How I PEE ANYWHERE without getting out of my wheelchair or onto a toilet
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- Опубліковано 10 жов 2020
- When you're paralyzed peeing goes from taking less than a minute to being a time consuming endeavor. There are catheters and wipes and lube; and if you have to get on the toilet to catheterize then there are transfers and clothes to get off and back on again. Adding those tasks up can easily take 10 minutes or more. If you pee 6 times a day that's at least an hour out of every day just to go to the bathroom. Who wants to waste that much of their life going to the bathroom?
Definitely not me. That's why when I was learning how to catheterize independently I knew there had to be a better way. Luckily for me, I had a friend that thought the same thing who figured out a brilliant technique that I could just borrow.
In this video I will show you how to catheterize from your wheelchair without having to get undressed, without getting out of your wheelchair and without getting onto the toilet.
What you need:
A 9 inch zipper in the crotch of your pants
A male urinal or other bottle to catheterize into (amzn.to/36LCmBv)
A standard size catheter (a very short female one won't work)
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/ bneunzig_em. .
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/ empoweredpara
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empoweredpara.com/
Being 100% able-bodied, I'm still not sure why I'm watching your videos for educational purposes, but I am. There's no doubt in my mind that there are disabled folks out there learning so much from you... both physically and mentally. You're an amazing person. If only 13 y/o you had access to something like this, there's no doubt you would've saved yourself a lot of stress and anxiety!
I never thought I'd be paralyzed someday. You never know if you'll need the information someday (I hope not though!). Happy to educate anyone who wants to stop by!
@@EmpoweredPara We never expect it to happen. Life changes instantly. We either adapt or are miserable. You've done a great job of adapting and having a positive attitude.
We are naturally afraid or scared of the unknown. I think that knowing the complications of a disability, and how people manage to deal with it, normalizes it. And helps us to understand if someone needs a hand or to improvise a piece of gear.
Kudos for having the bravery to educate us all.
@ridemywheelie yep most if us were able bodied at some point and never expected our lives to change!
@@lyfandeth Knowledge really is power!
I was an RN in a pediatric hospital, and I can't tell you how much I would have enjoyed a demonstration from you! You have a gift for delivering the information in a graceful and straightforward manner. I'm sure my many teen aged patients would have benefitted immensely as well. Thanks for doing these videos.
You're welcome! I wish I had the information when I was a teenager too!
A😊aa1qplpe@@EmpoweredPara
I am tremendously impressed with your openness and willingness to share information that can be vital for paraplegics. The medical community often does a very poor job of helping our patients adapt to their new lives.
As an RN at rural hospital this is amazing. What a great way to help others by sharing your tips and tricks. ❤
Dear Para, your programs are excellent and provide models for other presenters. You tackle topics that are socially so difficult in a delicate and educational manner. I watch every one and cannot thank you enough for the extraordinary help and advice that you are giving to others with disabilities as well as their helpers. Your supportive husband is so fortunate to have met you.
I was captivated, by the positive way you spoke, about a potentially troublesome, but essential subject. You have climbed some tough hills, and have every right to celebrate your triumphs.
I'm an old man but someday I will need tips on how to take care of myself. That's why I watch someone who can do better than I can. And she's a strong woman
Hopefully you'll never have to use a catheter!
My wife suffered a massive stroke after an aortic aneurysm over 12 years ago which left her without the use of her left side. One of the first things I learned was how to cath her. I was told to insert the cath where it looks like a little flower bud. I always used a lubricant to avoid any discomfort. And would always put some pressure on her bladder to avoid any leakage. Very informative video.
Thank you for advising us know nothings about what you have developed for a satisfying technique that we all just refer to 'every day'. Your video is a great reality check for all of us who have personal issues. You are brave lady.
Thanks for stopping by to learn!
You are an inspiration! I know your mom was coming from a place of deep love and devotion but I think she did more harm by not making you become more independent, I am not criticizing her at all, I can’t imagine what she went through with your accident, learning the diagnosis and the years that followed. She is a tremendous mother that everyone would be lucky to have. I have MS and am so worried that I may end up in a wheelchair someday, I am not at all a strong person. I never realized just what a paraplegic has to go through, thank you for demystifying it and making us aware of everything they endure.
I am sad to see what you have to go through to live your life as normal as possible. Putting this video says so much about your character, courage and willingness to help others. You are truly an inspiration!
