User Guide to Intermittent Self Catheterisation
Contents
Preface...................................................................................................................... 5
How does the urinary system function?.................................................................. 6
What can go wrong with the urinary system?....................................................... 14
What is Intermittent Self Catheterisation?............................................................... 20
The male anatomy.................................................................................................... 26
Male: How to use LoFric®....................................................................................... 29
Male: Suggested positions...................................................................................... 32
The female anatomy................................................................................................. 34
Female: How to use LoFric....................................................................................... 37
Female: Suggested positions................................................................................... 40
What should I think about when choosing a catheter?......................................... 42
Facts about LoFric..................................................................................................... 46
LoFric product range................................................................................................ 50
LoFric types, tips, sizes and packaging................................................................... 52
LoFric accessories..................................................................................................... 54
User instructions........................................................................................................ 57
Questions and answers............................................................................................ 74
Personalised care plan............................................................................................. 78
Urine record card example..................................................................................... 81
Links and useful information..................................................................................... 83
“LoFric catheters are absolutely magnificent. They do not hurt me and
I am so grateful to you for creating them. When a patient has to do
something that hurts them they make up a million reasons not to do
it…subconsciously or consciously.”
Lisa, Minnesota, USA
Preface
Bladder problems can affect any one of us at any time in our lives. Don’t
worry, you are not alone. In fact, hundreds of thousands of people of all
ages perform intermittent self catheterisation (ISC) everyday.
In this ISC guide we would like to share with you some of the knowledge we have gathered over the last two decades, working closely with
the health care community and helping thousands of users of all ages to
successfully integrate ISC into their lives. We want to share this knowledge with you, because we know that the more information you have,
the more comfortable you will feel about your situation. Knowledge
is often the best antidote to fear. Knowledge empowers us, makes our
condition more manageable and gives us the means to make informed
decisions regarding the course of our treatment.
Naturally, this guide should be used as a complement to the in­
structions and information on ISC you have received from your health
care professionals, as they know the specifics of your condition.
If you have any questions concerning the information in this guide or your LoFric
catheters, please do not hesitate to contact us by phone at +46 31 773 3000 or
by e-mail at [email protected]. You can also visit our Internet site for more information www.lofric.com
5
How does the urinary system function?
From a glass of water to urine
When you drink a glass of water, the water goes down to your stomach.
This is where the first breakdown of food and drink takes place.
The contents of your stomach then go out to the intestines, where
the blood vessels absorb the liquid. Most of the water is then transported to the kidneys, which absorb the liquid and ensure that the necessary substances remain in your body. The substances your body doesn’t
need leave with the urine, and are then transported from the kidneys
via the ureters to the bladder.
The bladder collects and stores urine. When you feel the need to
empty your bladder, the bladder sends a message to the brain, which
tells the bladder muscle to contract and the sphincter muscle (which
seals the bladder) to relax. This starts the process of urination through
the urethra. We normally urinate about five to seven times a day and
occasionally at night.
6
The human body consists of 65% water.
Needing to drink water during the day
is vital, since we lose water all the time
in the form of sweat, breath and urine.
7
The organs in the urinary system
The urinary system is made up of the kidneys, ureters, bladder, sphinc­
ters and the urethra.
Kidneys – Purify your blood
You usually have two kidneys in your body. Their main function is to
filter your blood to remove excess water and waste products. The excess water and waste products are secreted as urine. In 24 hours, your
kidneys filter around 190 litres of blood and from this produce between
1 and 2 litres of urine.
Ureters – Transport urine from the kidneys to the bladder
The urine is transported from your kidneys to your bladder via two
narrow tubes, known as ureters.
Bladder – Stores and empties your urine
The bladder is a muscle-lined sack that stores urine and empties urine.
This muscle is called the detrusor muscle. It serves as a low pressure
reservoir for the urine. Almost like a balloon in shape, your bladder is
small when empty and expands as it fills up.
The bladder normally holds 400 to 600 ml of urine. When it contains
approximately 150 ml, nerve impulses are sent to the brain telling it
that the bladder is starting to get filled. When you urinate, the bladder
contracts and the pelvic floor muscles relax – allowing urine to drain
out through the urethra.
Urethra – Transports urine from the bladder out of the body
In the urethra, the pressure is higher than in the bladder, which helps to
keep the bladder under control. The female urethra is 3–5 cm long and
opens in the genital area just in front of the vagina. A woman’s urethra
is only used for urination.
The male urethra is 15–20 cm long and opens at the tip of the penis.
A man’s urethra is not only intended for urination, it is also the passage
along which semen (sperm from the testes and secretion from the prostate gland) passes during ejaculation.
8
Kidneys
Renal artery
Renal vein
Ureters
Detrusor
muscle
Bladder
Ureter opening
Internal sphincter
Prostate
External sphincter
Pelvic floor muscle
Urethra
Detrusor
muscle
Ureters
Male urine organ
Kidneys
Bladder
Ureter opening
Smooth muscle sphincter
Pelvic floor muscle
External sphincter
Urethra
Female urine organ
9
Sphincters – Seal the urethra
The urethra is surrounded by two small circular muscles called sphincters. The sphincter muscles are normally contracted – this seals the
urethra so there are no leaks. When you go to the toilet, the sphincter
muscles relax so the urine can come out. One sphincter muscle operates
involuntarily, and the other voluntarily, which means we can control
it.
Nerve connections – Communication between brain and bladder
For the urination process to function as planned, the bladder and the
brain need to communicate with each other. The following parts of the
nervous system are involved in the urination process: the brain, the
brainstem, the spinal cord, as well as some peripheral nerves.
Command centres
The PMC is one of three command centres involved in the urination
process:
The Cerebral Micturition Centre, CMC
The cerebral micturition center is located in the frontal lobe of the brain.
