C I C - Clean Intermittent Catheterization

Originally prepared by Jeanette Waters, BSN, RN and Andrea Sherbondy, MD
Most recently updated 9-28-00 by center staff

• C I C Introduction
• What is C I C?
• Why is C I C important?
• Learning to do C I C
• Why should my child learn to do C I C?
• What is the best age for my child to learn self-catheterization?
• How can I tell if my child is ready to learn C I C?
• How often will my child need to do C I C?
• Can my child do C I C at school
• How will the school nurse help my child with C I C?
• Will it cause concern if my child needs to be out of the classroom several times a day for C I C?
• Is there a chance my child might experience an allergic reaction as the result of C I C?
• How can I tell if my child has a latex allergy?
• C I C supplies
• Basic steps of C I C
• C I C medications
• Financial assistance for C I C
• Warning signs
• More information

C I C Introduction

Young children with special health needs often require medical procedures or routines that can be carried out by their parents. With time, most children - depending on developmental level - can learn to do these procedures themselves. This Center Care Bulletin will answer some of your questions about one of these procedures, clean intermittent catheterization (C I C).

What is C I C?

C I C is an abbreviation for "clean intermittent catheterization." It means:

Why is C I C important?

Urine is produced by the kidneys. It flows from the kidneys to the bladder through tubes called the ureters (see Figure 1: The urinary tract). Most people empty their bladders by going to the bathroom four or five times a day. When the bladder is not emptied, infections or other problems can occur. If the bladder is not drained, the urine may pass backward into the ureters. This condition is called reflux . Reflux can cause infection and damage to the kidneys. For many children, C I C helps prevent reflux, urinary tract infection, and toileting "accidents."

Figure 1: The urinary tract

Learning to do C I C?

You can talk to your family doctor about C I C, or you may want to talk with a specialist called a urologist - a doctor who has special knowledge of the urinary tract. Your doctor and nurse will provide you with a demonstration of the procedure, an opportunity to do C I C with supervision, and written instructions.

Why should my child learn to do C I C?

We all want our children to be as independent as possible, and an important part of this is learning personal self-care. One way to help children be more self-confident is to let them be responsible for as much of their own care - including C I C - as possible.

What is the best age for my child to learn self-catheterization?

Parents usually do C I C for their child until the child is about five years old. As the child becomes developmentally ready, he or she can be encouraged to participate in parts of the procedure, such as washing hands or organizing C I C equipment.

A child is often able to carry out his or her own C I C at the age of seven or eight years. At this age, the child may be a little more self-conscious about wetting "accidents," and thus more motivated to learn. You, your child, and your doctor can decide the best time for your child to learn C I C.

How can I tell if my child is ready to learn C I C?

A child is ready to do his or her own C I C when he or she:

• Has a mental age of 5 years
• Has the necessary coordination (fine motor skills); for example, can pick up a soda straw and place it on a tray at a specified location
• Wants to learn C I C
• Has the encouragement and support of parents and other adults

How often will my child need to do C I C?

Most doctors recommend 4 to 6 times per 24-hour day, with no longer than 8 hours between catheterizations at night.

Can my child do C I C at school?

Yes. Your doctor will write a letter to the school. The letter will outline your child's catheterization program and ask the school nurse or health aide to help your child with C I C. You and your child should demonstrate the specific C I C methods you prefer to use to your child's school nurse or health aide.

How will the school nurse help my child with C I C?

The school nurse or health aide will:

• Get supplies ready
• Help your child with the C I C process
• Check your child's progress
• Watch for any problems

Will it cause concern if my child needs to be out of the classroom several times a day for C I C?

As you plan your child's C I C schedule, talk with your child, the teachers, the school nurse, and your doctor. Careful scheduling, using lunch hours, recess, class breaks, and study halls, can minimize disruption of the school day.

Is there a chance my child might experience an allergic reaction as the result of C I C?

