Page 5 - CUAJ February 2019: Clean intermittent catheterization: Single use vs. reuse

Saadat et al

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may be preferable to standard UC catheters; nevertheless, ity to accommodate the usage technique. Single-use UC
as of April 2008, both Medicare and Medicaid fully reim- catheters, and finally reuse of catheters are considered as
burse for single-use catheters, in the U.S. in quantities that next options if HC catheters are found difficult to handle
allow for use of a new catheter several times per day. This is (especially in children doing self-catheterization).
consistent with the results of many health-economic studies
indicating the cost-effectiveness and improved QoL associ- Competing interests: Dr. Elterman has been an advisor and speaker for and has received funding
ated with single-use catheters. 30-33 from Allergan, Astellas, Boston Scientific, Ferring, Medtronic, and Pfizer; he has also participated in
The European Association of Urology (EAU) recommends BPH clinical trials supported by Astellas and Medtronic. The remaining authors report no competing
aseptic IC for patients with NB. Their definition of aseptic personal or financial interest related to this work.
IC refers to genital disinfection and using sterile catheters,
1
instruments, and gloves. Given the difficulty of completely
sterilizing catheters at home, and considering the challenge This paper has been peer-reviewed.
of keeping the sterility with reusable catheters, specifically
for neurologically impaired patients, single-use catheters
remain the only realistic option. References
The Society of Urologic Nurses and Associates (SUNA)
specifically recommends that a new catheter be used for each 1. Blok B, Pannek J, Castro-Diaz D, et al. EAU guidelines on neuro-urology, 2017. Available at:
35
catheterization. The European Association of Urology Nurses https://uroweb.org/wp-content/uploads/15-Neuro-Urology_2017_web.pdf. Accessed Jan. 28, 2018.
(EAUN) states that the gold standard remains a single-use ster- 2. Lapides J, Diokno AC, Silber SJ, et al. Clean, intermittent self-catheterization in the treatment of urinary
tract disease. J Urol 1972;107:458-61. https://doi.org/10.1016/S0022-5347(17)61055-3
ile catheter and highlights concerns about the cleaning effi- 3. Hakansson MA. Reuse vs. single-use catheters for intermittent catheterization: What is safe and preferred?
cacy and compliance associated with multiple-use catheters. 36 Review of current status. Spinal Cord 2014;52:511-6. https://doi.org/10.1038/sc.2014.79
The current Canadian Urological Association (CUA) 4. Averch TD, Stoffel J, Goldman HB, et al. AUA white paper on catheter associated urinary tract
recommendations for male and female CIC are to use a infections: Definitions and significance in the urological patient. Urol Pract 2015;2:321-8.
https://doi.org/10.1016/j.urpr.2015.01.005
catheter for a week or until physical damage is noticed. 5. Vapnek JM, Maynard FM, Kim J. A prospective randomized trial of the lofric hydrophilic-coated cath-
The wording specifically used for female CIC specifies that eter vs. conventional plastic catheter for clean intermittent catheterization. J Urol 2003;169:994-8.
“a catheter can be reused and cleaned for about a week https://doi.org/10.1097/01.ju.0000051160.72187.e9
or so.” This language is vague and leaves much to patient 6. Stensballe J, Looms D, Nielsen PN, et al. Hydrophilic-coated catheters for intermittent catheterization
interpretation, the result of which can be unsafe practices. reduce urethral micro-trauma: A prospective, randomized, participant-blinded, crossover study of three dif-
ferent types of catheters. Eur Urol 2005;48:978-83. https://doi.org/10.1016/j.eururo.2005.07.009
The recommended CUA cleaning protocol is to clean the 7. Cardenas DD, Hoffman JM. Hydrophilic catheters vs. non-coated catheters for reducing the incidence
catheter immediately after use with hand or dish soap and of urinary tract infections: A randomized controlled trial. Arch Phys Med Rehabil 2009;90:1668-71.
air dry. 37,38 The CUA stands out with recommendations that https://doi.org/10.1016/j.apmr.2009.04.010
specifically support the multiple use of intermittent catheters 8. Cardenas DD, Moore KN, Dannels-Mcclure A, et al. Intermittent catheterization with a hydrophilic-coated
in direct contradiction with what is supported by other North catheter delays urinary tract infections in acute spinal cord injury: A prospective, randomized, multicentre
trial. PM R 2011;3:408-17. https://doi.org/10.1016/j.pmrj.2011.01.001
American and European organizations. The recommenda- 9. Woodbury MG, Hayes KC, Askes HK. Intermittent catheterization practices following spinal cord injury: A
tion for reuse of single-use catheters also contravenes the national survey. Can J Urol 2008;15:4065-71.
Health Canada labelling for single use of these catheters. 10. Ercole FF, Macieira TG, Wenceslau LC, et al. Integrative review: Evidences on the practice of
Considering the emergence of new evidence supporting intermittent/indwelling urinary catheterization. Rev Lat Am Enfermagem 2013;21:459-68.
single-use catheters, the CUA stands alone with the position https://doi.org/10.1590/S0104-11692013000100023
on multiple catheter use. 11. Wyndaele JJ, Brauner A, Geerlings SE, et al. Clean intermittent catheterization and urinary tract infection:
Review and guide for future research. BJU Int 2012;110:E910-7. https://doi.org/10.1111/j.1464-
410X.2012.11549.x
Conclusion 12. Bermingham SL, Hodgkinson S, Wright S, et al. Intermittent self-catheterization with hydrophilic, gel reser-
voir, and non-coated catheters: A systematic review and cost effectiveness analysis. BMJ 2013;346:e8639.
Reuse of catheters exposes the patient to a plethora of pos- 13. Prieto J, Murphy CL, Moore KN, et al. Intermittent catheterization for long-term bladder management.
Cochrane Database Syst Rev 2014:CD006008. https://doi.org/10.1002/14651858.CD006008.pub3
sible cleaning techniques and duration of catheter use. 14. Prieto J, Murphy CL, Moore KN, et al. Withdrawn: Intermittent catheterization for long-term bladder
Patient adherence to cleaning method cannot be predicted management. Cochrane Database Syst Rev 2017;8:CD006008.
and this further amplifies the risk of complications and 15. Christison K, Walter M, Wyndaele JJM, et al. Intermittent catheterization: The devil is in the details. J
their burden on the healthcare system. Given the benefits Neurotrauma 2018;35:985-9. https://doi.org/10.1089/neu.2017.5413
of single-use catheters and all the uncertainties with reuse, 16. Hooton TM, Bradley SF, Cardenas DD, et al. Diagnosis, prevention, and treatment of catheter-associated
we believe that repeated use of catheters should not be the urinary tract infection in adults: 2009 international clinical practice guidelines from the Infectious Diseases
Society of America. Clin Infect Dis 2010;50:625-63. https://doi.org/10.1086/650482
preferred method for long-term bladder management. 17. Kanaheswari Y, Kavitha R, Rizal AM. Urinary tract infection and bacteriuria in children per -
Until more data becomes available, we recommend a forming clean intermittent catheterization with reused catheters. Spinal Cord 2015;53:209-12.
patient-centred approach to consider HC catheters as the https://doi.org/10.1038/sc.2014.210
first option, while considering the patient’s/caregiver’s abil- 18. Krassioukov A, Cragg JJ, West C, et al. The good, the bad, and the ugly of catheterization practices among
elite athletes with spinal cord injury: A global perspective. Spinal Cord 2015;53:78-82.

68 CUAJ • February 2019 • Volume 13, Issue 2