Learning self-catheterisation: who trains you, what you need to know

Key facts at a glance

• Legally, catheterisation in Germany is a medical activity that can be delegated to qualified nurses – and that patients and family members may take over themselves after instruction
• Good instruction is a prerequisite, not an extra: it covers more than the hand movements
• Training should replicate everyday life – on the toilet, in the wheelchair, with the material that will actually be used later
• You may try different systems; samples should be kept where training takes place
• Health insurance funds may not limit the quantity by reference to guide values; lubricants and disinfectants are reimbursable

The idea of inserting a catheter yourself several times a day puts almost everyone off when they first encounter it. Those who then learn it often report the opposite: intermittent self-catheterisation gives back independence. The clinical guideline devotes a chapter of its own to learning – this article summarises it.

Who may catheterise

The guideline classifies the legal situation in Germany as follows:

“According to the current legal view, performing catheterisation is (in Germany) a medical activity that can be delegated to qualified nurses with three years of training.”

For you yourself: “A prerequisite for performing IC is good instruction in catheterisation.” And for those around you: “Family members can also perform IC on the person concerned with their consent. They are then individually instructed in the catheterisation of the individual person concerned.” A doctor establishes the indication; after training, performance lies with you.

What makes good training

The guideline is unusually specific here – and its requirements are a good yardstick for judging your own instruction.

Everyday life is replicated

“In the course of training, everyday life should be replicated as far as possible, e.g. catheterisation on the toilet or in the wheelchair, and the procedures repeated and checked.” Anyone who only practises in a hospital bed learns a situation that does not occur at home.

The material fits you – not the other way round

The choice of catheter must be “individually matched to the motor and cognitive resources of the patients concerned”. It may be necessary to use different systems for different situations – for example with an integrated bag when out and about and without at home. The guideline recommends “starting with a system that experience shows many patients can catheterise with” and trying others over time. For this, different systems should be kept where training takes place – at least display samples that are ordered for trial if required.

More than the hand movements

“Instruction covers not only the performance of catheterisation, but also the regular checking of urine appearance and volume as well as the procedure when problems occur.” Anyone who does not know after training what to do about blood on the catheter, resistance or cloudy urine has not been fully trained.

Aids to make it easier

Mirrors, penis supports, insertion aids: such samples “should be presented to the patient”. With limited hand function, occupational therapy can trial aids; physiotherapy helps with sitting position and transfer. Anatomical charts and demonstration models make it understandable where the catheter goes – this takes away much of the fear.

Who may train

“Apart from specialist knowledge of the bladder emptying disorder and catheterisation, pedagogical skills are indispensable prerequisites for lasting training success.” The person training should know the common systems and complementary aids in order to be able to compensate for functional deficits.

The technique in brief

At home, aseptic catheterisation in non-touch technique is usually taught. The guideline names for this:

• hygienic hand disinfection – it is considered “mandatory”; washing hands alone is often not enough, for example if you then push on the wheels of a wheelchair
• a sterile single-use catheter
• disinfection of the urethral opening
• if lubricant is used, it must be sterile
• for catheterisation by another person, additionally non-sterile gloves

Two figures are part of basic training: in adults, the bladder should not exceed 500 ml per catheterisation, and the frequency is based on this – in a German survey between two and ten times a day, most often six times. A voiding diary in the first weeks shows which rhythm suits you. On choosing size and tip shape, see our article on Charrière size; on infection prevention, the article on urinary tract infections.

What the insurance fund pays – and what it may not do

The guideline takes a clear position on the health insurance funds:

“Attempts by health insurance funds to restrict the number of catheters (e.g. by referring to so-called product guide quantities, consumption guide values, quantity specifications for standard care) and/or to prescribe the type of catheter are fundamentally to be rejected.”

Mixed care is often necessary – catheters plus absorbent and other drainage aids. Limiting to one urine bag per day also “does not do justice to the goal of social reintegration of IC users”.

A point where things often get stuck in doctors' practices: lubricants and mucosal disinfectants are not prescription-only – but still reimbursable. The OTC exception list of the German Pharmaceuticals Directive lists under number 8 “antiseptics and lubricants only for patients with catheterisation”. If the prescription is refused with the remark that the product is “not prescribable”, this is a mistake according to the guideline: the indication for catheterisation must be documented on the prescription, then the fund pays.

Catheters themselves are medical aids – and as such “neither budget- nor guide-value-relevant” for the practice. How the supply process works is explained in our article on medical aids on prescription.

Frequently asked questions

How long does it take to learn?

The guideline gives no figure, and that is honest: it depends on hand function, anatomy and practice. What matters is that training is repeated and checked until the procedure is secure – not how many sessions that takes.

Can my partner take it over?

Yes, with your consent and after individual instruction. For catheterisation by another person, non-sterile gloves are part of it.

Do I have to stay with the first system?

No. The guideline expressly provides for other systems to be tried over time. If your supplier has no samples, ask for them – they should be able to order them.

Where is training provided?

In hospital or rehabilitation, in continence centres and by specialised nursing professionals – also at home. Ask about qualifications: specialist knowledge and pedagogical skills, according to the guideline.

What if it does not work?

Then the material or the technique is usually the reason, not you. The guideline lists solutions for every problem – resistance, blood, pain – from a different tip shape to an insertion aid. Raise it instead of giving up.

Your next step

We stock single-use catheters from Coloplast, Hollister, Manfred Sauer, Wellspect and B. Braun in all sizes, tip shapes and coatings – with and without integrated bag. We put together display samples for trial on request.

Sources

• S2k guideline “Management and performance of intermittent catheterisation in neurogenic lower urinary tract dysfunction”, AWMF register number 043-048, version 3.0, February 2026 – chapters 2, 4, 5.1 and 7 (in German)
• Pharmaceuticals Directive of the Federal Joint Committee, Annex I (OTC overview), number 8 (in German)