Urethral intermittent catheterisation in adults - CATHETER MATERIAL, TYPES OF CATHETERS AND EQUIPMENT

7. CATHETER MATERIAL, TYPES OF CATHETERS AND EQUIPMENT

7.1 Catheter material

Single-use medical devices have been under close scrutiny for several years; especially the choice of material. Many different requirements such as medical safety, treatment functionality and efficiency, patient comfort, and environmental performance must be considered. There is an increasing demand from the community for polyvinyl chloride (PVC)-free materials and their phthalate components in medical devices. [95] According to REACH (EU chemical regulation), phthalates are harmful and hazardous to the human body. Products containing classified phthalates must be labelled according to the Medical Devices Directive (93/42/ECC) as of March 2010. Finding good alternatives to phthalates is a technical challenge, but for some products phthalate-free alternatives are available.

Polyvinyl chloride

PVC is a thermoplastic polymer that is cheap, durable and flexible. PVC catheters are clear plastic and usually single use. PVC catheters exist in harder or softer versions, giving the catheter the correct rigidity, stability and buckling resistance for individual application. [95] To make the PVC catheter soft and flexible, plasticisers are used and they are not chemically bound in the polymer molecules. [96] As a result, these may cause problems (e.g., skin reaction).

Silicone

Silicone (group of synthetic polymers) is one of the most biocompatible synthetic materials available, thus offering reduced toxicity and tissue inflammation, and resistance to UV light. Silicone catheters are durable but highly flexible. Silicone devices can be manufactured with a thin wall, thus creating a large drainage lumen in relation to the external diameter. [96, 97]

Ethylene vinyl acetate

Ethylene vinyl acetate (EVA) also known as poly ethylene vinyl acetate (PEVA) is a polymer of ethylene and vinyl acetate that is similar to elastomeric materials in terms of softness and flexibility, yet can be processed like other thermoplastics.

7.2 Catheter lubrication/coating

The purpose of using lubrication is to reduce friction and thus protect the sensitive urethral mucosa during catheter insertion and removal. [98] Currently, most catheters have a hydrophilic coating that reduces friction between the urethral mucosa and the catheter. Apart from the hydrophilic coatings, there are plain PVC or silicone catheters that come packed with a separate gel/lubricant, or as pre-lubricated catheters with a gel coating applied.

Fig. 2 Example of a catheter packed with gel or water
(Courtesy of Manfred Sauer GmbH)

Different types of lubricants can be distinguished:

Lubricants with/without out anaesthetic lignocaine/lidocaine and/or chlorhexidine
Lubricants with chlorhexidine (antiseptic)
Lubricants with water and glycerine

Sterile lubricants are always for single use. An open package should not be used again.

Hydrophilic and gel coatings

Hydrophilic-coated catheters are characterised by a layer of polymer coating that absorbs and binds water to the catheter up to 10 times its own weight. This results in a thick, smooth and slippery surface reducing friction between the catheter surface and the urethral mucosa during insertion. The coating layer remains intact upon introduction into the urethra and ensures lubrication of the urethra throughout its length. [99]

Several companies produce a variety of products with a hydrophilic coating.

Some products require the addition of water for 30 s to activate the catheter coating (e.g., EasiCath®, FloCath®, Hi-slip®, IQ-Cath®, Magic3®, and VaQuaTM Catheter)
Others are presented pre-packaged with water or saline (e.g., LoFric®, SpeediCath®, IQ-Cath® and VaPro™)
Or with an inert transparent water-soluble gel that self-lubricates the catheter as it is advanced from the packaging (e.g., InstantCath Protect®, UroCath gel®, Actreen®, and IQ-Cath® gel).

7.3 Catheter tips

7.3.1 Nelaton

The Nelaton catheter is the standard catheter and has a soft rounded tip that is flexible with a straight proximal end. It has two lateral eyes for drainage that are often polished for comfort.

7.3.2 Tiemann/Coudé

The Tiemann (also known as Coudé) catheter has a slightly curved and tapered tip with up to three drainage holes. This type of catheter is particularly useful in individuals with a narrow urethral passage or prostatic obstruction. The angled tip gives directional stability, and the tip is slightly more rigid than a standard type to allow easier insertion through obstructed areas.