Children with neural tube defects, such as spina bifida, are at risk to develop an allergy to latex. So are children with urological abnormalities. These children may become allergic to the latex in certain products used with C I C. For this reason, we recommend the use of latex-free products.

How can I tell if my child has a latex allergy?

A child who is allergic to latex may have certain symptoms after using a product containing latex. These symptoms may include:

• Itchy, runny nose
• Itchy, watery eyes
• Skin rash with red, itchy bumps
• Swelling of lips, tongue, eyelids
• Breathing problems

How serious is a latex allergy?

Latex allergy can be very serious. It can cause anaphylaxis, an allergic reaction that can be life-threatening.

Can I do anything to keep my child from becoming allergic to latex?

Yes, you can, by not exposing your child to latex. Children who are at risk for latex allergy should avoid products that contain latex. This is true even if a child does not currently have allergic symptoms due to latex exposure.

How can I learn whether my child is allergic to latex?

You can ask your doctor whether your child should be tested for latex allergy. The allergy test is done using a blood test called a RAST, or a skin test.

What should I do if my child has a latex allergy?

Your child will need to avoid products containing latex.

Talk with your health care providers, including your physician and your dentist. They should not use products that contain latex when they care for your child.

Your child should use only latex-free products. Your physician can write a prescription for latex-free catheters, syringes, and gloves to use during C I C and other routines. You can order these through your local pharmacy or medical supply source.

It would be a good idea for your child to wear a medic alert bracelet indicating this allergy.

What kinds of latex-free products are available?

Catheters	Vinyl, from Mentor Corp. Polyvinylchloride, from Robnel Silicone retention
Gloves	Triflex vinyl gloves and Duraprene non-latex gloves, from Allegiance Healthcare Corp. Triflex vinyl gloves, from Baxter Healthcare Corp. Powder-free nitrile (co-polymer) gloves, from Safeskin Corp.

What other precautions should I take?

You will also need to tell your child's other caregivers. It is very important that they know, so that they can avoid using latex products with your child. Some caregivers you should talk with include:

• Babysitters
• Daycare staff
• Teachers, teacher's aides, and coaches
• School nurse
• Grandparents and other family members
• Your child's friends, and their parents
• Summer camp staff

Where can I get a list of latex-free products?

You can get this information from:

A.L.E.R.T. (Allergy to Latex Education and Resource Team) information packet, anaphylaxis guidelines, lists of materials that contain latex	Asthma and Allergy Center #411 PO Box 13930 Milwaukee, WI 51101 Phone: 414-677-9707 Web: http://www.latexallergyresources.org
The ABCs of Latex Allergy	Henry Ford Health System Division of Allergy and Clinical Immunology Phone: 1-800-7-ASTHMA
Guide to latex alternatives	Spina Bifida Foundation 4590 MacArthur Blvd NW, Suite 250 Washington, DC 20007-4226 Phone: 1-800-621-1141

 

What supplies will I need for C I C?

What are the basic steps of C I C?

Preparing your equipment:

1. Wash your hands with soap and water.
2. Place a clean towel or a disposable pad on a flat surface within arm's reach of the child.
3. Place supplies for C I C on the clean surface.
4. Fill one paper cup with soap and water solution. Add 3 cotton balls.
5. Fill another cup with plain water. Add 3 cotton balls.
6. If needed, fill the "INSTILLATION" and "IRRIGATION" syringes with the prescribed instillation or irrigating solution.

Position your child as he or she is accustomed and remove clothing from the genital area. Then:

1. Wash hands again using soap and water or a wet wipe.
2. Wash the genitalia with wet wipes or soap-and water-saturated cotton balls. Do this three times using a clean wet wipe or cotton ball each time. For females, wipe front to back. For males, use circular motion (see Figure 2: Cleansing before doing C I C).
3. Rinse the genitalia with clean wet wipes or with clean, water-saturated cotton balls. Do this three times, using a clean wet wipe or cotton ball each time.

