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 his bladder.
- Clean: as germ-free as possible
- Intermittent: done on a regular schedule many times a day
- Catheterization: using a catheter, a kind of 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 her bladder on her own, when her 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.
CIC is not hard to do. Your child cannot hurt her bladder if she follows the nurse's directions. With a little practice, almost everyone can learn the technique, even a five-year-old child.
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 your urine.
You have a strong muscle at the bottom of your bladder called a sphincter, which stops the urine from coming out until you are ready to use the toilet.
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 or not it is a good time to empty. If you do not empty the bladder at the first signal, the 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, infections or other problems can happen. If the bladder is not drained, urine may pass backward into the ureters and kidneys. This is called reflux and can lead to kidney infections, scar tissue, and lasting kidney damage. For many children, CIC is a way to completely empty the bladder, stop reflux, urinary tract infections and wetting accidents.
Supplies you will need for to do a clean intermittent catheterization
- Catheter
- Lubricant jelly such as 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
- Vinegar or a pot of water (this is for sterilization)
Ten steps to do a clean intermittent catheterization
There are 10 steps to properly do a CIC for girls:
- Get all the supplies and put them together in a place where you can easily reach them.
- Ask your child to try to urinate without straining or trying too hard.
- Ask her to wash her hands well with soap and water and dry. Try to keep her fingernails short and clean.
- Make sure she is in a comfortable position. She can sit on the toilet or in a chair across from the toilet. Also, she can do it lying down or standing with one foot on a chair or the toilet rim.
- Tell her 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 Muko or K-Y jelly on the catheter tip to lubricate it. Try to cover about 5 to 8 cm (about 2 to 3 inches) of the tip. Do not put the catheter into the jelly tube. She should grasp the catheter as she would a pencil. Make sure the other end of the catheter is in a cup or set to drain into the toilet. She may need to use one finger to feel her clitoris to help her find the right hole. It is normal to accidentally put the catheter into the vagina when learning how to do CIC.
- Keeping the labia separated, have your child slowly insert the lubricated catheter into her urethra until urine starts to flow freely. Then 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 her muscles.
- 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 her legs and wash her hands.
Other things to remember:
- Always clean and properly store the catheter. The instructions on how to do this are lower on this page.
- Check the color, smell and how clear the urine is. These can be signs of infection or other problems. If the urine is changed, you need to tell the doctor or nurse about this.
- Write down how much urine came out. This information will help the doctor and nurse work with you to set up a regular schedule that is right for your child.
How to clean the catheters
Keeping the catheter clean and germ-free will help prevent urinary tract infections. There are two steps to keeping your catheters clean, which are described below. Step 1 should be done after each time the supplies are used. Step 2 should be done once a day for sterilization. This means any germs on the catheters are removed, which helps prevent your child from getting an infection. There are two options for sterilization: boiling in water, or soaking in vinegar.
Step 1: Cleaning the catheters (just after using)
- Wash catheters with a warm, soapy water and rinse well, inside and out.
- Liquid hand or dish soap works well and is safe.
- You can also use a syringe to flush the catheter. A syringe is a hollow tube with a plunger.
- Dry the catheter with a towel and store it in a plastic bag labelled "dirty" to be sterilized later in the day.
- Go to Step 2: either Option 1 or 2.
Step 2: Sterilizing (once per day)
The nurse will tell you if you need to sterilize the catheters by boiling or if you can sterilize with vinegar only.
Option 1: Sterilizing by boiling
- Once a day put all the washed catheters in a large pan of hot boiling water for about 10 minutes.
- Do not forget to take the catheters out or the catheter will be damaged.
- Then place catheters on a clean paper towel to air dry. It is important not to have any wet spots or any moisture inside the catheter because this will be a good area for germs to grow.
- Store the catheters in a clean zip-lock plastic bag or container in a safe place.
- The same catheter can be reused and cleaned for about a week unless it becomes rough, stiff, cracked or damaged in any way.
Option 2: Sterilizing with vinegar
- Wash the catheters with warm, soapy water.
- Rinse thoroughly two times.
- Soak catheters in a solution of about 1 cup of vinegar in a basin of room temperature water for about 30 minutes.
- Rinse catheters with clean water.
- Put catheters on a clean paper towel to air dry. It is important not to have any wet spots or any moisture inside the catheter. Germs could grow in these damp places.
- Store the catheters in a safe place in a clean zip-lock plastic bag or container.
- The same catheter can be reused and cleaned for about a week unless it becomes rough, stiff, cracked or damaged in any way.
Possible problems
- The catheter does not go through. If your child is not relaxed at the time of the catheterization her urethral sphincter, the "bladder door," will be closed. If your child is not able to put in the catheter, even though she is relaxed, you should call the nurse or doctor.
- The catheter causes bleeding. Some small blood drops may appear once in a while around the catheter during the procedure. If it does not happen too often, it is probably nothing serious, but tell the doctor or nurse.
- The urine seems infected and your child has a fever. If the urine becomes cloudy and is foul smelling with a fever, you must call your doctor as soon as possible.
- The urine seems infected but your child has no fever. If the urine becomes cloudy and is foul smelling but your child does not have a fever, she should drink more. Make sure that she is doing the catheterization properly. If a fever does develop, call your doctor.
Clean intermittent catheterization four to six times per day
Most doctors say it is better to do CIC four to six times per day, depending on a child's needs. Your child should not go longer than eight hours without doing CIC at night.
The right catheter size for your child
Your child's doctor will give your child the catheter that is just right for her.
The thickness of the tube of the catheter is measured in a unit called French (FR). Catheters used for clean intermittent catheterization range from 5 to 16 FR. The smaller the number, the thinner the catheter.
The doctor 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.
Some important things to know
- It is very important that your child self-catheterizes on time and does not skip doing it. Try to have a set regular schedule from morning to night.
- 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
Supporting your child
When preparing your child for an operation, the urology team recommends that whenever possible, your child and family members attend the Pre-Admission Program offered at Sick Kids. For more information call 416-813-6150 or visit the website at www.sickkids.ca
A Child Life Specialist can also help to prepare and support your child if they are anxious about the operation.