How does the urinary system work?

The urinary system consists of the kidneys, the bladder, the ureters and the urethra. The kidneys filter the blood to remove waste products and form urine. The urine flows from the kidneys, down through the ureters to the bladder. From here it passes through another tube called the urethra to the outside when urinating (weeing/peeing).

What is clean intermittent catheterisation?

Clean intermittent catheterisation is a way of emptying the bladder of urine if weeing is difficult or impossible. It involves passing a catheter (thin, plastic tube) through the urethra into the bladder and then removing once the bladder is empty. Good hygiene is extremely important in clean intermittent catheterisation as it reduces the risk of developing a bladder infection.

Why does my child need to have clean intermittent catheterisation (CIC)?

Your child’s Consultant and Urology Nurse will explain the reasons, some possible reasons:

• To allow urine to drain if your child has a blockage or narrowing in their urethra.
• To allow your child to empty their bladder if there is nerve damage which is affecting their ability to urinate.
• If a child has trouble emptying their bladder completely – leaving a small amount of urine behind in the bladder this can increase the risk of infection.
• Children who are wet (incontinent) can also benefit from CIC as it will increase the amount of time, they can stay dry during the day.

What are the benefits of clean intermittent catheterisation?

By regularly emptying the bladder CIC can help prevent growth of bacteria in the bladder and protect your child’s bladder and kidneys from infection and damage. CIC allows the bladder to empty and this may help prevent reflux (backflow) of urine to the kidneys that can cause damage. It can also help a child to improve their continence.

How is a clean intermittent catheter inserted?

The catheter is inserted through the urethra into the bladder to drain the urine. Once the bladder is empty the tube is then removed. This usually takes less than five minutes. This procedure is done using a clean, non-sterile technique. The catheters are single use and disposable.

You and your child will be offered a choice of catheters. Catheters come in different diameters (width) and lengths. The size of the catheter will increase as your child grows. Catheters are available in three lengths paediatric, male and female.

How often will my child need to have clean intermittent catheterisation?

It will vary according to how much urine your child passes normally and how much urine they leave in their bladder. Your child’s Consultant/Urology Nurse will discuss the frequency of catheterisation with you. Normally CIC is performed every 4 hours from first thing in the morning until bedtime. Some children may need catheterisation overnight.

Equipment you will need:

• Appropriate size catheters
• Disposable wipes
• Water-based lubricant (if required)
• Container for collecting urine (if not using a toilet)
• Mirror (if your child is doing the catheterisation).

Catheters can be pre-lubricated (coated with lubricating gel), self-lubricated (they become slippery when soaked in water) or non-lubricated.

Catheters are usually supplied by a home care company so remember to re-order new supplies in plenty of time. If you have any problems getting hold of supplies, please tell us.

Most catheters are disposable ‘single use’ catheters. Please do not re-use single use catheters as it can increase the risk of infection. Used catheters can be disposed of in your household rubbish.

If you are going abroad on holiday, it can be helpful to carry a letter from your child’s consultant explaining why you are carrying catheters. Remember to keep a few days’ supply in your hand luggage just in case your suitcases go astray.

Instructions of how to practice CIC

1. Collect all the equipment needed
2. Wash your hands with soap and water
3. Get your child into a comfortable position

• Sitting on the toilet
• Lying on their back
• Sitting in their wheelchair

4. Clean your child’s genital area

• Boys – clean the tip of the penis using an inwards circular motion towards the urethra, gently pulling back their foreskin to clean underneath

5. Wash your hands again with soap and water
6. Open the catheter packaging – avoid touching the end of the catheter
7. Add a small amount of lubricant to the outside surface of the catheter (unless it is a lubricated type)
8. Gently insert the tip of the catheter into the urethra
9. Use gentle pressure to pass the catheter through the sphincter (ring of muscle) at the neck of the bladder
10. Continue to insert the catheter into the bladder until urine starts to flow
11. Hold the other end of the catheter over the container or toilet
12. Keep the catheter in place until the flow of urine stops
13. Slowly remove the catheter, pausing if urine starts to flow again
14. Dispose of the catheter as instructed
15. Wash your hands again with soap and water

You should check the amount, colour and smell of your child’s urine. If your child’s urine is dark in colour they may need to drink more. If your child’s urine is offensive smelling they may have a urinary tract infection and you should contact your child’s doctor or nurse for advice.

What are the risks of my child having clean intermittent catheterisation?

• Urinary tract infection (UTI)

All children who are catheterised will have a small amount of bacteria in their urine. Antibiotic treatment is only prescribed if your child becomes unwell with symptoms of urinary tract infection.

Symptoms of urinary tract infection include:

1. offensive smelling urine
2. cloudy urine
3. lethargy (tiredness)
4. nausea (feeling sick),
5. loss of appetite,
6. high temperature.

If your child has any of these symptoms it is important to seek medical advice as soon as possible. A sample of urine must be taken before antibiotic treatment is started. Encouraging your child to drink lots of fluids can help prevent urinary tract infection by reducing the amount of bacteria in the urine. Good hygiene, including thorough hand washing before catheterising, is also important.

• Bleeding

If it is just a couple of specks of blood, it could mean the lining of the urethra has been scratched during catheterisation. This will settle. If the bleeding is heavy or does not stop you should seek medical advice.

• Stricture

Stricture is a rare complication of CIC. Stricture is a narrowing of the urethra due to scar tissue caused by repeated use of a catheter. The catheters used for CIC are designed to reduce this risk.

Important points to remember about clean intermittent catheterisation

• Always wash your hands with soap and water and dry them well before and after clean intermittent catheterisation.
• Clean intermittent catheterisation should always be performed in a private, clean area and the equipment should be placed on a clean surface.
• Please ask your child’s nurse how you can obtain a RADAR key that will allow your child to have access to disabled public toilets. A RADAR Key (sometimes called an NKS Key) is a large, silver-coloured skeleton key that opens more than 10,000 locked, disabled toilets in the UK.
• It takes practice for you to learn how to catheterise your child.
• If you are going on holiday you will need a medical letter to explain why you are carrying catheters. You should keep some of your child’s catheters in your hand luggage.
• It is important to observe for constipation. Constipation can prevent the catheter draining well. It can also increase the risk of urinary tract infection. Encouraging your child to eat a healthy balanced diet that includes fruit, vegetables and fibre can help prevent constipation. Drinking good amounts of oral fluids can also help
• Sometimes laxatives may be prescribed to help prevent constipation. If you are concerned your child may have constipation please contact their doctor.

Trouble Shooting

Problem

Cloudy or smelly urine

What to do

This may be a sign of infection

• Take a sample of urine using the catheter and take it to your family doctor for testing
• A course of antibiotics may be needed

Drinking plenty of fluids will also help.

Problem

Pain when inserting the catheter

What to do

This usually improves in time

If pain continues, talk to your clinical nurse specialist

Problem

Blood in the urine

What to do

This may be a sign of infection

• Take a sample of urine using the catheter and take to your family doctor for testing
• A course of antibiotics may be needed
• Drinking plenty of fluids will also help It may also be a sign of bladder irritation

If it does not improve in a few days, talk to your consultant or clinical nurse specialist

For further information please contact

If you have any questions or problems either before or after, please do not hesitate to contact, Urology Clinical Nurse Specialist, on 020 7580 4400, 10838 (09:00-17:00 Monday to Friday).

For Out of hours: Contact our Paediatric Site Practitioner via the switchboard on: 02075804400 ex 10843