Intermittent Catheterisation Sarah Boulby Urology CNS

Definition Clean Intermittent urethral catheterisation (CIC) is the method used to empty urine from the bladder. It is a simple procedure that involves putting a catheter in the urethra up into the bladder to drain out the urine. CIC empties the bladder and therefore, reduces the risks of infections and kidney damage.

Why catheterise? A child may catheterise daily due to congenital abnormalities or other complications such as retention or illness such as UTI’s. Urethral catheters can be inserted each time the bladder requires emptying and then removed following completion of drainage. Research evidence associates this method with the least number of complications and lowest risk of infection. ( Lapides et al,. 2017).

Pre-assessment 1)Only catheterise after a full assessment of the child has been taken including fluid balance, abdominal assessment and alternatives have been discussed such as, a warm bath, if possible. 2)Select most appropriate catheter and equipment for catheterisation depending on child’s age/size, type of catheterisation required and expected length of intervention. 3)Catheterisation should only be performed by trained and competent staff. It is the responsibility of staff undertaking the procedure to ensure they have the knowledge and skills for safe and effective catheterisation.

Catheter Selection The person undertaking catheterisation is responsible for insuring that the most appropriate catheter is used for the individual patient. It is important to select the correct material, size and length of catheter. There are many varieties of catheters manufactured by a range of companies. Some catheters require lubrication before insertion but many are pre-lubricated or have a coating, which is activated by either adding water or releasing a solution into the catheter’s packaging.

Guide For Catheter Sizes Age. Size of catheter (CH) Neonate Guide For Catheter Sizes Age Size of catheter (CH) Neonate 4-6 (4ch – Vygon stocked on NSU) Infant (< 1year) 6 Infant (1-5 years) 8-10 Child (5>) 10-12 Adolescent 12-14 Catheter length: Catheters come in male (45cm), female (25cm) and paediatric length (30cm). Please use caution and assess the child’s size, as well as their age when choosing an appropriate catheter size.

Male urethral catheterisation   This can be undertaken by male or female staff provided appropriate training and assessment has been completed. Potential problems include:  1. Sensitivity when inserting catheter - use of anaesthetic gel can help reduce discomfort 2. Stricture formation- pre-coated catheters should be used to prevent incidence 3. Urethral trauma on insertion or removal of catheter

Female Urethral Catheterisation This can be done by both female and male nurses once competent and consent gained from the patient. Potential problems include: Catheterising the patient’s vagina – try the hole above and use first catheter as a guide Urethral trauma – ensure catheter is adequately lubricated

GUIDELINES FOR ASEPTIC URETHRAL CATHETERISATION • Assemble equipment – catheter, lubrication, dressing pack, saline to clean and sterile gloves • Wash hands and apply gloves • Clean between the child’s legs with saline • Change gloves • Lubricate catheter (if not already) • Insert catheter into the urethra until urine obtained. Keep hold of the catheter to prevent it from falling out • Allow all the urine to drain out • Remove catheter slowly, if urine begins to drip again wait until the bladder is completely empty • Dispose of the catheter and dressing pack, according to health and safety guidelines, into a yellow clinical waste bin