382
CHAPTER 26
The most popular type of indwelling catheter today is the Foley type for urethral
and also for suprapubic drainage in those few patients, where, from rare reasons men
tioned earlier, the latter form of bladder drainage is indicated. A good deal of research
has been carried out both by medical staff and manufacturers to improve the original
rubber type of Foley catheter, and in recent years it has been replaced by plastic material
which is infinitely less harmful to the urethra than that made from rubber. In particular,
urethritis and allergic reactions are less seen with the plastic material. However, faults
still occur with the balloon as described earlier in the book and the ideal indwelling
catheter for long-term drainage is not yet developed. The small side-tube for distending
the balloon with sterile water or saline is occluded either with a special spiggot, with the
fluid injected under pressure by an adaptor fitted to the syringe, or by a rubber stopper
already fixed to the tube. In the latter case, the fluid to distend the balloon has to be
introduced through a small needle which perforates the rubber stopper. Catheters are
used in various sizes but, as a rule, no larger sizes than 14 or 16 F gauge should be used
in the male. In the female with wide urethra, it is sometimes necessary to use a larger
size. The balloon should not be larger than 5 cc but again in women a larger size may be
necessary. For suprapubic drainage, the balloon should not be distended more than with
3 ccs.
The frequency of changing the indwelling catheter is of great importance. The
custom, unfortunately still widely used, to leave the catheter in for 1-2 weeks or even
longer as a routine is deprecated as this inevitably leads to complications, in particular
collection of mucus, stone formation and damage to the mucosa of bladder and urethra.
It is our practice to change the catheter at first every other day and later 2-3 times
a week, and this has proved very beneficial to the patient. The exception, leaving the
catheter connected with a closed drainage system longer than 3 days, will be discussed
later.
Catheterization at home, self-catheterization
Once the patient is at home, he can be provided with a sterilization set, rubber gloves
and catheters from his District Medical Officer of Health, and his catheter is usually
changed by the District Nurse unless he is able to carry out the catheterization himself
with scrupulously aseptic precautions, helped by a member of his family. At Stoke
Mandeville, we have trained certain paraplegics, being discharged with an indwelling
catheter, in self-catheterization. He (and his attendant at home) are specially trained in
the principle and technique of changing the catheter, and from all our experience gained
it can be concluded that this has proved more satisfactory than the catheterization
carried out by a medical practitioner or district nurse who are not familiar with this type
of patient or are too busy to carry this out regularly. Even women can carry out self-
catheterization efficiently, and I have watched one of my female patients performing this
procedure who sustained a complete transverse lesion below T6 in 1943. She has done
this for many years most skilfully, using a mirror placed in front of her legs which are
spread apart. Autoclaved disposable catheterization sets including disposable catheters
of the kind as shown in Fig. 158 have recently been manufactured, and although this has