7.3.3 Flexible rounded tip

The flexible rounded catheter tip permits passage into almost any orifice and the urethra, irrespective of configuration, tortuosity, or degree of obstruction. Its flexibility can cause a lack of control for some patients.

Fig. 3 Flexible tips with various Charrières

Ergothan tips
(Courtesy of Teleflex Ltd.)

7.3.4 Pointed tip

The pointed tip is squeezable and has a bendy end. This tip can be useful in case of obstruction and dilatation because the Charrière increases in size along the first centimeter of the catheter. The tip ends in a ball to prevent the catheter becoming trapped in the urethra.

Fig. 4 Pointed tip

IQ-Cath®
(Courtesy of Manfred Sauer GmbH)

7.3.5 Introducer/protective tip

It is assumed that many urinary tract infections are caused during intermittent catheterisation (IC) when the catheter tip passes through the colonised portion of the urethra, pushing the bacteria further into the urinary tract. A sterile introducer/protective tip catheter system seems to allow the catheter to bypass the colonised portion of the urethra. [100]

The Working Group did not find any studies to underpin the advantages of the introducer/protective tip.

Fig. 5 Example of an introducer/protective tip
(Courtesy of V. Geng)

7.3.6 Micro-hole zone catheter

The micro-hole zone technology catheter has more than 80 micro-holes instead of 2 or 3 eyes for emptying, which empties the bladder completely in one free flow without the need to reposition the catheter. The micro holes may prevent suction in the bladder, and subsequently reduce the risk of microtraumas and residual urine. [101]

Fig. 6 Micro-hole zone catheter

Luja TM
(Courtesy of Coloplast)

7.4 Catheter diameter, length and connectors

7.4.1 Size

The external diameter of intermittent catheters is measured in millimetres and is known as the Charrière scale (Ch or CH) or French scale (F, Fr or FG) which measures the circumference. Sizes range from 6 to 24. Female adult sizes are commonly 10–14 and male adult 12–14, although larger sizes are used for treating strictures. [102] The catheter chosen should be large enough to allow free flow of urine without causing damage to the urethra. Irrespective of the choice of catheter, the connection is universally colour coded to denote the size of the catheter. The colour coding of the sizes and connectors is the same (see 7.4.3. Catheter connectors).

7.4.2 Length

Intermittent catheters are available in both male and female lengths (~40 cm and 7–22 cm, respectively).

7.4.3 Catheter connectors

Catheter connectors generally have standardised colours, relating to size, for ease of recognition (see Table 11). The colours are international, but not every manufacturer uses the colour coding, so it is necessary to check the packaging and connector for size confirmation. (Connectors are generally attached during the manufacturing process and are already in place.)

Table 11. Standard catheter connector colour chart

Catheter size (Fr)	8	10	12	14	16	18	20	22
Colour
Tube diameter (mm)	2.7	3.3	4	4.7	5.3	6	6.7	7.3

Luer lock connector

A Luer lock connector is connected to a catheter when irrigating (or instilling) the bladder. This can be attached to the pre-installed connector. It is also possible to use a catheter with a standard connection and use a special connector with a Luer lock on one side and tip on the other side to insert the connector.

Fig. 7 Example of catheter with Luer lock connector

B. Braun
(Courtesy of V. Geng)

Fig. 8 Example of Luer lock adapter

B. Braun
(Courtesy of V. Geng)

7.5 Catheter packaging and disposal

Packaging for catheters and catheter sets can vary with regard to opening. Packaging should be considered when choosing catheters for patients with reduced dexterity.

If a urine bag is attached to the catheter, it can be easily drained by pulling a tap or cutting the bag with scissors. Once urine is discarded the used catheter can be discarded with the packaging.

In the community, packaging waste can be reduced by dispensing with outer packaging only or ordering bulk containers.

7.6 Types of catheters

Several types of catheters and sets are available for IC. Diagram 3 gives an overview of the existing types. The catheters illustrated in this document are examples only, and not exhaustive.