Thank you!
You are such a brave young lady to be so open about such personal things. I wish nothing but happiness for you and your family.
Thank you!
My I add I have the greatest of respect for you and your positive attitude, I have learnt so much and a better understanding of wheelchair problems
I myself am able bodied but feel like you have provided helpful answers to questions that I would not have even thought of, let alone asked about. I am incredibly impressed with your openness and ability to freely discuss subjects that many people would find embarrassing or awkward and I’m sure there are many people who will find your information life changing. Keep up the good work!
Thanks!
This is EXACTLY how I pee, I was so excited to see someone doing exactly as I do!
Also I wish rehab had taught me this, I learnt by myself as my life was ruined by having to be on a bed to pee after I left rehab. (T4 complete)
Great minds think alike!
Thank you. People around me think I'm crazy because of the things I've had to adapt to, just to keep clothes dry and urinate comfortably without transferring to the toilet every time I just need to urinate, which can be 8-12+ times daily. Oddly, I prefer to use a 'Female Bed Bottle' to transfer to as it is a nice urinal shape for me, when turning the bottle down the way instead of flat. Convenient handle on them too! I don't need to catheterise yet...but I'm getting older now. Good on ya, lass.
To everyone who is coping with disability, Keep Well As Possible and Keep Strong As Possible and don't be told 'no' by able people who can't or won't try to understand. They can't know it all.
I agree 100%! We all have to adapt and learn to be resourceful. Most able bodied people don't get it. Even ones that know people wirh disabilities reqlly well. I don't even think my husband truly gets what I feel like and how creative I need to be at times.
Although I'm neither female nor paralyzed I found your video very helpful. I'm an 84 year old cancer survivor who has had 5 surgeries in the past 10 months. Your video was quite helpful and I do thank you for making it. You are more than empowered; you are an amazing woman.
Best regards, David
Wow, you've dealt with a lot over the past 10 months! Congratulations on being cancer free (assuming that is the case since you referred to yourself as a cancer survivor)! Thank you for the kind words. I believe we all have so much to learn from one another and I appreciate you stopping by my corner of the internet to learn something about how I live!
I have cp but had a friend that was a quad that I assisted. Your videos are extremely helpful and enlightening. Keep up the great videos.
Check you out I'm so proud of you and the fact that you were able to overcome some of this stuff and the fact that you're willing to share and be so open with people that's so cool
Thank you! I look forward to your comments every video I post! Thanks for being such a loyal subscriber!!!
@@EmpoweredPara not a problem at all I have found that your videos are very helpful and therapeutic in some ways in the fact that I'm not alone so it's the least I can do is to be loyal to your UA-cam channel take care
With the advances in medical treatments I sincelry wish folks like you could get out of that chair. God bless your openess.
Thank you. I was paralyzed a year ago and I am thinking of the Mitrofanoff surgery. This allows me an option to try before surgically altering myself. I very much appreciate this video.
I almost got thr mitrofinoff too and this saved me from that surgery! It takes a while to get the hang of it but once you do it'll change your life!!
The Mitrofanoff does not spare you from getting surgically altered and it's not really comparable to the suprapubic catheter.
@@EmpoweredPara when I broke my neck...the sensation was affected more than movement (there is a nerve branching off each side of the vertebrate) and cathing feels like I am being stabbed. I would much rather go with a supra pubic catheter and a flip flow valve.
@@morgancalvi6675 yeah I have lots of friends with a supra public catheter.
That's stupid you can't even actually pull your pants
Very informative, well explained and a beautiful presenter
Great Video... Feeling gratitude for your kindness to share this idea for those who are in deliberate need. 💕
Thanks!
This video popped up in my UA-cam and the title got my attention so I clicked out of curiosity. I only watched the 1st 5 minutes or so which was enough to get the idea. Wow, I didn't have to watch much to clearly see you are an impressive brave and beautiful young lady. Such a wonderful service you are doing; no doubt helping so many dealing with difficult circumstances. God bless you.
thanks! I hope so!
You are one amazing person. Thankfully I'm not at the point yet where I need this but was interested in learning about this when I ran across your video. It was so interesting and the way you do the video is absolutely wonderful. You speak so clearly and the way you demonstrate makes it very easy to understand what is going on. You should be a teacher. I'm sure you are helping a lot of people.