This is where we actively make the decision to delay or allow bladder
emptying. This is done by sending a signal to the PMC.
The Pontine Micturition Centre, PMC
Located in the brainstem, the PMC co-ordinates the sphincter and bladder muscles. It acts like an on/off switch. When you want to delay bladder emptying, the PMC sends signals down the spinal cord, through the
sacral reflex centre, to keep the bladder relaxed and the sphincter con­
tracted. When you decide it is appropriate to urinate, the PMC allows
the bladder to contract and the sphincter to relax.
The Sacral Reflex Centre
The sacral reflex centre is located in the lower part of the spinal cord.
This is where the nerves that are important for bladder function branch
out from the spinal cord.
10
Cerebral Micturition Centre
Pontine Micturition Centre
Spinal Cord
Sacral Reflex Centre
Hypogastric nerve
Bladder
Pelvic nerve
Pelvic floor
Pudendal nerve
Sphincter
Urethra
11
Peripheral Nerves
The PMC is helped by three nerves that emanate from the spinal cord:
The Hypogastric Nerve is responsible for the active relaxation of the
bladder muscles during filling. When the bladder is full, tension receptors in the bladder wall are activated and a strained feeling is registered
in the PMC.
The Pelvic Nerve is activated in connection with bladder emptying. The
pelvic nerve contracts the bladder muscle and makes emptying possible.
The Pudendal Nerve is responsible for the relaxation and contraction of
the external sphincter muscle.
12
What can go wrong with the
urinary system?
There are many conditions that affect the body’s ability to store and empty urine.
The most common causes are illness, injury and aging.
There are three main types of bladder problems:
1. Storage problems: Inability to keep urine in the bladder, for
example various forms of incontinence.
2. Emptying problems: Inability to empty the bladder totally which,
if untreated, leads to retention.
3. A mixture of various forms of incontinence and retention.
Incontinence
Reasons for incontinence
Incontinence, or the inability to keep urine in the bladder, is a very common problem. The reasons behind the incontinence can be divided into
two main groups:
Poor sphincter functionality This is caused by a weakness in the sphincter
muscle which keeps the urethra closed when you are not passing urine.
Incontinence can also be caused by a weakness in the pelvic musculature. The pelvic musculature helps the sphincter to stay closed when
abdominal pressure increases, for example when you sneeze or cough.
Poor sphincter functionality or a weak pelvic floor can occur after childbirth. The sphincter can also be damaged by surgery. For women a lack
of oestrogen after menopause can result in weakened pelvic muscles
and sphincter muscle.
Bladder Hyperactivity The bladder muscle (detrusor) is hyperactive and
contracts uncontrollably. This is often due to neurological changes or
injury, however it can also occur for no known reason (idiopathic).
14
The different types of incontinence
The reasons for changes in the bladder’s ability to hold or empty urine
vary greatly. That is why the different types of incontinence are normally classified as follows:
Urinary stress incontinence Involuntary urine leakage due to exertion,
coughing or sneezing, is due to poor sphincter functionality or a weak
pelvic floor.
Urge incontinence Urine leakage associated with an urgent need to pass
urine which can be due to a hyperactive bladder.
Mixed urinary incontinence Involuntary leakage of urine where one has a
combination of stress incontinence and urge incontinence.
Functional incontinence Difficulty in getting to a toilet due to reduced mobility, confusion or accessibility.
Overflow incontinence Incontinence resulting from an overfilled bladder,
due to a reduced or lacking emptying reflex and/or too strong urethra
resistance.
Neurogenic incontinence Neurogenic incontinence means that the incontinence is due to an injury or disease in the nervous system. Neurological
diseases that can affect the bladder are those that involve the central
nervous system (MS, Parkinson’s disease or stroke) the bladder’s peripheral nerves, such as diabetes. Neurogenic incontinence can also be
caused by an injury, surgery or a tumour, or congenital defects such as
spina bifida.
What are the symptoms of incontinence?
For poor sphincter functionality the symptoms are urine leakage, especially when the bladder is full and abdominal pressure increases. Leakage
can also occur when the muscles of the pelvic floor are weakened.
Symptoms of a hyperactive bladder are the need to pass urine often,
urinary urgency and urinary leaking if one does not get to the toilet in
16
time.
Retention
The causes of incomplete bladder emptying
The inability to empty the bladder completely can have many causes.
Generally they can be divided into two main groups:
Outflow obstruction and Acontractile bladder.
Outflow obstruction – a generic term for an obstruction during voiding.
Characterised by pressure within the bladder and a weak flow when
urinating.
Outflow obstructions can be caused by
A. injury to the urethra,
B. narrowing of the urethra due to strictures*,
C. inability to relax the sphincter muscle, or
D. an enlarged prostate
*Strictures can be scars after an injury, operation or infection.
Certain neurological illness can lead to a deterioration of the coordination between the bladder muscle (detrusor) and sphincter muscle. Both
muscles contract at the same time (detrusor-sphincter dyssynergia).
Acontractile bladder – when the bladder muscle doesn’t have the strength
to empty the bladder completely.
An acontractile bladder can be caused by
A. injury to the nerves that control the bladder muscle,
B. an injury to the bladder, or
C. malformations
You can also experience difficulty urinating after general anaesthesia or
some other form of anaesthesia.
17
Symptoms of retention
The most common symptom of retention is a weak urine flow. Urine
retention can continue until the bladder cannot cope with being filled
further, which leads to overflow incontinence. Urine retention should
be treated as, the residual urine can easily become infected, or urine can
flow back up via the ureters to the kidneys and cause kidney damage.
Urinary tract infection
Urine – a good growth medium for bacteria
Urine is a good growth medium for bacteria. The number of bacteria
doubles every 30-60 minutes. It is therefore important that you empty
your bladder regularly and completely.