Diagram 3. Types of catheters

Standard catheter

Standard types of catheters have no bag attached, are easy to store when travelling, discreet, and easy to dispose. Standard catheters enable the patient to pass urine via the catheter directly into the toilet.

Complete catheter set

Complete catheter sets contain a catheter connected to a urine bag that enables the patient to measure residual volume with ease, is convenient when the patient needs to catheterise in a non-hygienic area or lying on a bed. Clinical practice shows that patients with reduced dexterity sometimes find sets easier to use because urine is contained. Sets can be used for aseptic or non-touch techniques.

7.6.1 Single-use catheter

All the catheters are available in male and female versions.

7.6.1.1 Single-use catheter without coating

Single-use sterile catheters without any equipment and no coating can be used with lubricants.

Single-use catheters in hospitals are often used in combination with standard catheter sets.

Non-coated catheters are widely considered in the literature to cause an increase in urethral irritation, poor patient satisfaction, increased bacteriuria, and long-term urethral complications, although there is a lack of hard evidence to support this. [24]

Fig. 9 Single use catheter

EasiCath®
(Courtesy of Coloplast)

7.6.1.2 Single-use catheter with coating or gel

Single-use sterile catheters with hydrophilic coatings are a ready-to-use solution, with gel on the surface of the catheter or in the wrapping. As the name suggests, these catheters are designed for single use and are precoated to allow ease of insertion and removal, thereby reducing the risk of urethral mucosal irritation that can be more prevalent with an uncoated product. [103]

7.6.1.3 Catheters with sleeves or non-touch catheters

In catheters with a plastic sleeve or plastic grip, the sleeve/grip around the catheter is used as guide to introduce the catheter without touching it. There are two types:

1) catheter with a plastic sleeve/grip around it (sleeve/grip does not cover the catheter completely)

Fig. 10 Male catheter for non-touch use

LoFric® OrigoTM Insertion Grip
(Courtesy of Wellspect)

Fig. 11 Female catheter partly covered by a sleeve/grip for non-touch use

Liquick® Base (Teleflex)
(Courtesy of V. Geng)

2) catheter with a plastic sleeve completely covering the catheter, so that the catheter can be inserted safely without sterile gloves and without touching the catheter, available for men and women.

Fig. 12 Sleeve catheter for men
(Courtesy of Manfred Sauer)

7.6.1.4 Meatal dilator /meatal dilatation catheter

Meatal dilators are used for dilatation of the penile urethral meatus. There are different sizes and tips, and ideally they are hydrophilic-coated.

Fig. 13 Hydrophilic meatal dilators

WyCath Meatal Dilators
(Courtesy of Flexicare)

Fig. 14 Meatus dilatation catheter

LoFric® Dila-CathTM
(Courtesy of Wellspect)

7.6.2 Catheter systems/complete sets

Most of the above-described catheters are also available as catheter set or complete set; the lubrication is the same as in single-use catheters. The catheters are pre-connected with a urinary bag. However, there is a difference in handling and how to use them with a non-touch technique. For details, refer to the manufacturer’s insertion instructions.

Complete sets usually contain a catheter suitable for IC, a drainage/reservoir bag to collect the urine, and a lubricant or activator such as water if the catheter is hydrophilic. These sets are ideal for use in confined spaces or restricted facilities such as aeroplanes, building sites, or extremely rural settings where access to toilet facilities may be limited. They are particularly useful for wheelchair users and those patients who catheterise from a seated or prone position.

7.6.2.1 Discrete/compact catheters

Some manufacturers offer a compact intermittent catheter that is small and therefore more discreet. The small packaging is more convenient, and the products are sterile and for single use. Compact intermittent catheters for women are available from different companies. Only one company also offers male compact catheters (see table in section 7.7.2).

The female catheters are designed specifically for the short urethra and are smaller than a standard writing pen, whereas the male version is less than half the size of a standard intermittent catheter.

The compact products have the same coating/lubrication as the standard-length products. Both are easy to use and dispose, offer a simpler storage solution, and can be used with a non-touch technique. Manufacturers that offer a compact style intermittent catheter also offer additional products specifically for these catheters, such as drainage bags.

