Clean Intermittent Self-Catheterization

Clean intermittent self-catheterization is a normal procedure for urinary elimination in people with various diseases that cause urinary retention.

“Urinary retention is the inability to voluntarily empty the bladder completely, resulting in the build-up of residual urine in the bladder. This may lead to complications such as urinary incontinence, bladder damage, kidney disease, and urinary tract infections (UTI). Urinary retention can be acute or chronic. Intermittent catheterization is the first line of recommended treatment for people with chronic urinary retention. This is a procedure that people can do at home, in which a tube (catheter) is inserted into the urethra or a surgically created opening (stoma) in the abdomen to drain the bladder. The catheter is immediately removed after the urine has drained. A person with complete urinary retention typically self-catheterizes 4 to 6 times per day to empty the bladder”¹

Intermittent self-catheterization refers to the sporadic or irregular frequency of catheterization. The catheter remains inside your body temporarily and for a short time. Hence, clean self-intermittent catheterization means to perform your own catheterization every time you feel urgency. The catheter remains inserted only until voiding is complete.

Purpose of Clean Intermittent Self-Catheterization

“Clean Intermittent Self-Catheterization (CISC) is a way to empty the bladder by using a clean catheter. It involves putting the catheter in and taking it out several times a day. CISC helps people who cannot empty their bladders the usual way. By emptying your bladder regularly, you can help prevent bladder infections.”²

The purpose of clean intermittent self-catheterization is to drain your bladder from urinary waste using intermittent catheters. This avoids or minimizes chances of acquiring a urinary tract infection (UTI). Certain medical conditions require self-catheterization to empty the bladder.

Conditions that may require ISC

The following conditions may require intermittent catheterization:

• Urinary incontinence
• After certain surgical procedures such as a Cystectomy
• Various psychological disorders such as Dementia.

“People who need to perform CIC include those who have certain medical conditions, including:

• Stroke
• Parkinson’s disease
• Multiple sclerosis
• Spinal cord injuries
• Spinal surgeries
• Erectile dysfunction
• Trauma/accidents
• Central nervous system tumors
• Cerebral palsy
• Heavy metal poisoning

If you have to perform CIC, you will be inserting and removing the catheter several times a day; your doctor will tell you how many times. By performing this procedure every day, you will not have to wear a catheter all the time. In addition, you will help prevent kidney infection and keep your bladder from stretching.”³

People who practice intermittent self-catheterization or want to start this practice must learn proper sanitary techniques. Otherwise, the risk of complications or counterproductive results will be high.

“To prevent UTI a non-infecting technique is needed. But also, some additional factors can play a role in infection prevention. Nursing education is important and educational intervention by a clinic nurse is a simple, cost-effective mean to decrease the risk of UTI’s in individuals with SCI on IC who are identified as at risk.”⁴

The inability to completely empty your bladder may cause urinary tract infections, ultimately inducing renal failure if untreated.  Unpolluted intermittent self-catheterization facilitates urinary tract infections and other risks associated, so thorough and hygienic voiding is the ultimate goal.

How to self-catheterize

Uncontaminated intermittent self-catheterization for females is completely different from the method for males as the bladder systems differ greatly.

“Urine will drain through your catheter into the toilet or a special container. Your health care provider will show you how to use your catheter. After some practice, it will get easier. Sometimes family members or other people you may know, such as a friend who is a nurse or medical assistant, may be able to help you use your catheter.”⁵

For Her

Clean your hands with soap and water; follow this up by cleaning the region around your urinary meatus. Identify the urethral opening. Prepare the intermittent catheter with lubrication and gently insert it into the urethra.

“With one hand, gently pull the labia open, and find the urinary opening. You can use a mirror to help you at first. (It is sometimes helpful to sit backwards on the toilet with a mirror propped up to help see the area.) With your other hand, wash your labia 3 times from front to back, up and down the middle, and on both sides. Use a fresh antiseptic towelette or baby wipe each time. Or, you may use cotton balls with mild soap and water. Rinse well and dry if you use soap and water.”⁶

As the catheter reaches the bladder, urinary waste will drain into the drainage bag. When urine flow halts, extract the catheter. Measure and record the amount of urine in the bag.  Discard the urine and sanitize both the catheter and the bag with regular soap and boiling water after use for proper storage.

For Him

Cleanse your hands thoroughly with soap and water. Wash theglans penis, especially around the urethra. Prepare for insertion lubricating several inches of the catheter. Carefully begin insertion.

Pay attention to the first 6 inches of insertion because the urethral sphincter that controls the expelling of urine, may resist further insertion. If this is the case, breathe easy and deeply to continue insertion. When urine flow has ceased, slowly remove the catheter. Measure and record the amount of urine drained and then empty the collection bag. Clean the catheter and urine receptacle with soap and hot water immediately. Rinse the supplies and air dry for storage in a clean and dry place.

