I had spasms similar to yours, and cathing was the main reason I treat them. On note that might be helpful, I found when the spasms/tone were the worst, wearing sneakers helped me keep my feet in the frogged position. Barefoot, they would just straighten out, and clamp together.