Fig. 15 Various female compact catheters. The top catheter is partly covered by a sleeve/grip

Pictured from top to bottom are: Liquick® Base (Teleflex), SpeediCath® Compact Female (Coloplast), LoFric® SenseTM (Wellspect), Actreen® Lite Mini (B. Braun)
(Courtesy of V. Geng)

Fig. 16 Telescope catheter

SpeediCath® Compact Male catheter (Coloplast)
(Courtesy of Coloplast)

7.7 Examples of catheters with type of material and coating

This subchapter shows examples of different types of catheter/catheter set from various countries, selected by the international working group. The information in the table was provided by the manufacturers on request. This list does not pretend to be exhaustive.

7.7.1 Catheters and catheter sets

(in alphabetical order company name)

* The Nordic Swan Ecolabel is an environmental labelling scheme certifying that a product or service complies with the requirements for the label. The Nordic Swan Ecolabel offers:

- A recipe on how to reduce the environmental impact from production and consumption of goods.

- A credible, third party certified guidance for their consumers and professional buyers to choose goods and services that are among the environmentally best.

7.7.2 Compact male catheters

(in alphabetical order company name)

7.7.3 Compact female catheters

(in alphabetical order company name)

7.8 Reusable catheters

Several studies have investigated the advantages and disadvantages of various cleaning methods for reusable catheters in the home setting where catheterisation is performed by the patient or caregiver. There are some concerns about the efficacy and compliance with the cleansing techniques. [104-106] Reuse of catheters intended for multiple use occurs in several countries with poor availability of single-use catheters, but off-label reuse of catheters is not legally supported. [107] However, evidence about how often and for how long they can be reused and how to cleanse effectively is missing. The gold standard in hospital and residential settings remains to use a new sterile catheter, because of the risk of cross-infection. [26, 108]

Available data on IC do not provide convincing evidence that single or multiple use is superior for all clinical settings. This reflects the lack of reliable evidence rather than evidence of the absence of a difference. An ongoing study is investigating reusable catheters for chronic urinary retention. [109]

Currently, clinicians need to base decisions about which technique and type of catheter to use on clinical judgement, local context and in conjunction with patients, because of uncertainty about the best technique and type of catheter. [110] Differential costs of catheters/techniques may also influence decision-making. [24]

7.9 Insertion aids and help devices

There are a variety of accessories available to enable easier catheter insertion, vision or handling. These products can be used when IC is performed by patients or caregivers using a clean or non-touch technique.