Thank you for taking the time to do this and help us all understand. I'm so impressed. Thank you.
I am a teacher lol!
Hi, I am a paraplegic T-5 level I use a para cord to hold my Duck (urinal) and my hands are free to cath. urinal hangs between my legs with the para cord. 78 year old, male 53 years in wheelchair.
You are an awesome person for sharing this. Very brave and unselfish. I am an able bodied person but I'm sure there are people whom you have really helped. and appreciate this video. All the best for you.
Your sharing helps take the stigma out of your situation.
I think so too! That's what I hope to do anyway!
It is an honor to subscribe your channel. The information you share is surely life changing for a lot of people. I admire how comfortable you are talking about daily challenges that you face. We all have a journey in this life and never know what new skills we will have to learn. You are such a beautiful woman and you have such a sweet soft voice.
Thanks!
Great video! I’ve been using a foley for years and now finally learning to self cath and your video is very helpful. My question is what’s the price range your seamstress charges for the zipper alterations? Please and thank you.
Sorry I thought I replied to this! I pay 16-19 dollars which includes the zipper. Kinda annoying because it makes pants more expensive but totally worth it!
@@EmpoweredPara not too bad I was nervous it was going to cost up to 40 dollars. I’ll definitely look around for a seamstress who can do this. Thanks again.
@@ZombiieLoveQuadCreations any seamstress can. Just ask for a zipper in the crotch. I have never run into one that was confused about it! Must be more common than we think 🤔
Top points for giving us good practical information clearly.
👋i hope you're safe over there? I hope this year brings happiness prosperity love and peace 💞❤️🕊️🕊️ all over the world! Happy New year 🎆 🙏🌍
I'm originally from Canada currently living in California ☀️☀️and you where are you from if i may ask?💭😊
You know, sometimes when my wife and I are watching your videos, we have to stop watching in the middle, and really think about what you are saying. For this one, we are doing that. We are marvelling at what a great method you employ to be able to use a catheter during the day. With that zipper in the crotch of your pants, and the fact that no one can even see it, is such a brilliant idea! So much more convenient and less time consuming than having to find a bed or similar to use to cath. Or even a toilet. Since you cath so many times a day, how much more restrictive your life would be if you couldn’t cath in your chair. Kudos to you and your friend for coming up with this method!
Britney, what you are doing is simply amazing! All the while watching your video, I kept thinking to the people who are starting to get more and more autonomous despite the handicap. I have Crohn's disease and had a stomae (bag) for 11 months. Living with a stomae for these 11 months has been challenging but I did learn a lot on so many aspects. THANKS AGAIN for sharing your experience and tricks. This will be a TREMENDOUS ressource for a LOT of people. KUDOS TO *YOU* BRIT !!!! 🙂
Thanks! You're so kind! Crohn's disease is hard. I have many people in my family with it. I recommend the book Breaking The Viscious Cycle. My brother improved his Crohn's with it!
I think ur awesome helping others ,alotta people would be shy to talk about this area but u make it so comfortable I have a paralyzed from the waste down cousin and I didn't stop to think how hard it is for me to do daily things .ur awesome,!!
Thanks again! Definitely some really helpful tips & suggestions for me to check out.
You're welcome!
God bless you Darlin!! I can't tell you how much I admire your courage and winning attitude. You are a HERO!! Ax
Thanks!
Bless you for being so open. When I had my mastectomy, I took women aside and gladly shared my scarring. It doesn’t help to hide behind closed doors and act ashamed. I figure if it helps one lady at a future date not be afraid of the process then I’ve done well.
Thank you for sharing.
Exactly! Seeing what something looks like relieves so much anxiety for others that are new to the situation!
I a 2x watcher, very clear instructions 👍 , you are just simply amazing.👍
You are a GORGEOUS woman!!! I hope your hubby knows how lucky he is
He does lol
OMG! I thought having MS was a problem but I can't imagine having to go through that every time you have to urinate. You have a wonderful attitude. :)
MS isn't a walk in the park lol. And i know manay people with MS who have to use a catheter, so we share many of the same challenges often!