Under normal conditions the urinary tract has a built-in resistance to
infections. One of the resistance mechanisms is natural emptying (voiding), which means that bacteria are washed out of the bladder. When
you see your doctor and leave a urine sample, he/she can analyse it and
see many things, for example the bacteria content per ml of urine. If the
amount of bacteria per ml is more than 100,000, the sample is deemed
positive. The type of bacteria found in urine can vary. The most common are E-Coli, which are a type of bacteria found in the intestine.
Bacteria in urine does not always need to be treated:
Non-symptomatic Bacteriuria
Sometimes we can have bacteria in our urine without having any problems or symptoms, this is called non-symptomatic bacterieuria. This
is a situation that is quite common for people who practice intermittent
catheterisation. The bacteria are present in the urine but do not attack
the mucous membrane or the bladder wall. Non-symptomatic bacteriuria is usually not treated. The reason for this is to minimise the risk of
developing resistance to antibiotics.
18
Urinary Tract Infection (UTI)
A UTI is when the amount of bacteria in your urine is more than 100,000
bacteria per ml and you show symptoms such as:
• Need to urinate often
• Burning sensation when urinating
• Fever
• Tenderness over the bladder region
• Blood in the urine
• A decreased general state of health
A UTI occurs when the bacteria attack the mucous membrane and then
the bladder wall.
UTIs are ususally treated with antibiotics to prevent the infection
from getting a strong foothold and spreading through the ureters to the
kidneys, as this could cause kidney damage (hydronephrosis and hydroureter) with the risk of urine poisoning (uraemia). More than thirty
years ago – before clean intermittent catheterisation (CIC) was used –
uraemia was the most common cause of death for patients with spinal
injuries.
“Four years ago I was introduced to the LoFric Catheter. Immediately there was a positive change. Since I have been using the LoFric catheters I have experienced less than
five UTI’s during those four years. My involvements and activities have increased. It is
great not to have my mind stuck on dealing with infections.”
Cole, Seattle, USA
19
What is intermittent self catheterisation?
Intermittent self catheterisation (ISC) involves periodically passing a
small tube, called a catheter, up into the bladder to allow all of the urine
to flow out. This allows the bladder to be emptied completely when
needed. Once the bladder is emptied the catheter is removed from the
body.
Intermittent catheterisation is not a new concept. Some data suggest
that catheters have been used by many people, including the Ancient
Romans and Egyptians.
Today, ISC is the preferred form of treatment for the management of
incomplete bladder emptying.
Is it difficult?
Although it can seem quite alarming at first, most people find learning
to catheterise very easy. Almost everyone can perform ISC. Handling
a catheter by oneself is possible from around five years of age. Many
people with limited mobility or hand dexterity perform ISC regularly.
With some practice, emptying your bladder with ISC can take only
a few minutes. Before you get used to it and find the right grip, it can be
a little fiddly, but your ISC teacher will help you find the right technique and answer any questions you may have while you learn. You will
quickly find your own style and position to accomplish this. It will become natural very quickly.
Will it be painful?
Provided that you use the right type of catheter and follow the instructions that you have received from your ISC teacher, you are likely to
feel pressure but should not feel acute pain. Some people find that their
urethras can become very sensitive when first learning ISC. This should
settle with time, but if it bothers you too much, contact you doctor or
nurse.
20
THE ADVANTAGES OF
ISC:
plica1. Reduced risk of com
ses
ea
dis
d
tions an
2. Healthier kidneys
3. Healthier bladder
4. Reduce residual urine
ry-tract
5. Reduced risk of urina
infections
e
6. Improved continenc
t
for
com
7. Improved
8. Increased autonomy
9. Improved sex life
life
10. Improved quality of
It is possible that you will feel extra pressure when the catheter passes the sphincters and, for men, when it passes the prostate. Don’t worry, this is normal. Taking a deep breath or coughing a couple of times
may help to relax your sphincter muscle.
Will it damage my internal organs?
If you select the right type of catheters and carefully follow the instructions you received from your ISC teacher, catheterisation should not
cause any damage to your bladder or urethra, even if you carry out ISC
over long periods of time.
How will it affect my life?
ISC using the right catheter is the next best way of passing urine. Once
incorporated into your daily routine, ISC will not prevent you from living a normal life. The only difference is that you will use a catheter
when you empty your bladder. In fact, compared to some alternative
treatments, such as indwelling catheters, ISC will help you to continue
living as normal a life as possible.
Many users tell us that thanks to ISC, they have regained their freedom, that their bladders no longer control them and that they feel they
have regained control. They agree that it felt scary at first but the psychological involvement quickly paid off.
How do I fit ISC into everyday life?
You should create a routine that smoothly fits ISC into your life. Try
to find situations and times of the day that are convenient for carrying
out ISC, such as coffee breaks and before lunch. This will allow you
to manage ISC without it interfering with your work, studies or other
activities. If possible, leave some spare catheters at places where you go
often, such as work, friends’ homes, holiday homes or with relatives.
Will ISC affect my sex life?
ISC should affect your sex life in a positive way. You’ll be able to maintain a sexual relationship without embarrassing leakage or discomfort.
22
“Thanks to Astra Tech and LoFric, my situation is as near normal as
possible. After very short instruction I was able to perform ISC with
no bother at all. It is both simple and painless. Also, with all the
various accessories I can be very discreet when the bathroom door
is closed.”
Joan, age 56, UK
How many times a day should I carry out ISC?
This varies from person to person and will be decided when you are
taught ISC. It depends on the amount of urine you pass each time or the
amount you drain using the catheter (or both). How often you catheterise can also be affected by your specific bladder problem and certain
medications. A general rule is that the bladder should not contain more
than 350 – 400 ml. At first, your ISC teacher may ask you to keep a urine
record and will give you advice on this. You can find an example of a
urine chart that you could use on page 81.