Various types of help devices are pictured in: Appendix H: Help devices/aids

Catheter	Description and material	Used for	Photo courtesy of
Actreen® Mini Cath	Catheter: 9 cm ready-to-use catheter with Nelaton tip. Available from CH8 to CH16 Catheter material: Actreen® Mini Cath is made of TermoPlastic polyolefin (TPO). Eyes: There are 2 eyes per Actreen® catheter Coating: Actreen® Mini Cath pre-lubricated with glycerin and water-based formula Catheter package material: Polyethylene (PE film) Additionally, Actreen® Mini Cath is not made with PVC, DEHP-(phtalate) and latex		B. Braun
Actreen® Mini Set	Catheter: 9 cm ready-to-use catheter connected to a bag. Available from CH10 to CH14 Catheter material: Actreen® Mini Set is made of TermoPlastic polyolefin (TPO) Eyes: There are 2 eyes per Actreen® catheter Coating: Actreen® Mini Set pre-lubricated with glycerin and water-based formula Bag particularities: • Volume capacity: 700 ml • There is an anti-reflux valve integrated into the bag allowing to limit the risk of leakages Catheter package and Urine bag material: polyethylene. Additionally, Actreen® Mini Set is not made with PVC, DEHP-(phtalate) and latex		B. Braun
Actreen® Hi-Lite Cath	Catheter: Ready-to-use catheters available as following: - 20 cm available with Nelaton tip: CH6 to 16 - 41 cm available with 2 tips: • Nelaton: CH8 to 18 • Tiemann: CH8 to 18 Catheter material: Actreen® Hi-Lite Cath is pre-lubricated with Glycerin and water-based formula. Eyes: There are 2 eyes per Actreen® catheter Coating: Actreen® Hi-Lite Cath pre-lubricated with Glycerin and water-based formula No-touch: Actreen® catheters rely on the no-touch technique to avoid catheter contamination. Catheter package material: Polyethylene/ polypropylene Additionally, Actreen® Hi-Lite Cath is not made with PVC, DEHP-(phtalate) and latex		B. Braun
Actreen® Hi-Lite Set	Catheter: 37 cm ready-to-use catheter connected to a bag 2 tips available: • Nelaton: CH10 to 18 • Tiemann: CH10 to 18 Catheter material: Actreen® Hi-Lite Set is pre-lubricated with glycerin and water-based formula. Eyes: There are 2 eyes per Actreen® catheter Coating: Actreen® Hi-Lite Set pre-lubricated with glycerin and water-based formula No-touch: Actreen® catheters rely on the no-touch technique to avoid catheter contamination Bag particularities: • Volume capacity: 1000 ml • There is an anti-reflux valve integrated into the bag to limit the risk of leakages Catheter package and Urine bag material: Polyethylene/polypropylene. Additionally, Actreen® Hi-Lite Set is not made with PVC, DEHP-(phtalate) and latex		B. Braun
EasiCath®	Catheter: Single-use, sterile catheter available with Nelaton and Tiemann tip Catheter material: phthalate-free Coating: Hydrophilic coating Catheter package: Individually packaged in an easy to open sleeve		Coloplast
EasiCath® Set	Catheter: Single-use, sterile catheter with an integrated bag available with Nelaton and Tiemann tip Catheter material: phthalate-free Urinary bag: 700 - 1,200 ml Coating: Hydrophilic coating Catheter package: Individually packaged in an easy to open sleeve		Coloplast
LujaTM	Catheter: Innovative dry-sleeve ready-to-use catheter with a flexible tip with 80+ micro-holes (Micro-hole Zone Technology) for complete bladder emptying in one free flow Catheter material: PU, therefore PVC- and phthalate-free Coating: Hydrophilic prelubricated coating with the Triple Action Coating Technology Catheter package: Pocket size and standard size packaging as well as drip-free re-closure for discrete disposal		Coloplast
SpeediCath®	Catheter: Ready-to-use catheter available with Nelaton and Tieman tip Catheter material: PU, therefore PVC- and phthalate-free Coating: Hydrophilic prelubricated coating with the Triple Action Coating Technology Catheter package: Easy opening with ring-pull feature		Coloplast
SpeediCath® Flex	Catheter: Dry-sleeve catheter with a flexible tip instantly ready-to-use Catheter material: PU, therefore PVC- and phthalate-free Coating: Hydrophilic prelubricated coating with the Triple Action Coating Technology Catheter package: Pocket size and standard size packaging as well as drip-free re-closure for discrete disposal		Coloplast
SpeediCath® Flex Set	Catheter: Dry-sleeve all-in-one catheter with a flexible tip and an integrated, dry-to-touch bag instantly ready-to-use Catheter material: PU, therefore PVC- and phthalate-free Urinary bag: 1000 ml, with handle, tearline and pull ring for easy emptying Coating: Hydrophilic prelubricated coating with the Triple Action Coating Technology Catheter package: Drip-free re-closure for discrete disposal		Coloplast
Advance™ Intermittent Catheter	Catheter: Flexible catheter with a sleeve protective tip Catheter material: Phthalates-free, PVC, not made with natural rubber latex Urinary bag material: User-regulated gel reservoir		Hollister Incorporated
Advance Plus™ Intermittent Catheter	Catheter: Flexible catheter with a sleeve, protective tip, and integrated 1500 ml collection bag Catheter material: Phthalates-free, PVC, not made with natural rubber latex Urinary bag material: User-regulated gel reservoir		Hollister Incorporated