I just subscribed!!!! And you, you little cutie are an awesome person. You are so sweet and kind to offer your knowledge about different procedures and helpful hints about the how and why's you need to do this and that regarding a new procedure. Sorry if I made that sound like a jumbled mess, lol!! I just want to give you a GREAT BIG HUG AND THANK YOU FOR ALL OF YOUR KINDNESS AND HELP!!!!!!! You are the BEST! God bless you forever!!! Joannie xo
Thanks ❤️! Virtual hig back at ya!
brilliant! Was never able to cath from my urethra as a quad, very impressed with peers who can. I ended up getting the mitrofanoff surgery to be able to cath anywhere and use a blender bottle to void into. Great technique thanx for sharing!
You're welcome! Somehow I missed your comment! Sorry for the super late reply!
@@EmpoweredPara ha ha it’s all good it’s hard to keep up with all the comments on our socials😉
Thanks for sharing. Empowering and honest. You're doing good stuff for people.
I hope so! Thank you!
You are amazing Thank You for sharing the way you do different tasks. Very interesting.
I am 52 and have used Catheters since i was 9 yrs old i have Spina Bifida . I Discovered your channel purely by accident but enjoyed watching it.
Thank you. I had a military parachute malfunction. the education is absolutely stunning for any person. Thanks
Scary!! That's why i'll never skydive!
You are fabulous, thanks Brittany! 😊
You could have flashed us. Mature people wouldn't have cared. But thank you for describing the technical way you do that. It was informative.
What a wounderful person you are ..your absolutely gorgeous ,so intelligent and loving ...you may have helped so many people ..God bless you
Hats off for staying positive and your openness -keep positive ❤
I try my best!
Well explained!
Well done young lady!
Thanks!!
Thank you for the education. Much respect for you.
You’re are amazing and please don’t stop with your videos & tutorials
I plan to keep it up! Thank you!
Really great video iam in a wheelchair as a man i think i do a great job i lost my left leg due to a infection but I still drive i don't let anything stop me again great video
Im 100% able-bodied like some of your other viewers but found it interesting how you overcame an obstacle .
Excellent video and good information for anyone who has paralysis. I am not paralyzed but did go to an ER to be cathed after abdominal surgery with pain killers that prevented me from peeing for 15 hours. The only thing I wonder is how you locate the urethra without having any feeling in your perineum. Do you use a mirror?
No I use touch technique. I just use fingers to feel the right area
Hello from Barcelona, Spain! I am following your videos since months ago, they are so helpful! I couldn't find any Spanish content regarding coping with paraplejia (I am a recent paraplejic (1 year and a Half), so I switch to English searching and tadaaa, there yo were.
I have been using indwelling catether till now, but Monday I will start with self cathing and I am so scarred!! I have quite spasticity in my inner thights...do you have any advice for that?
also, do you ever used mirrors?
And last question, they told me that ideally I should cath every 4 hours, even 6; although at first I won't be able to hold that long. Do you agree with that?
Thanks in advance!! gracias :)
I started self cathing on a bed with a mirror and then once I got good at that began feeling what it felt like with my fingers when the catheter went in the right hole. It took a long time to get good at it. My suggestion for the spasms would be to do stretches every morning. I can try to find you some videos on the stretches I would recommend. I also have a friend that is paralyzed that is from spain! I will connect you with her if you want. She speaks fluent Spanish. Can I have your email?
@@EmpoweredPara I started yesterday in bed. I sat indian stlye with a mirror ( the urologist nurses taught me in the morning like that) and so for I managed to do it , after expending 3 catheters at some point and having my sister in law pointing with her cellphone flashlight at bedtime!
Thanks for you advice, I will be patient.
It would be great speaking to your friend...I am subscribed to your newsletter so I will write you there so you can have my contact
Thanks again for your time an congratulations on your channel :)))
@@inmamartin8334 sounds like you did awesome!! Good luck with everything. Keep me updated!
Well done. Keep up the good work. Very educational.
Wow this is so useful thank you so much! Keep being awesome.
I had a GF a way back who has Spina bifida, a little different from you, but about the same with her relieving her bladder. We broke up in 2004, an eternity ago and I miss her SO much, think of her everyday. She said she didn't want only one person around all the time, so had to end it. She won't even acknowledge me anymore. Sorry to wine like this. I applaud your abilities and your ease of getting along, you are AMAZING!!!!! Bruce R...
May I ask which wipes you use? I am not a paraplegic but I do have to use catheters and I have had numerous infections. I was using BZK wipes but those are harsh. Thank you so much. You are such a great inspiration.
