Maintenance of the devices  

Safety issue on the reused catheter

  • Catheters for CIC can be reused.
    • Silicone cathether:
      • Safe [Kovindha 2004]
      • Clinical outcome, especially with regard to urethral abnormalities with this reusable silicone catheter is as good as with a disposable one. [Kovindha 2004]
    • Plastic catheter: may be reused [Bogaert 2004]
  • Increasing risk of UTI if reused?
    • Increasing risk of UTI should be considered [Kovindha 2004]
    • Not related to an increased likelihood of UTI

How long can a reusable catheter be used?

  • Further research should be conducted to determine how long is safe for use [Kovindha 2004]
  • In Japan it is commonly reused for only 2 weeks [Madersbacher 2002]
  • A silicone Japanese type self-catheter has proved to be reusable for a long time [Kovindha 2000]
  • When resources are limited, catheters are re-used for up to weeks and months.
  • SCI persons should be encouraged to forcefully rinse the catheter lumen with high-speed tap water to minimize encrustation

Disinfection techniques

  • To minimize the amount of bacteria introduced into the bladder the technique of cleaning or sterilizing must be safe, convenient and affordable [Sherbondy 2002]
  • Washing: Rinsing and drying catheters immediately after use was the most effective at reducing bacteria to very near zero [Lavallee 1995]
    • Tap water alone
    • Soap and water
    • Dishwashing detergent
  • Soaking it in an antiseptic solution:
    • Sodium hypochlorite
    • Bleach in a 1:4 solution with tap water [Kurtz 1995]
    • Hydrogen peroxide 0.6% [Kurtz 1995]
    • Betadine in a 1:2 solution with tap water [Kurtz 1995]
    • Benzethonium chloride (0.02-0.05%) with sterile glycerine in solution.
    • Chlorhexidine or iodine contained disinfectant:
      • Not recommended as they may damage the silicon catheter tip
    • Savlon solution (chlorhexidine 1.5% and cetrimide 15%) [Moore 1990]
      • With a concentration of 1:100
      • Change twice a week
      • No reports of the catheter tip damage
    • Alcohol 70% solution in a resealable plastic bag (Ziploc): catheters are immerged [Bogaert 2004]
  • Resterilization
  • Boiling:
    • may help but may cause more stiffness [Kovindha 2004]
  • Home microwave:
    • To re-sterilize rubber catheters [Silbar 1980]
    • Possibility of catheter melting during microwaving [Sherbondy 2002]
    • Variability in the power setting and duration of microwaving [Sherbondy 2002]
Key Points of This Section
  • The basic tenant of CIC is do it often enough to keep your bladder volume below 400mls, or a safe volume determined by urodynamics.
  • Data on catheter sterilization has not been linked to outcome.
  • Patients vary in acceptance of the CIC technique and we use whatever method will make the patient comfortable with the method.
  • We do not provide written prescriptions for sterile catheters to be used once to patients feeling that this is not an absolute requirement.

References

  • Bogaert GA, Goeman L, de Ridder D, Wevers M, Ivens J, Schuermans A. The physical and antimicrobial effects of microwave heating and alcohol immersion on catheters that are reused for clean intermittent catheterisation. Eur Urol. 2004 Nov;46(5):641-6.
  • Kovindha A, Mai WN, Madersbacher H. Reused silicone catheter for clean intermittent catheterization (CIC): is it safe for spinal cord-injured (SCI) men? Spinal Cord. 2004 Nov;42(11):638-42.
  • Kovindha A, Na W, Madersbacher H. Radiological abnormalities in spinal cord injured men using clean intermittent catheterization with a re-usable silicone catheter in developing country. Poster 86 presented during the Annual Scientific meeting of IMSOP Sydney. 2000; Abstract book. p. 112.
  • Kurtz MJ, Van Zandt K, Burns JL. Comparison study of home catheter cleaning methods. Rehabil Nurs. 1995 Jul-Aug;20(4):212-4, 217.
  • Lavallee DJ, Lapierre NM, Henwood PK, Pivik JR, Best M, Springthorpe VS, Sattar SA. Catheter cleaning for re-use in intermittent catheterization: new light on an old problem. SCI Nurs. 1995 Mar;12(1):10-2.
  • Madersbacher H, Wyndaele JJ, Igawa Y, Vhancellor MB, Chartier-Kastler E, Kovindah A. Conservative management in the neuropathic patient. In: Abrams P, Khoury S, Wein A (eds) In: Abrams P, Cardozo L, Khoury S, Wein A. (editors) Incontinence. 2nd International Consultation on Incontinence, Health Publication Ltd. Paris, 2002;697-754.
  • Moore KN. Two methods for cleaning catheters used for intermittent catheterization: Sunlight® liquid detergent and cetrimide 1:30 (Savlon®). Can J Rehabil, 1990;4:87.
  • Sherbondy AL, Cooper CS, Kalinowski SE, Boyt MA, Hawtrey CE. Variability in catheter microwave sterilization techniques in a single clinic population. J Urol. 2002 Aug;168(2):562-4.
  • Silbar E, Cicmanec J, Burke B, Bracken RB. Microwave sterilization. Method for home sterilization of urinary catheter. J Urol 1980; 141: 88-90.

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