Lubrication:

For males - Fill a syringe with 1 to 5 cc. of lubricating jelly. Lubricate the urethral opening. With a clean syringe, instill 1cc. to 5cc. lubricating jelly into the urethra.

For females - Lubricate the tip of the catheter with water, if necessary.

Collecting the urine

1. Place the urinal or collecting basin in a position to collect urine from the catheter.
2. Insert the catheter slowly into the urethra (see Figure 3: Inserting the catheter). Continue until you see urine begin to flow from the catheter. Let the urine drain into the collecting basin.
3. Empty the bladder completely. If the flow seems to stop, actions that can help empty the bladder include having the child sit up, lie down, or roll from side to side.

Bladder instillation or irrigation

If prescribed by your doctor, you will now continue with the bladder instillation or irrigation procedure, both of which are explained below.

What is bladder instillation or irrigation?

Follow these steps ONLY if your doctor has told you to carry out bladder instillation or irrigation.

Irrigation - With irrigation, a solution flows through the catheter into the bladder, and is held for one minute. Then it is allowed to drain out again. You use a syringe labeled "IRRIGATION" to put the solution into the catheter. Your doctor may suggest irrigating the bladder before instilling another solution.

Instillation - With instillation, a solution is left in the bladder and the catheter is removed. Use the syringe labeled "INSTILLATION" to instill the antiseptic or antibiotic solution through the catheter and into the bladder. Use the amount of solution prescribed by your doctor. Do not let the solution drain back out again through the catheter. Remove the catheter and syringe at the same time.

What needs to be done when C I C is completed?

1. Wash your hands with soap and water when the procedure is completed.
2. Help your child get dressed.
3. Help your child clean up catheters and supplies.

How should we clean the catheters and syringes? Do they need to be sterilized?

Proper care of the catheters and syringes keeps the equipment germ-free, and this helps to prevent urinary tract infections. You should clean your supplies after each each C I C session. Once a day, you should sterilize these supplies.

To clean your C I C equipment:

Wash and rinse the catheter with soap and cool water.

• Use the syringe marked "RINSE" to force cool water through the catheter.
• Rinse the INSTILLATION, IRRIGATION, and other syringes, such as the syringe for the lubricating jelly.
• Set the catheter and syringes on a clean surface to air dry.
• Put the dry catheter and the syringes in a plastic bag labeled "Dirty" to be sterilized later in the day. Throw away all disposable items.

Sterilizing your C I C equipment:

Once each day, you need to sterilize the C I C equipment.

• Using your stove: Once a day, put all the washed, dry catheters and syringes in a large pan of hot water on your stove. Bring to a boil. Boil for 10 minutes. Then place catheters on a clean paper towel to air dry.
• Using your microwave oven: Once a day, gather up all the washed, dry catheters and syringes. Put them on a paper towel and place in microwave beside a glass of water. Microwave at the highest setting for 6 minutes.
• Storage: Immediately put each catheter in its own bag marked "Clean." Zip-lock the bag shut, or use a twist tie. Store in clean, secure place.

Is C I C uncomfortable for my child?

You may worry that C I C will be uncomfortable for your child. Remember, children with myelomeningocele and similar conditions have little feeling in the genital area. You observed the amount of discomfort your child experienced during the clinical demonstration of the technique. If your child does feel discomfort, your doctor can prescribe an anesthetic gel. This will help to numb the urethra and make C I C more comfortable.

Is help with C I C available if we need it?

Your doctor and nurse will show you how to do C I C. You can practice while one of them is with you to help. You should write down the phone numbers of your doctor and your nurse. If you have any questions when you do C I C at home, you should call one of them.

If you are worried about C I C, you might want to talk with someone who has personal experience, like another parent who helps a young child with C I C, or an older child who does self-catheterization (S C I C). Your nurse or another staff person can help arrange this.

Will my child need special medicines?