Huggies Natural Care
Thank you, will go right out and get some today!!!!!
Like your cushion, do you mind me asking what kind it is ? Great skills
It is a synergy solutions. I don't think they make it anymore which sucks because I really like it! Thanks for the compliment!
@@EmpoweredPara www.quantumrehab.com/quantum-seating-and-positioning-systems/synergy-seating-cushions.asp and www.medservdme.com/Catalog/Online-Catalog-Product/117335/Synergy-Solution-1-Cushion you can still get it. These pages were edited in 2021...so they are still selling it.
@@morgancalvi6675 yes I discovered that! Thank you!
Thanks for explaining this! Excited to show my wife. Perfect!!
Hope it helps! Here if you have any questions!
God Bless you Lady, Subscribed and liked.
Your an amazing woman, love your openness. God bless you.
Thank you!
Good for you ..Mike from Oakville Ontario Canada 😮
I love your videos ! You are cute and i know that you will live long and HAPPY im crippled myself but only 30% you are special KEEP SMILING AND STAY STRONG i have a few friends that are in a wheelchair and they aren't even half as lively as you i will recommend your videos to them
❤Your Amazing-u go girl -very impressive-prayers ur way for a million subscribers! :)
I'm a Psw and had no idea you could do this
----will watch ur other ones also. Very informative!
And thank u so much for sharing
U are so positive
💕
Thanks for stopping by! Glad you found it helpful!!
Good morning from the Philippines.
Being able to pee anywhere in a bag is some of the best privilege is I've ever had. I use the bard touchless which have a 1 liter bag to collect it. Although sometimes I have to do it in my car because there are no convenient bathrooms.
That's kinda the nice thing about paralysis lol...peeing anywhere
@@EmpoweredPara even if u go out in public and do it, wouldnt ppl notice ur jar filling up?
@erikayou5249 sometimes yep!
@@EmpoweredPara you dont feel embarrassed that ppl know that ur pissing? it feels like a vulnerable state to be in
WTG, Girl. You are AWESOME! All the "very best" to you now & forever!!! 👍👍👍
That is interesting. My wife is catheterized 24/7. Removing the catheter has been suggested to us to let her muscles get used to controlling her urination again. Thank you.
Depends on how long she has had the catheter in as to how successful bladder retraining will be. Worth a try though!
Hello ... I am from Algeria ... I do not know English well ... but you are the one who encouraged me to learn it ... because I like the topics you present ... Good luck, my friend
That means so much to me! Thank you for your kind words! I hope you continue to watch? Is your language Arabic?
@@EmpoweredPara Hello ... Yes, I speak Arabic ... and a little English ... and I will do everything in my effort to learn English ...
@@EmpoweredPara I want to tell you that I admire ... your strong personality
@@koukou8721 I am honored that I was part of what inspired you to learn English. Glad to have you as a subscriber!
@@EmpoweredPara I am very happy that I met a friend ... who had a good heart ...
I'm an outdoors woman. I came across this video looking for tips to help me pee in the woods and off the edge of boats more efficiently. This video not only helped me with the idea of using a zipper like yours so I can use a female urination device without having to pull my pants all the way down, I learned about how someone in a wheel chair, also finds a way to pee faster and more efficiently too. Interesting and helpful. Thank you!
9:45 This is such an interesting concept "Doing this thing the usual way(toilet) is difficult for me, but I've found a way to make it easy, and now the unusual way (car, roadside etc), that other might struggle with is just as easy for me"
As an autistic person, I have the same experience with eye contact. Normal eye contact is a bit difficult to do, but with the training I have, I can do it, and I can just as easily maintain eye contact so intense that it makes everyone else uneasy
Exceptionally well done. Kudos
Thank you! Cheers!
at the age of 26 I started having issues with walking. Around 27 or 28 I had to resort to a wheelchair due health issues. I have ankleloysis Spinatlitis and Psoriastic Arthritis. Majority of my joints are fused. I am also a right knee AKA. I can use a prosthetic leg, but with help.
Your videos are amazing. I am new to your channel. I subscribed.
Good Night from England, U.K. Thankyou for sharing.
My pleasure!
