Children who need to use a catheter to empty their bladder can be taught to do so by themselves. Read step by step catheterization instructions for boys.
Key points
Clean intermittent catheterization (CIC) is a technique that your child will have to do several times a day to help empty urine from his bladder.
CIC is necessary when your child is unable to empty his bladder on his own, when his bladder leaks urine, or when very high pressure has developed in the bladder.
Your child should empty his bladder using CIC four to six times per day and should not go longer than eight hours without doing CIC at night.
There are two steps to keeping your child's catheters clean. Step 1 should be done after each time the supplies are used and step 2 should be done once a day for sterilization.
Introduction
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 his bladder on his own, when his 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 his bladder if he follows the nurse's directions. With a little practice, almost everyone can learn the technique, even a five-year-old child.
More information
How the urinary system works
Urinary system (male)
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.
Preparing for the treatment
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)
Treatment
Ten steps to do a clean intermittent catheterization
There are 10 steps to properly do a CIC for boys:
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 him to
wash his hands well with soap and water and dry. Try to keep his fingernails short and clean.
Have your child position himself in front of the toilet or in a chair across from the toilet, or propped up in a bed.
If your child is uncircumcised, have him pull back on his foreskin and keep it back during the catheterization. Have him wash the end of his penis well with soap and water.
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. Make sure the other end of the catheter is in a cup or is set to drain in to the toilet.
Have your child hold his penis straight out from his body. He should grasp the lubricated catheter as he would a pencil and slowly insert it into the urethra until urine begins 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 his 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 his penis, push the foreskin back to its usual position, and wash his hands.
More information about the treatment
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 colour, 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.
After the treatment
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 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 250 ml (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.
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.
Complications
Possible problems
The catheter does not go through. If your child is not relaxed at the time of the catheterization his urethral sphincter, the "bladder door," will be closed. If your child is not able to put in the catheter, even though he 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, he should drink more. Make sure that he is doing the catheterization properly. If a fever does develop, call your doctor.
Helping your child
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 him.
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
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 SickKids. 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.