What will happen if I do not catheterise as often as I was told to?
If you miss catheterisation once or twice, don’t worry. However, make
sure that it does not happen often, as this may cause both urinary tract
infections and urine leakage. If the pressure in your bladder becomes
too high, there is a risk that your urine will move up to your kidneys,
which could cause serious injury.
How long will I need to use a catheter?
How long you will need to practice ISC depends on your specific condition. Your need for ISC could be temporary for a short time after an
operation or injury while your bladder regains its normal function, or
permanent; due to a spinal cord injury. But, whatever the reason, ISC
will help you to manage and improve your bladder health.
How will others react?
The fact that you use a catheter is not obvious. Unless you say some­
thing, nobody will notice. However, it might be helpful to feel able to
discuss this with someone close, such as parents or family members. It
can be useful if they can assist you if necessary.
24
“At first, I was scared about learning to catheterise, I didn’t know if I was able to do
it without hurting myself. But it was unneccecary – it is easy to catheterise. As long as
you learn progressively and are relaxed.
Thanks to the LoFric kit I am using, I can catheterise in a car, at school and feel totally
independent.”
Lucie, age 19, France
26
26
Male: Suggested Positions
There are many possible positions. Choose a position that is
suitable based on your specific condition and circumstances.
32
33
Female: Suggested Positions
There are many possible positions. Choose a position that is
suitable based on your specific condition and circumstances.
40
41
What should I think about when
choosing a catheter?
How to try out catheters
When trying out catheters it is important that you get help from a health
care professional. Your catheter must be the right length and diameter.
If the catheter is too short there is a risk you will not empty your
bladder properly, which may lead to urinary tract infection. If the catheter is too long, it may be more difficult for you to handle it. There
is, however, no risk if you insert the catheter too far. The bladder is an
incredibly strong and elastic organ that can easily cope with a pliable
catheter pressing against it from the inside.
A catheter that is too thick (large diameter) can cause unnecessary strain on your urethra. On the other hand, catheterisation will take
longer if you use a catheter that is too thin (small diameter).
Once you know which length and size is right for you, you will
need to select amongst different brands and types of catheters.
Safety
This should be your first concern when selecting a catheter. ISC should
solve problems for you, not create new ones.
Choosing the right catheter
A common myth is that all catheters approved for use in health care
are equally good. In reality, this approval often means that the catheter
offered meets minimum standards. Amongst the available catheters,
some merely meet standards while other surpass them. It is therefore
extremely important that you and your health care professional compare the different options available to select the catheter that is best suited for you.
Hydrophilic catheters give less friction
Hydrophilic catheters have a coating that binds water. The result is a
very wet and slippery surface, which greatly reduces friction against
42
the urethra. Compared with traditional catheters (in combination with
gel), friction against the urethra can be reduced by up to 90–95%.
Not all hydrophilic catheters are the same
Inserting a catheter to drain your bladder is only part of the procedure.
The catheter needs to be removed as well. To ensure minimum friction
when the catheter is removed, the coating must bind and retain water
to the catheter.
The urethra is made to be in contact with urine, which has a high
salt content. If the salt concentration of the catheter coating is the same
as in urine (isotonic to urine), the balance is maintained and the water
remains on the catheter during the entire catheterisation process, ensuring minimal friction.
However, if the salt concentration of the water covering the catheter
is less than in urine (hypotonic to urine), the water may be absorbed by
the urethra. The catheter surface layer can dry out causing the catheter
to “stick” and become difficult to pull out, which can cause injury and
bleeding.
On the other hand, if the salt concentration is higher than that of
urine (hypertonic to urine) the opposite occurs. The surface layer absorbs water, which may irritate the lining of the urethra.
The choice of catheter type has long-term consequences
Several studies show that complications such as urethral strictures (a
narrowing of the urinary passage caused by scar tissue) or epididymitis (swelling of the tube leading from the male testicle to the urethra)
usually only become apparent after some years of catheter use. It is therefore not enough to test different catheters for just a few days to say
which ones are the best for you in the long term.
If you want to be certain to avoid long-term complications, you
should make sure that the catheter’s health implications in long-term
use are well documented. This is a security and your guarantee that the
catheter will not end up injuring you.
44
Other aspects to consider
Hygiene is an important issue
Safe handling and opening is more important than speed. Some catheters offer ways to handle them without touching them directly with
your fingers. This minimises the risk of bacterial contamination and
thus minimises the risk for infections. This can be especially convenient
if it is not possible to wash your hands before catheterisation.
Different models and different applications
Your needs may vary when you are at home, at work or when you are
travelling abroad. No matter where you are – hygiene is always important. Some catheter models are designed to work well in environ­
ments that cannot offer the level of hygiene that you would wish for.
For example, some catheter kits have a urine collection bag and their
own water supply, which is very practical when you have neither access
to a toilet nor to clean water. Catheters that are discrete and easy to take
with you are more convenient.
“I have had a chronic problem with Urinary Tract Infections (UTI’s) since my spinal
cord injury in 1985. I would get three or four UTI’s a year and in January 2001
I started using the LoFric catheter. My UTI’s has been reduced tremendously. I
recommend this product to everyone who has UTI problems because of it is simplicity of use and the benefits of reducing UTI’s is essential to all people with urinary
tract issues. I have felt the best I have in these past years since I began using the
LoFric.”
Steven, Phoenix, USA
45
Facts about LoFric
Over 20 years experience
LoFric has been on the market for over 20 years and is the market’s
most documented catheter. Studies have shown how well LoFric works
in long-term use. Today, LoFric* is the only hydrophilic catheter that
can display documented reduced long-term risk of complications.
