11. TROUBLESHOOTING INTERMITTENT CATHETERISATION
| Problem | Suggested action |
| Skin lesions (on the urethral meatus) | • Check the skin-cleansing agents and their additives • Change of disinfectants • Check for fungal infection • Removal of disinfectant residues/lubricant with water • Consider referral to a dermatologist |
| Urethral mucosal trauma | • Check size of the catheter and tip • Check insertion technique • Check catheter material/coating/lubrication |
Problems with insertion of the catheter - Mechanical problems - Blood on the catheter/catheter tip - Urethral bleeding | • Check catheterisation technique • Check sufficient lubrication • Check catheter (tip, rigidity, etc.) • For women, use Tiemann tip as an alternative • Urethral calibration if necessary • X-ray diagnostics of the urethra or cystoscopy if necessary • Check for signs of constipation |
| Pelvic floor spasticity/spastic sphincter | • Provide relaxation (breathing technique, cough thrust) • Check or change positioning (e.g., frog position) • Possibly adapt the choice of catheter and catheter tip • In most cases, it helps to wait until the spasticity is relieved |
| Pain | • Check catheterisation technique • Advocate pelvic floor exercises before inserting catheter • Provide for relaxation during catheter insertion and removal • Check for urinary tract infection • Check catheter system, tip and coating • Use of anaesthetic lubricant (e.g., Instillagel) • Consider psychological aspects |
| Incontinence | • Check for urinary tract infection • Check catheterisation times • Review drinking log and voiding diary • Temporary supply with absorbent or draining aids • Request bladder function diagnostics |
Change in appearance and odour of the urine | • Urine diagnostics • Check daily fluid intake • Think about possible nutritional factors and medications |
If problems persist or complications occur, a medical consultation should be made.
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