VaPro™ No Touch F-Style Intermittent Catheter* * Improved catheter design with new HydraBalance™ lubricating technology. Availability and timing varies by country (starting 2024).	Catheter: 100% No Touch Protection catheter with cap, protective tip and sleeve. Offers more firmness in the catheter tube Catheter material: Phthalates-free, PVC free material, not made with natural rubber latex. Coating: Ready to use, hydrophilic, pre-lubricated Catheter package: Designed with two finger holes to be easy to open		Hollister Incorporated
VaPro™ No Touch Intermittent Catheter* * Improved catheter design with new HydraBalance™ lubricating technology. Availability and timing varies by country (starting 2024).	Catheter: 100% No Touch Protection catheter with cap, protective tip and sleeve Catheter material: Phthalates-free, PVC free material, not made with natural rubber latex Coating: Ready to use, hydrophilic, pre-lubricated Catheter package: Designed with two finger holes to be easy to open		Hollister Incorporated
VaPro Plus™ Intermittent Catheter* * Improved catheter design with new HydraBalance™ lubricating technology. Availability and timing varies by country (starting 2024).	Catheter: 100% No Touch Protection catheter with cap, protective tip and sleeve, with an integrated collection bag Catheter material: Phthalates-free, PVC free material, not made with natural rubber latex Coating: Ready to use, hydrophilic, pre-lubricated Catheter package: Designed with two finger holes to be easy to open		Hollister Incorporated
VaPro Pocket™ Intermittent Catheter* * Improved catheter design with new HydraBalance™ lubricating technology. Availability and timing varies by country (starting 2024).	Catheter: 100% No Touch Protection catheter with cap, protective tip and sleeve in pocket-sized packaging Catheter material: Phthalates-free, PVC free material, not made with natural rubber latex Coating: Ready to use, hydrophilic, pre-lubricated Catheter package: Designed with finger hole to be easy to open		Hollister Incorporated
VaPro Plus Pocket™ Intermittent Catheter* * Improved catheter design with new HydraBalance™ lubricating technology. Availability and timing varies by country (starting 2024).	Catheter: 100% No Touch Protection catheter with cap, protective tip and sleeve with integrated collection bag in pocket-sized packaging Catheter material: Phthalates-free, PVC free material, not made with natural rubber latex Coating: Ready to use, hydrophilic, pre-lubricated Catheter package: Designed with finger hole to be easy to open		Hollister Incorporated
IQ2004	Catheter: Hydrophilic single use catheter IQ-Cath, not ready for use, length 40 cm Coating: Hydrophilic to activate Catheter package: 30 pcs.		Manfred Sauer GmbH
IQ2104	Catheter: Hydrophilic single use catheter IQ-Cath, ready for use, length 40 cm, integrated saline 0.9% Coating: Hydrophilic to activate Catheter package: 30 pcs.		Manfred Sauer GmbH
IQ2604	Catheter: Hydrophilic single use catheter IQ-Cath, ready for use, length 40 cm, urine collection bag 1 litre, integrated saline 0.9% Coating: Hydrophilic to activate Urinary bag: PE Catheter package: 30 pcs.		Manfred Sauer GmbH
IQ4304	Catheter: Hydrophilic single use catheter IQ-Cath, ready for immediate use, “Peel” packaging, Sleeve, length 40 cm (IQ4303) or 30 cm (IQ4303) Coating: Hydrophilic - pre activated Catheter package: 30 pcs.		Manfred Sauer GmbH
IQ2302	Catheter: Hydrophilic single use catheter IQ-Cath - Women, ready for immediate use, “Peel” packaging, length 12 cm Coating: Hydrophilic - pre activated Catheter package: 30 pcs.		Manfred Sauer GmbH
IQ3204	Catheter: Gel single use catheter IQ-Cath, ready for immediate use and already immersed in gel, length 40 cm Coating: Gel - pre activated Catheter package: 30 pcs.		Manfred Sauer GmbH
Liquick Base	Catheter: Intermittent catheter with blue protective inner sleeve, Ergothan tip, Nelaton tip and Tiemann tip – sachet with saline solution for activation included Catheter material: PVC, DEHP-free Coating: Hydrophilic to activate Catheter package: Tyvek with self-adhesive patch		Teleflex
Liquick Pure	Catheter: Intermittent catheter for women with blue protective inner sleeve, Ergothan tip and Nelaton tip – sachet with saline solution for activation included Catheter material: PVC, DEHP-free Coating: Hydrophilic to activate Catheter package: Aluminium with sealing flap		Teleflex
Liquick X-treme	Catheter: Intermittent catheter with protective inner sleeve, Ergothan tip and Tieman tip – ready-to-use Catheter material: PVC, DEHP-free Coating: pre-activated hydrophilic Catheter package: Aluminium with sealing flap		Teleflex
Liquick X-treme Plus	Catheter: Intermittent catheter with protective inner sleeve preconnected urine bag, Ergothan tip and Tiemann tip – ready-to-use Catheter material: PVC, DEHP-free Urinary bag: LDPE with non-reflux valve Coating: pre-activated hydrophilic Catheter package: Aluminium with sealing flap		Teleflex
