A catheter is a catheter .....!

Are they really all the same? What is the true difference between catheters?

“My catheter LOOKS GOOD, it is like a jewellery piece if I take it out in front of other able men to use!” ...can you say the same about your catheter?

Well, we tried to find out what the differences really are, what is available, and how to cut costs. We would like to thank everyone who responded to our questionnaire. Your feedback has been invaluable.

Cost saving tips:

Buy directly from the manufacturer or distributor or contact them to find out who is their recommended agent in your area. When buying directly, they may have a minimum order or only sell by the box.

Buying in bulk is a huge cost saver.

Try shopping around; different retailers add different mark-ups on the products.

Urinary tract infections also cost money. Your care of your catheter and legbags can save you lots of medical bills.

A number of people have commented that taxes and import duties should be dropped from these products to help keep the costs down. The Independent Living Centre together with Mobility 1 and OSDP are working on a document to present to SARS to consider a revision on taxes for incontinence products and other assistive devices and equipment. We will follow this development with interest!

The choices for urinary drainage include intermittent or indwelling catheters, condom drainage or pads. The decision about which method of drainage is used is normally made by an urologist who does urodynamic studies to evaluate what type of bladder an individual has. It generally depends on a combination of the Detruser muscle (the muscle that surrounds the bladder and which contracts in order to empty the bladder) and the sphincter valve (the valve that closes the exit from the bladder into the urethra.) Whichever method of drainage is used, it is important that the bladder is properly drained and that minimal residual urine is left inside the bladder, as residual urine quickly causes infections.

The Suprapubic indwelling option has become very popular in recent years as it is easy to manage and has lower risks than the other options. It involves inserting an indwelling catheter into the bladder through a cut in the tummy, a few inches below the navel (belly button). Once the catheter is inserted a small balloon on the end of the catheter that is inside the bladder, is inflated, which prevents the catheter from falling out. To remove the catheter this balloon is deflated and the catheter easily pulled out. The urethral indwelling catheter uses the same catheter as the above, but it is inserted through the urethra into the bladder. Both of these options then have a drainage bag fitted to the end of the catheter pipe to collect the urine and they are generally used when the sphincter valve is flaccid and therefore does not keep the bladder closed, so urine constantly leaks out. Condom drainage is another option for a male with a bladder that constantly leaks. Intermittent catheterization is generall y used when the sphincter valve is spastic and will not open to release the urine. It involves inserting a catheter up the urethra, into the bladder, draining the bladder and then removing the catheter.

Sizes:
When ordering new catheters it is important to know the correct size of catheter that you use. Experts recommend that the smallest possible catheter be used. Some people may require larger catheters to control leakage of urine around the catheter or if the urine is thick and bloody or contains large amounts of sediment. Be aware that larger catheters are more likely to cause damage to the urethra.
All catheters are colour coded according to their sizes. Catheter sizes are measured according to the external diameter, using the “French Gauge” (Fg) 3 Fg = 1mm. The balloon sizes of foley catheters vary according to the volume of fluid that they can accommodate. For children generally a 1,5 ml to 3 ml balloon is used. For adult use the balloon size can vary with the most common sizes being 5 - 10 ml, or 5 – 15 ml or 30ml.

The length of catheters may vary slightly from one manufacturer to the next, however male catheters are usually approximately 40 cms and female and pediatric catheters are between 15 – 20 cm.

French Gauge

Green = Fg 6 (2.0mm)
Blue = Fg 8 (2.7mm)
Black = Fg 10 (3.3mm)
White = Fg 12 (4.0mm)
Green = Fg 14 (4.7mm)
Orange = Fg 16 (5.3mm)
Red = Fg 18 (6.0mm)
Yellow = Fg 20 (6.7mm)
Purple = Fg 22 (7.3mm)
Dark Blue = Fg 24 (8.0mm)


Disinfectant:
Any form of catheterization brings a risk of urinary tract infections. Therefore it is important to avoid any opportunity of introducing bacteria to the system. There are a number of different sterilization products on the market, but it is always important to take note of any reactions should you change the type of disinfectant. Often people have an allergic reaction to the disinfectant, and they mistakenly believe that the reaction is to the catheter. Kendon Medical have a recommended sterilizing liquid called Quadex which is highly effective and very inexpensive, they also have a number of other sterilizing liquids and products available. . Lydia Holmes , wife of a long term paraplegic, recommends the use of a Steritech residual disinfectant called Steri 201 Green, which she sells for R80 per litre, along with the Steri 601 hand cleaner, R60 for 500ml.

