Clean intermittent self-catheterisation: teaching technique, schedule and warning signs

Why clean technique is used at home

People with nerve damage, spinal cord injury or other causes of incomplete emptying may need to drain the bladder themselves. Intermittent self-catheterisation is generally preferred over a long-term indwelling catheter, which carries a high risk of recurrent urinary infection. Regular complete emptying also protects the kidneys and reduces overflow leakage.

At home the technique is clean rather than sterile: thorough handwashing, cleaning the urinary opening, and a clean catheter. Gloves are optional. Hospital insertion of an indwelling catheter follows sterile technique, so an exam option that insists on sterile gloves for home self-catheterisation confuses the two settings. The aim is to reduce the number of bacteria introduced, which is achievable with simple routines that fit everyday life.

Teach the critical steps where errors happen

The person gathers supplies, washes hands with soap and water, and cleans the urinary opening; women wipe front to back, and men retract the foreskin if present and clean the tip of the penis. Lubricant is applied to the catheter tip unless it is pre-lubricated. The catheter is advanced gently until urine flows, and men advance it a little further to ensure it is fully in the bladder.

Once flow stops, the catheter is withdrawn slowly so any remaining urine drains, then the area is cleaned, foreskin replaced and hands washed. Teach the person never to force the catheter: relaxing and breathing deeply often helps if there is resistance. Persistent difficulty is a reason to call the provider, not to push harder.

Schedule, fluids and catheter care

A common schedule is every four to six hours, including on waking and before bed, with extra catheterisations after larger fluid intake. The actual timing is set by the prescriber, sometimes guided by measured volumes. Skipping catheterisations allows overdistension, which raises infection risk and, in people with high spinal cord injury, can trigger autonomic dysreflexia.

Some catheters are single use; others are designed to be cleaned and reused according to the product instructions. Reusable catheters are typically washed, rinsed, air-dried and stored in a clean bag, and discarded if they become brittle or cracked. Teach the person to follow the specific product guidance rather than a general rule.

Adapting the teaching to the person

Assess hand function, vision, balance, mobility and cognition before choosing the teaching approach. Someone with limited dexterity may need a different catheter design or a carer trained to help, and a woman may find a mirror useful while she learns to locate the urinary opening. Practise in the position the person will actually use at home, such as sitting on the toilet or in a wheelchair.

Use teach-back and a supervised return demonstration rather than a verbal explanation alone. Confirm the person knows how to obtain supplies, where to store them, and what to do when away from home. Ask them to describe their daily schedule so catheterisation times fit around work, school or care routines; a plan that clashes with daily life is unlikely to be followed.

Signs to report and a hypothetical teaching check

Teach the person to call their provider for burning, fever, chills, cloudy or foul-smelling urine, blood in the urine, pain, urine leakage between catheterisations, skin rash or sores, or inability to pass the catheter. Someone with a high spinal cord injury should know that a pounding headache with flushing may mean bladder distension and needs immediate action.

Consider a hypothetical patient with multiple sclerosis being discharged on self-catheterisation. Which statement shows a need for more teaching: I will wash my hands first; I will catheterise on waking and at bedtime; I will push harder if the catheter will not go in; or I will call if I have fever? Pushing harder is the error because forcing can injure the urethra.

Sources and further reading

MedlinePlus: Self catheterization - female. Handwashing, optional clean gloves, cleaning front to back, lubrication, not forcing the catheter, four-to-six-hour schedule, reusable catheter cleaning and when to call.

MedlinePlus: Self catheterization - male. Retracting the foreskin, advancing slightly after urine flows, slow removal, discarding brittle catheters and infection signs to report.

MSD Manual Professional: Neurogenic bladder. Intermittent self-catheterisation preferred over indwelling catheters, UTI and stone risk, and autonomic dysreflexia triggered by bladder distension.