SafetyCat Active	Catheter: Intermittent catheter with protective inner sleeve, Ergothan tip, Nelaton tip, Tiemann tip – ready-to-use Catheter material: PVC, DEHP-free Coating: pre-coated with lubricating gel Catheter package: Aluminium with sealing flap		Teleflex
LoFric®	Catheter: Hydrophilic intermittent catheter Available with Nelaton and Tiemann tip. 15, 20, 30, 40 cm length Catheter material: Polyolefin-based elastomer (POBE) without PVC, phthalates and latex Coating: Hydrophilic, Polyvinyl pyrrolidone (PVP) and NaCI. All LoFric catheters are coated with the unique Urotonic™ Surface Technology. This ensures the catheter remains smooth and safe, both during insertion and withdrawal Item packaging: Lacquered paper, laminated film of PP/PA/PE		Wellspect
LoFric® Origo™ LoFric® Origo™/Flexible LoFric® Origo™ Sleeve	Catheter: Instantly activated hydrophilic intermittent catheter with sachet included for activation. LoFric Origo is eco labelled with the Nordic Swan.* Catheter material: Polyolefin-based elastomer (POBE). Not manufactured with PVC, phthalates or latex Coating: LoFric catheters are coated with the unique Urotonic™ Surface Technology. This ensures the catheter remains smooth and safe, both during insertion and withdrawal Catheter package: Discreetly packaged and foldable to pocket size. The different grip solutions gives control without having to touch the catheter tube during insertion. LoFric Origo is available in: Nelaton tip: CH08-CH12, length 30 cm Nelaton and Tiemann tip: CH10-CH18, length 40 cm Flexible tip: CH12-CH16, length 40cm Different grip solutions, Insertion Grip and Protective sleeve		Wellspect
LoFric® Sense™	Catheter: Instantly activated hydrophilic intermittent catheter with sachet included for activation. The ergonomic grip allows for a better grip and non-touch technique. It’s easy and discreet to carry and use anywhere. CH 8-14, length 15 cm. LoFric Sense is eco labelled with the Nordic Swan.* Catheter material: Polyolefin-based elastomer, POBE. Not manufactured with PVC, phthalates or latex. Coating: All LoFric catheters are coated with the unique Urotonic™ Surface Technology. This ensures the catheter remains smooth and safe, both during insertion and withdrawal Item packaging: Laminate foil of PET and PE		Wellspect
LoFric Primo	Catheter: Instantly activated hydrophilic intermittent catheter with sterile solution pocket included for activation, integrated insertion aid and easy to open loops. Available with Nelaton and Tieman tip, LoFric Primo is eco labelled with the Nordic Swan.* Catheter material: Polyolefin-based elastomer (POBE) without PVC, phthalates and latex Coating: Hydrophilic, Polyvinyl pyrrolidone (PVP) All LoFric catheters are coated with the unique Urotonic™ Surface Technology. This ensures the catheter remains smooth and safe, both during insertion and withdrawal Sterile solution pocket: Laminate foil of polyethylene terephthalate (PET), polyethylene (PE) and aluminium. Sterile water with sodium chloride (NaCl) Item packaging: PE LoFric Primo is available in: Nelaton tip: CH06-CH18, length 20 cm Nelaton tip: CH08-CH14, Length 15 cm Nelaton tip: CH08-CH18, length 40 cm Tiemann tip: CH10-CH18, length 40 cm		Wellspect
LoFric® Hydro-Kit™	Catheter: Instantly activated hydrophilic intermittent catheter with sachet included for activation. Catheter material: Polyolefin-based elastomer (POBE). Not manufactured with PVC, phthalates or latex LoFric Hydro-Kit is eco labelled with the Nordic Swan.* Urinary bag: Collection bag with printed scale, 1000 ml Coating: LoFric catheters are coated with the unique Urotonic™ Surface Technology. This ensures the catheter remains smooth and safe, both during insertion and withdrawal Catheter package: The-all-in-one solution. Loops for easy opening, textured Insertion Grip gives good grip and control, allowing non-touch technique. Possibility to separate catheter from the bag. LoFric Hydro-Kit is available in: Nelaton tip, CH08-CH18, length 20 cm Nelaton tip: CH08-CH18, length 40 cm Tiemann tip: CH10-CH18, length 40 cm		Wellspect
LoFric® Dila-Cath™	Catheter: Single use, hydrophilic dilatation catheter. The catheter does not have drainage eyes and, therefore, cannot be used for bladder emptying. CH16, 18. Length 40cm Catheter material: POBE without PVC, phthalates and latex Coating: hydrophilic, PVP and NaCI for activation. Urotonic™Surface Technology Item packaging: Lacquered paper, laminated film of PP/PA/PE		Wellspect
LoFric® Insti-Cath™	Catheter: Single use, hydrophilic urinary catheter for intermittent bladder instillation solutions with Luer lock adapter Catheter material: POBE without PVC, phthalates and latex Coating: hydrophilic, PVP and NaCI Urotonic™Surface Technology Item packaging: Lacquered paper, laminated film of PP/PA/PE LoFric Insti-Cath is available in: Nelaton tip, CH08-CH14, length 20 cm Nelaton tip: CH08-CH14, length 40 cm Tiemann tip: CH12, length 40 cm		Wellspect