Tips from users:

A follow-up visit every 6 – 12 months to the urologist is recommended.

If your catheter blocks up quickly then try reducing your dairy intake.

If you suffer from a lot of bladder infections then try to take Cranberry Capsules daily or drink Cranberry juice as this reduces infections.

To make an indwelling catheter last longer flush it every day with 30 – 60 ml of sterile water by syringing it up the pipe that get attached to the legbag.

Flushing the bladder on a daily basis by injecting about 60ml of sterile water up the catheter into the bladder also helps to prevent bladder infections and keeps catheters unblocked. SA Biomedical have a product called “Flush Bladder” , which is sterile bottled water. They also have a “Catheter tip Syringe available” which can hold up to 60 ml for flushing the bladder.

FOLEY CATHETERS
Indwelling catheters are known as “Foley catheters”. Once they are inserted into the bladder, sterile water is injected via the catheter and a small balloon inside the bladder is inflated. This holds the catheter in position so that it does not slip out. Foley catheters are available in a 2-way or 3 way option – the 2-way option includes a pipe for the urine and a pipe for the balloon. The 3-way option has an additional pipe for taking urine samples; this is usually only used in hospitals.

Materials:
Latex catheters are a short term option and should not be used for longer than 3 days as the latex causes microscopic changes to the mucosa in the bladder and urinary tract. This results in an allergic type reaction in the majority of users, and can also be carcinogenic if used for long periods. Silicon coated is more expensive than latex, but can be used for up to 10 days, after this length of time the urea starts to leach the silicon, and the underlying latex starts causing reactions. 100 % silicon is the safest material for indwelling catheters. It is generally recommended that they should be replaced after 15 days; however some companies have developed catheters for long-term use, which can be used for up to three months. PVC should never be used for a foley catheter as this is carcinogenic if used long term.

Valve:
Sterile water should be used to inflate the valve of the foley catheters, and the valve should always be tested before it is inserted. It is extremely important that a good quality valve is used on these catheters, as it can be a major problem if the balloon cannot be deflated when it is time to remove the catheter.

Features to look for in a good quality foley catheter:

Smooth surface of catheter for easier penetration and maximum comfort of the patient.

Soft, flexible catheter for limited discomfort when in situ.

Reliable inflation valve that will deflate when ready to be removed.

Reliable, symmetrical balloon that will not burst or leak.

Firm tip of the catheter that will not collapse when inserted.

Tips:

The pipe of the foley catheter should always be secured to the thigh to prevent damage to the urethra if it gets pulled. It can be secured by a strap or tape. Jacques Pienaar, a quad, has developed a method where he cuts a small hole in the elastic of his underpants and inserts the inflation port section of the catheter through this, he then tapes the two pipes together and this safely keeps in it position.

Most foley catheters have a “radiopaic” line down the catheter which shows up on X-ray. This helps in detecting a blockage in the catheter.

GMS

Features and recommended life span:

GMS carry the Unomedical range of foley catheters. The products are designed to reduce trauma and improve patient comfort. All catheters have an anti-bacterial coating.Silicon coated latex – 3 days100% silicon – 2 weeks

Sizes:
Fg 12 – Fg 26
Male – 40cm,
Female 20cm
10 ml and 30 ml balloon sizes

KENDON MEDICALFeatures and recommended life span:The “Neovac” range made by NemMedic is ISO 9000 recognised The Neovac range of catheters are high quality catheters at very reasonable prices. They are very smooth, soft and flexible catheters. Other brands are also available through Kendon Medical.
Neovac Silicon coated latex –up to 72 hours
Sizes: Fr 10 – Fr 26, 5 – 15 ml or 30 ml balloon

ROYNHARDTRoynhardt is a South African company that has successfully been making catheters since 1982, and they supply a low cost range of catheters.Features and recommended life span:All latex catheters are treated to prevent protein allergy, and undergo an anti-bacterial and anti-fungal treatment. Each catheter is sterile and individually packed.
Latex Silicon coated – up to 15 daysSizes:
Fg 8 – 30, 5 ml and 30 ml balloons

SA BIOMEDICALFeatures and recommended life span: Bard have developed a method of bonding their catheters, which ensures that no latex is exposed to the patient. It is ideal for long term use as it prevents bacterial colonization, is very flexible for comfort, and is slippery when wet for easy insertion. Both their Hydrogel coated latex “Biocath” and 100% Silicon “Bard All-Silicon” can safely be used for up to 3 months. Sizes:
Male, female and paediatric from 12 Fg – 18 Fg