I know some women who are paraplegics and others who are wheelchair bound. I see many people who are overweight and some not upper body physically fit and doubt that they could do some of the things you are demonstrating but good for those who are. It would be good if all able bodied folks could be made aware and sensitized to the accomodations required for physically challenged people (even many seniors) and more desiging/adaptation equipment and spaces could be readily made available to everyone who needs it. Thanks for sharing.
Thank you 🙏 how many times you Cather a day is it painful
I cath about 8 times during the day and twice at night. I don't have sensation so it's not painful:)
Very interesting. I wouldn't have guessed. Thank you for sharing!! PS....your toilet paper roll is rolling the wrong way 😛
lol normally I put the right way!
@@EmpoweredPara Lol. Atta girl!
Wow - the zipper is GENIUS - great idea !! I have to get someone to do the same for me now.
Also - I use speedicath compact which come with a handy sac that catches the pee, so I don't need to use the toilet either. They're great, super handy. Great video - just found your channel, so thanks for sharing this 😊
I use speedie cath compact when I travel! So handy! I am subscribed to your channel!
@@EmpoweredPara hey! yeah I just saw your comment on the other vid, thanks so much, it's great learning from each other. Loving your vids 😁
@@FreddotheWheelchairGuy absolutely! Great to support each other as small youtubers! Soon to be big youtubers 😆
learn something every day ,god bless
great information, i will do my best not to get paralyzed.
That's a great plan lol
God bless you on what you do always from Jeff
Empowered,empowering, em powerful. Thanks
Wonderful video .. How many times do you empty your bladder and do you have an infection? How much is the bladder capacity of urine you usually have
I empty my bladder around 8 times a day. I don't get infections very often anymore but I used to get do many uti's. I have a video on how I cured them!
Never expected a video on this topic in my stream. Good for you for explaining this. Not going to watch but I am sure it helps people.
What do you have convering your seat cushion? It looks so comfortable
It's a homemade cushion cover:)
Do you get INCONTENANCE tape tabs diapers of ABU REARZE or abena airbri diapers or northshore megamax briefs or diapers it helps ?
Awesome, i cath very similiarly. My pants have velcro vs. a zipper. I use the longer male cath and void into the toilet, but if one is not around, i have used a bottle. The other 'tools' i need is a mirror and light, as i haven't progressed to easily find my 'pee hole'. i have a small magnifying mirror that we attache to a clamp. i clamp the mirror to my seat or the my pants opening. Then i use a book light to add lighting. I was thought how to do this 13 years ago in rehab, love the nurses who helped me figure this out!
I'm watching this because I walk with a cane but will likely be in a wheelchair in 1 to 2 years. So, wheelchair will be a new experience for me. Just walking with a cane has been quite a transition for me. Just 5 years ago I was an avid hiker, and I was training to hike the Appalachian Trail. Zipper in the crotch, never would have thought of that. Pretty cool! Kind of curious what I'll be facing.
How do you locate your urethral opening without using a mirror?
Thank you
You have a really good sense of humor and brave, glad you didn't fart😉🤗
😛 thanks lol!
Adapt and overcome! Never gave the whole process a lot of thought.
Can ou tell when the bladder is full, or do you just do it on a regular timed basis.
I have bladder sensation thankfully, but many people with spinal cord injuries don't and have to use timing.
Damn- ur so inspiring! I never realized how lucky I am to be able to move around everyday!
We all have our own challenges and things to be grateful for! I am pretty darn lucky in so many ways! Thankful for fully functional hands that keep me independent!
@@EmpoweredPara
@@nicolesdaddieasmr1070 why thank you. 😊
amazing independence & ingenuity and in-your-face practicality.... the best kind.
Subverting the dominant paradigm of stigma, shame, embarrassment & shyness all in one ...yea!!
That's one articulate compliment lol! Thank you!
Gotta say, I was so not expecting you to actually pee or show anything in a UA-cam video lol I thought it’d be with props or something.
Proud of you. My body is all fked up as well. We Did It!
Helps being in it together!
How do you see where to put the catheter. I need to use a special “knee spreader mirror” wedged between my thighs to see where to insert the catheter without contaminating the cleaned area of the urethra. I use Hygea wipes first, then insert the catheter. I am so fearful of UTI’s.
I use touch technique. I know what it feels like around the hole. There is not much space to miss. Clitoris at the top, vagina at the bottom and urethra in-between. I spread, slide the catheter from the top and when it catches a hole I make sure there is still some skin underneath