Children with bladder disorders often take medication. These medicines help relax the bladder and allow the bladder to hold more urine. Medicines that may be prescribed for your child include:

• Anti-spasm medicines like Ditropan, Pro-banthine, or Bladder Mixture (this last product, made without phenobarbital, is unique to the University of Iowa).
• Vaso-constricting medicines like Ornade or Resaid, phenylpropanolamine hydrochloride, or Sudafed.
• Antiseptic or antibiotic medicine.

What do these medicines do?

Ditropan and Pro-Banthine block nerve impulses to the bladder, to help prevent it from contracting in spasms. This means your child will wet less often.

Ornade contains phenylpropanolamine, which helps the bladder maintain steady muscle contraction to hold urine longer and thus prevent wetness.

Sudafed makes the sphincter contract.

Do any of these medicines have side-effects?

The most common side-effects of these medications are:

• blurred vision
• constipation
• dizziness
• dry mouth
• flushed skin around the cheeks
• headache
• sleepiness
• paleness around the mouth

None of these side-effects are harmful. Heat and physical activity may increase them. Reducing the amount of medicine (the dose) that the child receives will usually make them go away.

Ditropan may produce fewer side effects if it is instilled into the bladder, rather than taken by mouth. The Ditropan tablet can be dissolved in the saline or silver nitrate solution, and then instilled into the bladder.

What should I do if my child has these side-effects?

If your child has any of these side-effects, keep track of:

• How often the side-effects appear
• How long they last
• How serious they are
• Whether more than one side-effect occurs

If you notice any side-effects, call your doctor or clinic. The doctor may advise you to reduce the dosage. Remember, too, that it may take a little while for your child to adjust to the medicine.

How can I tell if my child has a bladder or urinary tract infection?

Inspect your child's urine regularly. Be familiar with its usual color and other characteristics when your child is healthy. Normal urine is clear and yellow - you can see through it.

Be alert to the following warning signs:

• Cloudy urine
• Bad or unusual smell
• Unusual color

Pay special attention if your child complains of:

• Stomach or back pain
• Chills or fever without a definite cause
• Skin irritation or a diaper rash that doesn't heal
• Less urine being passed during C I C, and more wetness during the day
• Nausea and vomiting

The symptoms below are sometimes seen if your child is not drinking enough fluids.

• Black flecks in the urine - These occur when the child isn't getting enough liquids to completely flush out the silver nitrate antiseptic solution.
• Blackish/greenish urine - Another sign that your child isn't drinking enough liquids.

It is VERY important that your child drink plenty of liquids each day.

If you see any of these signs, talk with your doctor. Whenever your child has a fever, your doctor should do a urinalysis. If there is a urinary tract infection, further tests may be needed.

Can we get financial assistance to help pay for our child's C I C supplies?

If you have health insurance or another health plan (such as Medicaid), this may pay for some or all of these supplies. Read your policy or check with your insurance agent about this. You might also want to discuss this with your nurse, who may be able to refer you to an appropriate resource.

You might also discuss this with your hospital social worker, or with your local social worker. They can tell you about state and federal financial aid programs that may be helpful.

Where can I find more information about clean intermittent catheterization?

Your doctor or clinic staff can answer other questions you may have about C I C. Below are some useful publications:

• Clean Intermittent Catheterization: Videotape and a User's Manual (1986). Denver, Colorado: University of Colorado Health Sciences Center, School of Nursing.
• Bladder and Bowel Management for Children with Myelomeningocele (1988), Marcia Henderson Lozes. Los Angeles: Children's Hospital of Los Angeles (Aspen Publishers).
• Introduction to Intermittent Catheterization (1986), Janet Mapel, in Mark L. Wolraich (ed.), What You Should Know about Your Child with Spina Bifida, pages 41-46. Iowa City, Iowa: Center for Disabilities and Development.
• Bowel and Bladder Maintenance (1990), Patricia Smigelski and Janet Mapel, in M. Craft & J. Denehy (eds.), Nursing Interventions for Infants and Children, pages 355-377. Philadelphia: W. B. Saunders Company.

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