SUPRALATEXFeatures and recommended life span:Supralatex supply the good quality yet low cost “Well Lead” range of catheters. These are soft, flexible and smooth catheters, with a neatly packaged, reliable balloon.
Well Lead Silicon coated latex – 1 month
Well Lead 100 % silicon 2 monthsSizes:
Variety of sizes depending on product ordered. Fg 6 – Fg 30
Balloon sizes 5ml or 30 ml

TECHNOMEDFeatures and recommended life span:Medium priced high quality comfortable and reliable catheters.
Silcath 100% Silicon - 3 months
Silcot Silicon coated – 1 monthSizes:
Variety of sizes depending on which type of catheter is ordered. Range from Fg 8 – Fg 28. Balloon sizes 3 ml, 5 ml or 30 ml

THEBE MEDICAL (GRS)Thebe Medical, who recently bought out GRS, supply the Fortune and Rüsch range of Foley catheters.
Accredited dealer Smartmed –ask for Valery TurnerFeatures and recommended life span:Good quality, smooth, flexible catheters with reliable balloons and valves.
Latex – “Silcolatex” - 1 week
Silicon coated - “Silasil” – 4 weeks
100% Silicon – “Silcath”, “Rusch Brillant”– 6 weeksSizes:
A variety of sizes is available, including paediatric, male and female from 6 Fg to 26 Fg.
Bulb sizes vary from 1,5 ml to 13 ml.

URENDO HEALTH TECHNOLOGIES
Urendo are the sole distributors of the high quality German made Urovision range of catheters.Features and recommended life span:100% silicon – 2 months
Silicon coated – 6 weeksSizes:
Male Fr 8 – 18 40cm long Female Fr 6 – 16 18 cm long
Catheterization sets are available for replacing foley catheters on an outpatient basis.

NELATON CATHETERS“Nelaton” is the generic name for intermittent catheters. They are inserted into bladder via the urethra, once the bladder has emptied, they are removed. They are generally available in the following materials: 100% silicon, silicon coated latex, latex or PVC (cheapest)
Catheter should be smooth and soft but a bit firm to be able push up through the urethra. They are generally not as soft as the foley catheters. They should have rounded tip to limit damage to the urethra as they are inserted. They are also available with a Tiemann or Coude tip, which are shaped tips which are used by people who have scar tissue in the urethra, and this helps the catheter to move past this area. Some makes of catheters have a variety of ‘eyes’ (drainage hole) available. “Whistle” style means a large eye, and the ‘Roberts style’ means it has two eyes.

Most intermittent catheters are designed for single use, however due to the cost of these products many people use them multiple times. Sterilization of the catheter is critical if it is being re-used. Disinfecting the hands and catheter before and after catheterizing is extremely important. Some people suggest putting it in the microwave at least once a week in a small amount of water to dislodge any encrustations or bacteria that may be building up inside the catheter.

There are four main types:

Plain catheters are made of plastic and have to be used with a special lubricant before insertion.

Coated catheters have a hydrophilic coating. The catheter is soaked in water for a short while before use. The water makes the coating become slippery so it is easy to insert. See the Urovision hydrophilic catheter, the Flocath Quick, and the Easicath from Coloplast.

Pre-lubricated catheters are plain catheters which come packed with lubricant so they are ready to use, such as the Flocath Intro Gel .

Re-useable catheters - some companies have developed good quality catheters which can be re-used, and they are supplied with a plastic case which should be filled with a suitable disinfectant. By regularly changing the disinfectant, and through good care, these catheters can last much longer, sometimes even up to a year.

COLOPLAST
The Easicath catheter is a pre-lubricated, single use catheter. It comes in a sterile packaging and is ready to use in one minute. The catheter bag must be filled with water and left for 60 seconds. The PVP binds the water molecules to the surface of the catheter, creating a smooth slippery film that allows it to pass through the Urethra with minimal discomfort or friction. The Easicath from Coloplast is also prelubricated – just add water to the package to activate the lubrication. Colopast also have the EasyCath set available, which includes an integrated collection bag and hydrating solution along with the hydrophilic-coated catheter for convenient catheterisation anytime, anywhere.Materials: Made of PVC, lubricated with PVP.Usage: Recommended once offSizes: Fg 8 – Fg 20,, men, women, pediatric and Tiemann tip.

GMSGMS have a range of transparent PVC catheters with a variety of tips to suit the catheterization needs.Materials: PVC, latexUsage: Recommended once off Sizes: Fg 5 – Fg 24, 40 cm long.