The world’s only catheter with Urotonic™ Surface Technology
LoFric is the only catheter with Urotonic Surface Technology – a patented surface layer technology that makes the catheter more comfortable
for the user. The secret behind Urotonic Surface Technology is a chemical process that makes the surface layer isotonic to urine. In plain
English, this means that the salt content in the catheter’s surface layer
is the same as in your urine. And as the urethra is made for urine, this
means that LoFric is carefully matched to the environment it is intended
to be used in, the urethra. The result is extremely low friction between
the catheter and the urethra.
Water
Urotonic™ Surface
Catheter
46
“LoFric is an evidence-based product and would be my first choice for
patients performing ISC.”
Wendy, Paediatric Nurse Specialist, Gloucestershire, UK
Lower friction during insertion and withdrawal
The salt content in urine is higher than in the rest of the body. If you do
not compensate for this, the catheter may dry out and therefore be difficult to withdraw. This is both painful and can lead to serious injury.
A normal hydrophilic catheter has low friction when inserted. Thanks
to Urotonic Surface Technology used on all LoFric friction is also low
when the catheter is withdrawn, even if it has been in for a some time.
This helps you avoid injuries to the urinary tract.
* Documentation available upon request
Six reasons to choose LoFric
1. LoFric is a low-friction hydro­philic
catheter with a unique coating,
designed to reduce friction during
catheterisation.
2. LoFric is the only catheter with
UrotonicTM Surface Technology.
This means that once wet, the
unique surface retains water
throughout the entire catheterisa­tion
process.
3. LoFric is proven to reduce the
risk of pain, damage to the urethra
and associated complications over
long-term usage.
4. LoFric is the most tried, tested
and documented hydrophilic
catheter and is the only hydrophilic
catheter with independent long-term
clinical evidence to support its use.
5. LoFric offers the widest choice of
catheter types, sizes and kits to all
user needs.
6. LoFric is developed in close
cooperation with users and offers
flexible opening options, allowing
you to select the way that suits you
best.
47
Choosing a catheter – Checklist
1. Try out with your health care specialist
Right length
Right size
2. Not all available catheters are the same
Compare to find the best
3. Friction should be kept to a minimum
Hydrophilic for low friction at insertion
Isotonic to urine for low friction at withdrawal
4. Complications occur after a few years of ISC
Make sure your catheter is documented to be safe
for long-term use
5. Other convenience aspects can also your final choice
Easy to use
Different models (pouch, water included) for different needs
Discrete and convenient
Other:
48
LoFric product range
No compromise between safety and convenience. A LoFric catheter combined with water for extra convenience. LoFric Primo is simple to open and use,
foldable and easy to take with you. It can be opened in many different ways
to allow you to select the way that suits you best. Its insertion guide gives you
a firm and hygienic grip.
This is the classic model. Very
simple to use. Just open the
package, fill with water and
let soak for 30 seconds while
you prepare for catheterisation. It is then ready to use.
The first PVC-free LoFric catheter. The LoFric® Plus is made
of a green colou­red PEBA
(poly ether block amide) material – a thermo­plastic without
chlorine and plasticisers. Its
material pro­perties combined
with the Urotonic™ Surface
Techno­logy offer even lower
friction than the classic LoFric
catheters.
A catheter kit including a LoFric catheter, water and a collection bag. Every­thing you
need for safe and convenient
catheterisation. With LoFric®
Hydro-Kit™ II you don’t need
to worry about access to a
toilet or clean water. You can
use it anywhere, anytime. It is
perfect for home use, journeys
and an active life.
A system combining a LoFric
catheter and collection bag.
An excellent alternative when
access to a toilet is limited.
Types, tips and sizes
52
Nelaton tip
This is the most common tip on LoFric
catheters. The catheter is straight and
has a rounded tip. It is available in several styles for men, women and children.
Tiemann tip
This is a catheter with an angled, tapered tip, specially designed for men with
tight urinary tracts, prostate problems or
strictures.
Four different lengths
40 cm For men
30 cm For children
20 cm For women and children
15 cm For women
Ten different sizes
LoFric catheters are available in sizes
from CH 06 to CH 24. CH is a measure
of the catheter’s diameter. The difference between each measure is 1/3 mm.
The colour of the connector shows the
diameter of the catheter.
Packaging
Top opening
The top of the box has a perforated surface. Tear it away as shown in the picture for
fast and easy access to your catheters.
Side opening
The box can also be opened from the side. By opening the box in this way, you can
open and close it when you want.
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2
1
3
4
5
6
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Our Accessories
We also offer a number of accessories the simplify catheter handling.
Product pouch. Allows you to carry your catheters for the day in a discreet
manner. To guarantee that your catheters stay in perfect condition, we recommend
that you put them in the pouch in the morning and remove any that you have not
used that evening.
1
Product pouch. Put your catheters here and you are ready for the day. To
guarantee that your catheters stay in perfect condition, we recommend that you
put them in the pouch in the morning and remove any that you have not used that
evening.
2
Medical validation certificate. A certificate that explains in five languages that
your LoFric products are prescribed by a doctor. If necessary, you can show this
declaration to the Customs Officer when travelling abroad.
3
Our antibacterial wet wipes are useful when you don’t have water and soap
to wash your hands.
4
If you have limited strength or mobility in your hands you may find our catheter handle useful.
5
6 A mirror can be helpful for women, as it makes it easier to locate the urethra
when learning to catheterise.
