What is clean intermittent catheterization?
Clean intermittent catheterization (CIC) is a technique that your child will have to do several times a day to help empty urine (pee) from their bladder.
- Clean: as germ-free as possible
- Intermittent: done on a regular schedule many times a day
- Catheterization: using a catheter, a thin tube, to drain urine out of the bladder
Clean intermittent catheterization can help with bladder problems
CIC is necessary when your child is unable to empty their bladder on their own, when their bladder leaks urine or when very high pressure has developed in the bladder. If the bladder is not properly emptied, infections or other problems can happen.
How the urinary system works
Urine is produced by the kidneys. It flows from the kidneys into the bladder through tubes called ureters. Urine is stored in the bladder. The bladder is a muscular bag that can stretch to hold urine.
There is a strong muscle at the bottom of the bladder called a sphincter, which stops the urine from coming out. When the brain sends a message to relax the sphincter muscle, urine is released and flows down the urethra and out of the body. The bladder sends a signal to the brain when it is full, about every two hours. Then the brain decides whether it is a good time to empty. If the bladder does not empty at the first signal, these signals will come faster and stronger. Finally, the bladder will empty on its own when the bladder becomes too full.
If the bladder is not emptied regularly, children can develop infection of the bladder or reflux. Reflux is the backwards flow of urine in the ureters and kidneys which can then cause kidney infections, scar tissue or long-term damage to the kidneys. For many children, CIC is a way to completely empty the bladder and stop reflux, urinary tract infections and wetting accidents.
Supplies for clean intermittent catheterization
- Catheter
- Water lubricant jelly (e.g., Muko or K-Y jelly). Never use Vaseline or mineral oil.
- Soap and water
- Wash cloth or wipes
- Clean, dry towel
- Urine collection container, if desired
- Hand mirror, if needed
- Catheter storage container or bag
Steps to do clean intermittent catheterization
Below are the steps to properly do CIC for children with female anatomy:
- Get all the supplies and put them together on a clean, dry surface where you can easily reach them.
- The person completing the catheterization should wash their hands with soap and water and then dry them. Fingernails should be kept short and clean.
- Make sure your child is in a comfortable position. They can sit on the toilet or in a chair across from the toilet. Also, they can do the catheterization lying down or standing with one foot on a chair or the toilet rim.
- Tell your child to separate the labia (vaginal folds) with one hand and wash from front to back with soap and water. Then rinse and dry.
- Ask your child to put lubricant jelly on the catheter tip. Try to cover about 5 to 8 cm (about 2 to 3 inches) of the tip of the catheter. Do not put the catheter into the jelly tube. Make sure the other end of the catheter is in a cup or set to drain into the toilet.
- Your child should grasp the catheter as they would a pencil. They may need to use one finger to feel the clitoris to help find the urethra.
Keeping the labia separated, have your child slowly insert the lubricated catheter into their urethra until urine starts to flow freely. After starting to see urine flow, gently push the catheter another 3 cm (about 1 inch) farther. There may be some resistance at the sphincter, which acts like a door into the bladder. It is important that your child breathes slowly and relaxes their muscles during this process.
Note: It is normal to accidentally put the catheter into the vagina when learning how to do CIC. If the catheter is accidentally placed into the vagina, keep it in place while re-attempting to insert a new catheter into the urethra. Once the new catheter is correctly placed, the first catheter can then be removed from the vagina. - Allow all urine to drain into the toilet or container.
- When the urine stops draining, slowly remove the catheter. Urine may still flow and continue draining until there is no more urine coming out.
- Your child should wipe off the area between their legs and wash their hands when CIC is complete.
Other things to remember
- Check the colour, smell and clarity of the urine. These can be signs of infection or other problems. If your child’s urine has changed from its usual appearance, contact your child’s health-care team.
- Write down how much urine came out. Keep a record of the volume of each void in a voiding diary. This information will help your child’s health-care team work with you to set up a regular schedule that is right for your child.
- Catheters should be discarded after a single use. Sterilizing and re-using catheters is not recommended. It can significantly increase a child’s risk of urinary tract infection.
The standard of practice is to discard catheters after one use. Sterilizing and re-using catheters is not recommended. It can significantly increase a child’s risk of urinary tract infection. If you choose to reuse catheters, please discuss ways of reducing the risk to your child with the health-care team.
Solving possible issues
- You are unable to insert the catheter: If your child is not relaxed at the time of the catheterization, their urethral sphincter (the "bladder door") will be closed. Encourage your child to relax and deep breath when inserting the catheter. If your child is not able to put in the catheter, even though they are relaxed, you should contact your child’s health-care team.
- Bleeding: You may occasionally see small blood drops around the catheter during the procedure. Make sure your child is using lubrication for every catheter insertion to minimize this from happening. Occasional drops of blood are not cause for concern. However, you should contact your child’s health-care team if bright red blood or pink tinged urine occurs with every catheterization.
- False passage: If you have completely inserted the catheter but do not see any urine draining, it is possible that a false passage was created where the catheter goes through the wall of the urethra. This may be associated with bleeding as well. Please speak to your child’s health-care team if this occurs.
- Infection: If you notice the urine is cloudy or foul-smelling WITH fever, or fever occurs without other symptoms, you should contact your child’s health-care team as soon as possible.
- Low fluid intake: If you notice the urine becomes cloudy or foul-smelling, or there are sand-like sediments in the urine WITHOUT fever, you should encourage your child to drink more water and complete catheterization as per their recommended schedule.
- Urinary retention: If your child has no urine output for more than eight hours (either on their own or with a catheter), bring them to the nearest emergency department for catheter placement.
CIC schedule
- Your child’s health-care team will tell you how many times a day or how frequently your child should be completing CIC. Depending on your child’s needs, this may be up to six to eight times per day. Your child should not go longer than eight hours without doing CIC at night.
- Your child should complete CIC on a regular schedule from morning to night as prescribed. They should NOT skip any scheduled catheterizations.
Types and sizes of catheters
- Your child's health-care provider will recommend a catheter size that is correct for your child.
- The thickness of the tube of the catheter is measured in a unit called French (FR). Catheters used for CIC range from 5 to 16 FR. The smaller the number, the thinner the catheter.
- Your child’s health-care provider will suggest changes in the size of the catheter if needed. For example, if it takes too long to empty the bladder, the catheter your child is using may be too thin.
- You may be instructed to use a straight tip or coude tip catheter depending on your child’s anatomy. A coude tip has a little hook at the end. This tip should point upwards (towards the sky) when inserting in the urethra.
Other tips
- If the catheter falls on the floor, use another one.
- Have your child drink a lot of liquids to help the flow of urine through the kidneys.
At SickKids
If you have questions about your child’s catheterization, please contact the urology clinic via phone or email.
6D Urology Clinic Phone: 416-813-6661
E-mail: urology.nurses@sickkids.ca
For URGENT concerns after hours or on weekends, please consult your child’s health-care provider or seek assistance in an Emergency Department.
A Child Life Specialist can also help to prepare and support your child if they are anxious about CIC. Ask a urology team member if you would like the child life team to be involved in care.
Useful websites
The Canadian Urological Association (CUA) – Patient Information and Brochures