KENDON MEDICAL

 

Neovac Nelaton catheters are low cost, non-toxic, kink free with a soft rounded tip with lateral eyes for efficient drainageMaterial: Siliconized PVC tube
Sizes: 8Fg – 16 Fg, 40 cm
Usage : Recommended for single use

ROYNHARDT
Low cost, locally made catheters.
Materials:
Latex – treated to prevent protein allergy – recommended once off use
Silicon coated latex– recommended once off use
Non toxic, thermosensitive PVC– recommended once off use
Sizes: 20 cm and 40 cm long

SA BIOMEDICAL

Bard Unisex Interglide Catheter is a vinyl catheter with a hydrogel coating and non-slip finger grip for enhanced control.
Sterile packaging, for single use.Sizes: male, female, pediatric sizes ranging from 8 – 18Fr

SUPRALATEX
PVC – recommended single use
Latex - Red Nelaton - recommended single use
Self Catheter 100% silicon – re-useable silicon catheter that folds into a protective sheath. Can be used for up to 1 year if properly cared for. Very cost effective option for this type of catheter.
Sizes: Fg 6 – 22 x 40cm or 20 cm
Self Catheter – Fg 10 – 16, male and female
[ No photo]

TECHNOMED
Technomed carry the exciting range of Fuji Selfcath and the DIY Self Cath.
All these catheters are designed for long term use and are supplied with a handy plastic case and lid which should be filled with a suitable disinfectant. It keeps the catheter clean and sterilized for people who lead an active life and if well looked after can last for up to a year.
Material: 100 % silicon
Sizes: Fg 9, 12, 15
Female 13cm, male 28cm, pediatric 23 cm
Comment from a user about the Fuji – “reacts to my bladder well, no forcing to insert, drains fast and complete with slight twist of the wrist. Bends to fit in discreet pouch on my seat cover. LOOKS GOOD, it is like a jewellery piece if I take it out in front of other able men to use.! Does not look industrial. “
[To take photo]

THEBE MEDICAL (GRS)
Standard Nelaton catheters:
PVC – Medicoplast, EMS VEN – these are low cost catheters, designed for single use
Silicon coated PVC - Pascho
Sizes: Male, female, paediatric 6Fg – 22 FgOut and About solutions:Flocath Quick – a ready to use hydrophilic-coated intermittent catheter with excellent gliding properties. Comes in sterile packaging. When the catheter is needed, without opening the package, a squeeze of the pouch containing sterile saline solution releases the liquid into the packaging, activating the hydrophilic coating within 30 seconds. It is then ready for use. A protective sleeve is included in the packaging, which enables the catheter to be inserted without touching it, and it also extends the catheter at the funnel end whilst emptying the bladder.

Flocath Intro Gel is a gel coated catheter inside a sealed bag. When ready for use the lid is removed, the catheter pushed out of the bag and then inserted into the urethra without having to touch the catheter which empties the urine into the bag. Once the bladder is emptied, the lid is put back on and the whole bag is disposed of.

URENDO HEALTH TECHNOLOGIES
Features: Urendo supplies the UroVision intermittent catheters which are available with no coating or a hydrophilic coating. The hydrophilic coating reduces bacterial infection and minimises friction. These are available with a standard Nelaton tip as well as a Tiemann tip. These are recommended for single use but with care can be used for up to 3 months.
Sizes:
Male , Fg 12 - 22, 40 cm long
Female, Fg 6 – 16, 20 cm long

GREEN RETAINERLydia and Richard Holes have developed the Green retainer. This is a PVC Nelaton catheter with a sealable container in which the catheter is stored in a disinfectant. It has been tested by a few paraplegics who are thrilled with the system and at a very low cost. Using this system makes catheters last much longer.
Cost: The starter pack Green Retainer with a black holding bag, including a catheter, 500 ml bottle of Steri 201 green residual disinfectant and 150 ml of Steri 601 sterilising gel (for clean hands) retails and R175.00

OTHER RELATED PRODUCTS
Sa Biomedical have some interesting products which provide different options from the products listed above.

The Penile Clamp is a small, re-useable clamp which can be clamped over the end of the penis to prevent urine leakage. When the bladder is full it can be emptied in the traditional way!
The ”Flip Flow” this valve / tap can be fitted directly onto the foley catheter instead of using a legbag. This allows the urine to be stored in the bladder – which helps to maintain the tone of the bladder muscles, and when the bladder if full, the catheter can be drained directly into the toilet.

Suppliers:
It seems that suppliers regularly change their brands, either according to the availability or the cost effectiveness of the product according to the exchange rate.

Columnist Photos