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Instructions
Extra large loop
• Easy opening
• To hang the catheter package
Adhesive area on back
keep the product folded
• To hang the package
• To close the water pocket
• To
Easy Peel-open packaging
• Open with minimal strength
• Alternative opening solutions
to meet your preferences,
needs and situations
LoFric® catheter
most documented
• Urotonic™ Surface Technology
• Minimal friction during insertion
• Minimal during withdrawal
• The only catheter that can show
clinical proof of reduced risk of
injuries during both short-term
and long-term use
• World’s
Extra large loop
• Easy opening
• To hang the catheter package
Sterile water
• A light press on the water-pocket releases
the water to activate the catheter’s surface
layer
• No worry about water quality
• Ready when you are
• Separate water for a small, foldable and
discreet package
Insertion guide
• Better grip
• Better control
• Better hygiene
Since the water is separate, the
packaging is small and foldable. It
fits easily in your pocket.
Developed with the user in mind
The basic idea behind LoFric Primo is to make catheter use more simple and convenient – without compromising your safety and long-term health. In LoFric Primo
we have succeeded in combining the world’s most well documented catheter
with packaging that is discreet and very simple for everyone to use. Thanks to
LoFric Primo, you don’t have to choose between convenience and safety.
Instructions
Opening 1 (Sterile opening)
1
2
4
5
3
B
A
6
C
1. Unfold the package. Hold it with the instruction images facing you.
2. Hold the package straight up. Fold the water pocket along the bluewhite border, so that the instruction images are partially covered. 3.
Press the water pocket with both thumbs to make the water flow down
to the catheter. Alternative: Instead of folding the water pocket you can
roll it like a tube (see picture), then press out the water. 4. Hang LoFric
Primo using the upper loops or the self-adhesive area. Let the catheter
soak for 30 seconds, while you prepare for catheter insertion. 5A. Peel
open the packaging. Hold the package at the loops with both hands.
Keep a firm grip and your hands close together, then pull hands slowly
apart. B. Take a new grip further down. C. Continue opening until you
see the catheter’s coloured connector. 6. Remove the LoFric Catheter
from the package and insert the catheter.
59
Opening 2 (Using the insertion guide)
1
2
3
4
5
6
8
9
10
7
1. Unfold the package. Hold it with the instruction images facing you.
2. Hold the package straight up. Fold the water pocket along the bluewhite border, so that the instruction images are partially covered. 3.
Press the water pocket with both thumbs to make the water flow down
to the catheter. Alternative: Instead of folding the water pocket you can
roll it like a tube (see picture), then press out the water. 4. Hang LoFric
Primo using the upper loops or the self-adhesive area. Let the catheter
soak for 30 seconds, while you prepare for catheter insertion. 5. Turn
the package upside down and let the water return to the pocket. 6.
Twist the water pocket slightly (on the level of the instruction pictures)
to make the water flow back easier. 7. Tear at indentation A from both
sides and remove the water pocket. 8. Fold the top of the water pocket
over the adhesive area. 9. Tear at indentation B from both sides. 10. The
remaining part can be used as an insertion guide for a hygienic grip.
You can insert the catheter without touching it with your fingers.
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“Now with the new LoFric Primo it is even better because
when I’m at work or out and about everything I need is in
one simple small package concealed in my handbag. LoFric has made what I thought was going to be a difficult,
embarrassing situation into a simple procedure.”
Joan, Hampshire, UK
Hints and tips
Releasing the water. Make sure not to block the indicated area by applying any pressure (see illustration). This area is designed to open up so
that the water in the water pocket can flow down and soak the catheter.
If you press on this area at the same time as you try to release the water,
the water will most likely leak through the sides of the water pocket in
an uncontrolled way.
An alternative way of opening is
to first roll the water pocket until
you reach the adhesive area, press
the water pocket to release the water and then unfold the product.
62
You can activate a rolled or fold­
-ed product with your teeth, by
biting it.
Opening the packaging. For easier
opening, tear half-way first, turn
the package over and tear the other half. Tear in a fast and decisive
manner to make it even easier.
To make opening easier, make
sure that the catheter/funnel-end
of the catheter is not sticking out
where you are going to tear the
packaging. If it is, push it down
before you tear.
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Folding the packaging. LoFric Primo 15 and 20cm can be folded for easy
and discreet transport during the day. Unfold the product and roll it
up by keeping the water pocket still and wrapping the catheter part 1.5
rotations around it (see illustration). Use the adhesive area to lock the
catheter and the lower loops in position. To preserve full functionality
of the catheter, fold the catheter tube loosely and only for the day.
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LoFric Primo 40 cm can be folded for easy and discreet transport during
the day. Unfold the product and roll it up by keeping the water pocket
still and wrapping the catheter part 2.5 rotations around it (see illustration). Use the adhesive area to lock the catheter and the lower loops in
position. To preserve full functionality of the catheter, fold the catheter
tube loosely and only for the day.
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Connector. Has different
colours depending on the
diameter of the catheter.
Catheter. Produced
in medical grade PVC. The
diameter is measured in
Charrière (1 CH is 1/3 mm).
A classic LoFric, but without PVC
Today there is constant pressure to reduce
the use of PVC in products. This is mainly
because PVC contains chlorine and plasticisers. LoFric Plus is made of PEBA, a
PVC-free plastic made without chlorine
or plasticisers. In addition, the outer layer
combined with the softer and more flexible
plastic results in an even greater ability to
attract water, making catheterisation even
more convenient for you as a user.
Hydrophilic surface layer with
Urotonic™ Surface Technology. Guarantees low friction during insertion
and withdrawal.
Eyes. The side holes where
the urine runs through.
Catheter tip. In two different types:
rounded (Nelaton) and tapered
(Tiemann).
The catheter with over 20 years of experience
LoFric is our standard catheter, available for men, women and children and in
different types, tips and sizes. Use of LoFric will make emptying your bladder
as natural, simple and kind to you body as possible. It is very easy to use and
provides low friction both during withdrawal and insertion, thanks to the unique
water binding outer layer provided by Urotonic Surface Technology.
Instructions
1
2
3
4
5
30+
sec
1. Wash your hands with soap and water. 2. Open the package by pulling the flaps apart 5 – 6 cm. 3. Pour water directly into the package.