Catheter	Description and material	Used for	Photo courtesy of
SpeediCath® Compact and Compact Plus	Catheter: Compact catheter with a Nelaton tip instantly ready-to-use. The Compact Plus has extra length Catheter material: PU, therefore PVC- and phthalate-free Coating: Hydrophilic prelubricated coating with the Triple Action Coating Technology Catheter case: Drip-free re-closable after use for discreet and hygienic disposal		Coloplast
SpeediCath® Compact Eve	Catheter: Compact catheter with Nelaton tip instantly ready-to-use (telescope design for male) Catheter material: Polyurethane (PU), therefore PVC- and phthalate-free Coating: Hydrophilic prelubricated coating with the Triple Action Coating Technology Catheter case: Drip-free re-closable after use for discreet and hygienic disposal		Coloplast
Infyna ChicTM Intermittent Catheter	Catheter: Designed for discretion Catheter material: Phthalates-free, PVC free material, not made with natural rubber latex Coating: Ready to use, hydrophilic, pre-lubricated Catheter case: Fully recyclable polypropylene case. Now contains 11% less plastic (when compared to previous version)		Hollister Incorporated
LoFric® Elle™	Catheter: A compact ready-to-use catheter, with a unique ergonomic design that allows the container to become an angulated handle when connected to the catheter. Using the handle is always optional. LoFric Elle is slim, discrete, and convenient to carry, reseal and dispose of. CH 10-14, length 15 cm. LoFric Elle is eco labelled with the Nordic Swan. Catheter material: Polyolefin-based elastomer (POBE). Not manufactured with PVC, phthalates or latex. Coating: Hydrophilic prelubricated, water based wetting fluid with glycerol Urotonic-surface Technology. This ensures the catheter remains smooth and safe, both during insertion and withdrawal. Catheter case: Fully recyclable case, now with bio-based raw material that cuts the carbon footprint with 55% compared to original product. Item packaging: Polypropylene		Wellspect