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Clean Intermittent Catheterizations: a guide for parents and guardians

For many different reasons, parents or guardians of children with urologic problems may need to learn how to do clean, intermittent catheterizations (CICs). This is a well-established technique to drain urine from the bladder, and is frequently started for children with problems emptying the bladder completely. This usually includes patients with spine problems causing problems with the bladder ("neurogenic bladder").

Why do some children need CICs?

Urologists and other care providers do not take the decision to recommend long-term CIC lightly.

This is because it can be an overwhelming and anxiety-inducing process for parents and guardians, as well as for children or babies only starting to get used to catheters.

However, some children who have persistent trouble emptying their bladders due to inborn urinary tract or spine problems at increased risk of:

recurrent urinary tract infections
persisting high pressures in the bladder
repeated damage to the kidney both from high bladder pressures and from UTIs
urinary incontinence when the urine overflows from a very full bladder

Since CICs were introduced in the last century, they completely changed the way that chronic urinary retention is managed.

Won't my child have more risks of infections with CIC?

Contrary to common belief, compared to chronic indwelling catheters (Foley catheters or suprapubic catheters), clean intermittent catheterization actually has a lower long-term risk of:

infections
formation of urinary tract stones
development of secondary cancer of the bladder

Of course, there is always a risk of discomfort, urinary tract bleeding, or injury--which is why it is very important to learn and practice proper techniques.

Your child's pediatric urologist or specialized nurse will be able to show and demonstrate proper technique to minimize risks of injury and to ensure that drainage is adequate. You may start by looking through the following materials and directions list, and make sure to reach out to your pediatric urologist for any questions on the process!

Materials

1. Catheter in sterile packaging

Many different types of catheter are available. Whether they are straight catheters (only one channel) or two-way catheters (with a port for balloon inflation), they may be used for intermittent catheters.
For infants, catheter sizes may vary from 6 to 10 French (“Fr”). As a general rule, the larger the catheter, the better or quicker the urine drainage.

2. Lubricant jelly

Lubricant jelly may also contain topical anesthetic like lidocaine.
Some catheters are also pre-lubricated, and thus you may not need extra jelly.

3. Cleansing materials that are safe for your child’s genitals

In “Sterile” catheterizations, we typically prepare the genital area with povidone-iodine (“Betadine”). However, for clean intermittent catheterizations, we may also use non-alcohol disposable wipes.

4. Drainage receptacle

You may use any type of container to drain the urine. If your physician is still determining an optimal draining schedule for your baby, you may be asked to measure the output using a graduated container with or without a syringe.

5. Good lighting or a lamp, as needed.

Steps

1. Collect all the equipment needed.

2. Wash your hands with soap and water.

3. Place the child in position. Usually lying on their backs is a good position to start with.

4. Clean the genital area.

In girls: clean the outside area first, then part the labia to clean thoroughly, from front to back.
In boys: clean the tip of the penis using an inwards circular motion towards the pee-hole or urethra. If there is a foreskin, gently pull back the foreskin as much as possible (without causing pain) to clean underneath.

5. Clean your hands again.

6. Open the catheter packaging.

Avoid touching the end of the catheter (the tip that goes into the bladder).

7. If applicable, add a small amount of lubricant to the tip.

8. Gently insert the catheter into the urethra.

In girls, you may need to gently pull on the labia in a “down and out” direction to be able to see the urethral opening.
You may need to use a small amount of gentle pressure to pass through the catheter through the “sphincter” or ring of muscle.
Continue to insert gently until urine starts to flow.

9. Hold the other end of the catheter over the drainage receptacle.

10. Keep the catheter in place until urine flow stops.

11. Slowly remove the catheter. If urine start to flow again, hold it in place before drawing the catheter out again. Repeat this process until the urine stops flowing entirely and the catheter is all the way out of the bladder.

12. Dispose of the catheter and materials as necessary.

13. Clean your hands with soap and water.

14. If you used povidone-iodine, make sure to wipe this off from your child’s genitals.

"I can't see the hole!"

Catheterization may be a little easier in little boys, since the opening of the "pee tube" or the "urethra" is easy to see.

In little girls, especially if you are just starting to learn CICs, you may need help from one other person to see the urethra well. It helps to gently pull the labia in a "down and out" position to see the urethral opening better.

See the image below for a better look! (Image source: AboutKidsHealth)

What happens next?

You must have a conversation with your pediatric urologist about how often to do clean intermittent catheterizations, and whether CICs are expected to be a lifelong procedure for your child.

The interval varies depending on the reason for doing CICs, your child's diagnosis, and how much urine is withdrawn after each catheterization.

If your urologist suggests that you track how much urine is drained with each catheterization, you may click here to download a copy of an easy to fill out bladder diary, which allows you to note your child's drain volumes so you and your urologist may come up with the best plan.

The information in this infographic is for general information purposes only.

We encourage you to seek an individualized consult for the most appropriate management. You may book an appointment with us or with your preferred pediatric urologist or pediatric surgeon.

Please feel free to send us a message for questions on pediatric urologic health!