You can use drinking water, sterile water or a sodium chloride solution.
4. The package has an adhesive sticker. Remove the blue protective
strip and attach the package to a dry surface. 5. Soak the catheter for 30
seconds while you prepare yourself. Carry out the catheterisation.
67
For females and children
Sterile water
• Ready when you are
• No worries about water quality
• Easy water release
• Separate water for a small, foldable and discreet package
• Fold and press to release the water
and activate the coating
Graduated collection bag
• 1000 ml
• Suitable for daytime and
night time use
Emptying possibility
to empty the bag
• Tear
Possibility to separate catheter
from collection bag
• Usage without collection bag
• Separate disposal
• Easy emptying of the collection bag
Insertion guide
• Better grip
• Better control
• Better hygiene
Loop
• To hang the catheter kit
• To help support the collection bag
during catheterisation
LoFric® catheter
• World’s most documented
• Urotonic™ Surface Technology
• Minimal friction during insertion
• Minimal friction during withdrawal
• The only catheter that can show clinical
proof of reduced risk of injuries during
both short-term and long-term use
The kit that gives you more freedom
LoFric Hydro-Kit II makes it easier. It combines everything you need in a smart
package that is small and very easy to carry with you. LoFric Hydro-Kit II has its
own water, so you don’t need to worry about the availability or the quality of
the water. It has an insertion guide, which gives you a firm grip without touching
the catheter. Moreover, you don’t even need a toilet – the collection bag can be
used anywhere. The only limit is your discretion.
For males
Graduated collection bag
• 1000 ml
• Suitable for daytime and
night time use
Emptying possibility
to empty the bag
Sterile water
• Ready when you are
• No worries about water quality
• Easy water release
• Separate water for a small, foldable and discreet package
• Fold and press to release the water
and activate the coating
• Tear
Possibility to separate catheter
from collection bag
• Usage without collection bag
• Separate disposal
• Easy emptying of the collection bag
Insertion guide
• Better grip
• Better control
• Better hygiene
Loop
• To hang the catheter kit
• To help support the collection bag
during catheterisation
LoFric® catheter
• World’s most documented
• Urotonic™ Surface Technology
• Minimal friction during insertion
• Minimal friction during withdrawal
• The only catheter that can show clinical
proof of reduced risk of injuries during
both short-term and long-term use
Alternative tear indentation
• To expose only the top part
of the catheter
Pre-folded and ready to go
Instructions
1
2
3
30+
sec
4
5
6
7
8
9
1. Hold the product upright. Fold the water sachet and squeeze. Let the
water run down to the catheter. 2. Use the loop to hang up the product.
Soak the catheter for 30 seconds while you wash your hands and prepare yourself. 3. Turn the product upside down to allow the water to
drain into the collection bag. 4. Tear at indentation “A” to uncover the
tip of the catheter. 5. Tear at indentation “B”. 6. Use section “B” as an
insertion aid. Catheterise. 7. Push the catheter into the collection bag.
8. Tie a knot to seal the bag. 9. Empty the collection bag by tearing
at the indentation. The water sachet contains sterile water that should
only be used for soaking the LoFric Catheter.
Hint: To ensure a tight seal between the catheter and the collection bag before
catheterisation: gently pull the catheter out of the packaging until the connector
comes to a full stop.
! Hint: After catheterisation, you can throw away the collection bag and the catheter separately by tearing at indentation ”C”.
!
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Opening for water. Fill with approximately 30 ml water
and let the catheter soak for
30 seconds while you prepare
yourself for catheterisation.
Emptying possibility. Tear to empty
the bag.
Graduated collection bag.
“LoFric catheters have reduced the number of
bladder infections and the irritation caused by
standard catheters. The catheter with bag is great
for anytime that I cannot access an accessible
bathroom. Just a little water and I am ready to go.
I Would highly recommend LoFric catheters.”
Victor, Scottsdale, USA
Hydrophilic catheter with Urotonic™ Surface
Technology to ensure the lowest friction
during insertion and withdrawal.
It is about making everyday life a little easier
LoFric® Cath-Kit™ combines all the benefits of the LoFric catheter with the convenience of a urine collection bag. LoFric Cath-Kit is very useful in situations when
access to a toilet is limited but clean water is easily available.
Instructions
1
2
3
30+
sec
4
5
6
1. Hold the bag upright and fill with approximately 30 ml water (drinking water, sterile water or sodium chloride solution). 2. Tie the bag.
Soak the catheter for at least 30 seconds while you prepare yourself.
3. Invert the product and tear off the flap. 4. Pull the catheter out and
perform the catheterisation. 5. Push the catheter back into the bag and
tie the bag. 6. The bag is equipped with a tearing slit for emptying.
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Questions and answers
How often should I wash my genital area?
To avoid washing away the natural bacteria that protect us from infection, it is recommended that you wash your genital area once a day with
mild soap and water. It is a good idea to clean your genital area when
catheterising after a bowel movement.
What if I can’t insert or withdraw the catheter?
Don’t worry. This is usually because you are tense and the sphincter
muscle is not relaxed, so relax and try again. Coughing may also help to
loosen the catheter by relaxing your muscles. Never force the catheter
in or out. If you are still having problems, contact your doctor or nurse
for advice. Never try to cut a catheter if you are having problems inserting or withdrawing it. Always contact your doctor or nurse. Men with
narrow urethral passages can use a Tiemann catheter from the LoFric
range, as the slightly curved tip tends to facilitate insertion.
Do my bowel habits affect catheterisation?
It is always best to avoid becoming constipated as this may interfere
with your ISC. Try to eat a well balanced diet with plenty of fruit and
vegetables. If you do become constipated, speak to your doctor or
nurse.
How much should I drink?