“Your penis may feel irritated after you catheterize. This is normal. You may have some bleeding during or after your catheterization. Your urine may turn light pink due to this blood, so drink some water. This will flush your bladder.”⁷

Your doctor might require a log of your daily liquid intake and output to observe normal renal and bladder functions. Intake includes drinks, like water, juice, soda, tea, alcoholic beverages, and coffee. “You should drink 1500 to 2000 mls a day. This is 6 to 8 large glasses of fluid a day. Each time you catheterize, the amount of urine needs to be 400 to 600 mls. Avoid becoming overdistended. This means that you have too much urine in your bladder. Pick times during the day that will drain the right amount of urine so your bladder does not get overdistended.”⁸

If your kidneys are operating properly, you ought to flush out a similar quantity of fluid as it enters over the course of the day. If your recorded output does not match up with your intake, inform your doctor.

What are the possible secondary effects?

Intermittent Catheterization will involve some discomfort as the tubing enters the bladder via the urethra. It takes time to get used to intermittent self-catheterization. At first, you will need help from a medical practitioner. Cleanliness prevents urinary tract infections, and you can achieve it with common sense, discipline, and proper sanitary habits.

“Prostatitis can be a cause of recurrent UTI. Either acute or chronic it is difficult to diagnose in patients with neurogenic bladder and special tests have been developed for this. Urethral bleeding is frequently seen in new patients, and occurs regularly in one-third on a long-term basis. Trauma of the urethra especially in men can cause false passages, meatal stenosis but the incidence is rare.”⁹

Inform your doctor if you are experiencing abdominal and/or lower back pain, as well as any burning sensation throughout the catheterization as these are often symptoms of a UTI.

Reuse of Catheters in CISC

“Although hospitals and long-term care facilities use a new sterile catheter for every catheterization, the reuse of intermittent catheters in the home setting is common in some countries and remains controversial. Reasons for reuse are mainly related to costs and environmental concerns, and reuse is less common in countries that reimburse people for single-use catheters.”¹⁰

Consider an appropriate cleansing method when reusing a catheter. “If reusable urinary catheters are to be used for IC, the method of sanitation becomes particularly important. Several methods have been reported in the literature, including: cleaning with antibacterial soap and water; alcohol sterilization; using aseptic solutions, such as chlorhexidine 1.5% and cetrimide 15%, microwave sterilization; or simply rinsing with water and combinations of these methods.”¹¹

Even when some patients reuse catheters, most specialists advise using a new one each time. “According to international guidelines, it is recommended to use a new sterile catheter for each time you perform intermittent catheterization. The overall goal for a one-time use of intermittent catheters is to help maintain bladder health and minimize the potential for bacteria overgrowth in the bladder, as this may lead to complications such as urinary tract infections.”¹²

Evidence from various studies and international associations show that CISC offers positive long-term results. Clean intermittent self-catheterization implies draining the bladder and removing the catheter using regular cleansing methods, and disposable or cleansed reusable catheters. Disability or age should not impede intermittent self-catheterization; even patients with visual impairments, dyskinetic disorders, spinal deformities or absent perineal sensation could perform this with the right training. CISC has established as an optimal method of bladder emptying and has transformed the lives of people with bladder or lower urinary tract dysfunction.

References

(1, 10) Intermittent Catheters for Chronic Urinary Retention: A Health Technology Assessment. Health Quality Ontario. Ontario Health Technology Assessments Series. 2019.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6395058/

(2) Clean Intermittent Self-Catheterization (CISC). Newman, D. National Institutes of Health. 2006. https://www.cc.nih.gov/ccc/patient_education/pepubs/bladder/ciscwomen5_22.pdf

(3) Clean Intermittent Catheterization. Cleveland Clinic. Cleveland CLinic. 2014.https://my.clevelandclinic.org/health/treatments/15434-clean-intermittent-catheterization

 (4, 9) Complications of intermittent catheterization: their prevention and treatment. Wyndaele, J. Spinal Cord. 2012. https://www.nature.com/articles/3101348

(5, 6) Self catheterization: For Females. Shah, S. MedLine Plus: Trusted Health Information For You. 2019. https://medlineplus.gov/ency/patientinstructions/000144.htm

(7) Self-Catheterization for Males. Memorial Sloan Kettering Cancer Center. 2017. https://www.mskcc.org/cancer-care/patient-education/self-catheterization-males

(8) Intermittent Self-Catheterization – A Guide for Men and Women. St. Joseph’s Healthcare Hamilton. 2013. https://www.stjoes.ca/patients-visitors/patient-education/patient-education:-f-j/intermittent-self-catheterization—a-guide-for-men-and-women-pdf

(11) Clean intermittent catheterization: Single use vs. reuse. Hossein, S., Shepherd, S., Van Asseldonk, B., & Elterman, D. Canadian Urological Association Journal. 2019. https://cuaj.ca/index.php/journal/article/view/5357

(12) Coloplast Care. Useful hygiene tips for cathing.  2019. https://www.coloplastcare.com/en-US/continence/routines/establishing-sound-routines/r1.2-useful-hygiene-tips/