It is usually recommended that you drink at least six to eight glasses of
fluid every day. Try to limit the amount of tea and coffee you drink, as
the caffeine in these can irritate your bladder.
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What can I do to avoid a urinary tract infection (UTI)?
1. Hygiene
A. Make sure to wash your hands and genital area well prior to catheterisation.
B. Make sure to use clean water when you activate your catheter.
C. Make sure the catheter surface does not come in contact with any­
thing before entering the urethra.
2. Empty totally
A. Urine is a good environment for bacterial growth, so it is important
that you completely empty your bladder.
B. Once the urine flow stops, it could be because the eyes of the catheters are above the urine level in the bladder. To make sure you have
emptied your bladder completely, remove the catheter slowly/stepwise
and stop if more urine starts to flow.
C. To make sure you empty your bladder properly, your upper body
should be elevated during catheterisation.
3. Empty frequently
A. The volume per catheterisation should by clinical experience and
studies not be more than 400 ml – this closely mimics the function of a
normal bladder and maintains muscle tone.
B. If the volume is large, the bladder wall is extended and the mucous
membrane can be damaged, which makes it easier for bacteria to attack
and cause a UTI.
4. Choice of catheter
Use a catheter with low friction. The theory is that high friction leads to
microtrauma in the urethra, which can help bacteria to get a foothold
in the mucous membrane. By decreasing friction, you decrease the risk
of infection.
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How do I know if I have a urinary tract infection (UTI)?
If you experience shivering, a high temperature or fever, or cloudy or
smelly urine, you may have an infection. Drink extra fluids, continue to
catheterise and contact your doctor or nurse for advice.
What do I do if I see blood in my urine?
It is normal to see a few specks of blood in your urine when you are first
starting ISC, but it should clear up in a few days. If it continues or gets
worse, contact your doctor or nurse, as this may be a sign of urinary
tract infection.
What if no urine drains when catheterising?
If no urine drains when you are inserting your catheter, gently remove
the catheter and contact your doctor or nurse.
Where do I store my LoFric catheters?
Your supply of LoFric should be keep flat, dry and away from direct
sunlight, extreme cold or damp areas. Do not tie them in bundles with
string. You may fold the catheters loosely for easy transportation during
the day. Just make sure to unfold the unused catheters in the evening,
to ensure that the catheters remain in perfect condition. Remember to
check the expiry date of your catheter before you use it. This is printed
on the outer pack of each catheter.
Am I still able to travel?
Yes, of course. Astra Tech can provide you with a Medical Validation
Certificate stating that the LoFric catheters you are taking with you are
for emptying your bladder. This can save you a lot of trouble with Customs officials. If you have any doubts about the quality of water abroad,
use LoFric Primo or LoFric Hydro-Kit II, which both have their own
water supplies. Remember to take enough LoFric catheters with you and don’t
forget to pack some in your hand luggage.
Is the LoFric catheter reusable?
LoFric must not be re-used and cannot be re-sterilized. The unique iso76
tonic surface only works once on each catheter. Never try to reuse a
LoFric catheter.
Do I have to use sterile water to wet the surface?
If you use LoFric Primo or LoFric Hydro-Kit II, you do not need to
worry about water as it is already included. With products that do not
already include water, you should follow the recommendation of your
health care provider. In most cases, regular tap water can be used but
recommendations may vary depending on local factors such as the water quality.
What should I do when I have my period?
Hygiene is particularly important when you menstruate. You should
wash the genital area with mild soap prior to each catheterisation. To
avoid getting blood on the catheter you could change your tampon before emptying the bladder. You could also hold a piece of toilet paper in
front of the vaginal opening while you insert the catheter.
What happens if I become pregnant?
During pregnancy, just continue catheterisation as usual. Intermittent
self catheterisation (ISC) will do no harm to you or your child. You
should talk to your health care professional for further advice about catheterisation as your pregnancy progresses, as you may need to change
the length of the catheter you are using.
For more information, tips and advice regarding ISC with LoFric, please visit our
internet site at www.lofric.com or contact us directly at +46 31 776 3000.
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Personalised Care Plan
User name:
Doctor/Nurse:
Contact telephone:
Emergency contact:
LoFric type:
Size:
Ref.no:
Frequency of
catheterisation:
Timetable:
Follow-up by:
Doctor/Nurse
Community Continence Advisor
District nurse
Follow-up appointments
date
Follow-up complete?
Signature:
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time
location
Date:
Notes
79
Notes
80
Notes
DATE
Glasses
of
fluid
per day
1
2
3
4
Urine passed if able to (ml)
5
6
1
2
3
4
5
Volume of urine drained with each
catheterisation (ml)
6
Urine Record Card Example
81
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Userful links
LoFric
www.lofric.com
The International Continence Society
www.continenceworldwide.org
Disabled Peoples’ International
www.dpi.org
The World Institute on Disability (WID)
www.wid.org
The International Federation for Spina Bifida and Hydrocephalus (IF)
www.ifglobal.org
The Multiple Sclerosis International Federation
www.msif.org
Rehab-International (RI)
www.rehab-international.org
USA
UrologyHealth
www.urologyhealth.org
UK
Spinal Injuries Association
www.spinal.co.uk
International Alliance of Patients’ Organizations (IAPO)
www.patientsorganizations.org
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We at Astra Tech have worked in close co-operation with health care professionals since the 1940’s. Our business today is focused on medical devices and dental
implants. LoFric is a good example of our goal of integrating medical research and
modern material technology. The aim is to create sophisticated products that improve the user’s quality of life and simplify the work of health care professionals.
Astra Tech AB, P.O. Box 14, SE-431 21 Mölndal, Sweden.
Phone +46 31 776 30 00. Fax +46 31 776 30 10. www.lofric.com
77767-GBX-0508
What is Astra Tech?