Clean intermittent catheterisation

Clean intermittent catheterisation is a way of emptying the bladder of urine if weeing is difficult or impossible. It involves passing a catheter (thin, plastic tube) through the urethra into the bladder. 

Good hygiene is extremely important in clean intermittent catheterisation as it reduces the risk of developing a bladder infection, which is unpleasant and can sometimes lead to more widespread infection.

The urinary system consists of the kidneys, the bladder, the ureters and the urethra. The kidneys filter the blood to remove waste products and form urine. The urine flows from the kidneys, down through the ureters to the bladder. From here it passes through another tube called the urethra to the outside when urinating (weeing).

Children who have spinal problems, such as spina bifida or a spinal cord injury, may find it more convenient to use clean intermittent catheterisation. It is also suggested if a child has trouble emptying their bladder completely – leaving a small amount of urine behind in the bladder can increase the risk of infection. Children who are wet (incontinent) can also benefit from clean intermittent catheterisation as it will increase the amount of time they can stay dry during the day.

You will need:

• catheters
• disposable wipes
• water-based lubricant (if required)
• container for collecting urine (if not using a toilet)

Catheters can be pre-lubricated (coated with lubricating gel), self-lubricated (they become slippery when soaked in water) or non-lubricated. Please discuss which type suits your child best with your clinical nurse specialist.

Catheters are usually supplied by a home care company so remember to re-order new supplies in plenty of time. If you have any problems getting hold of supplies, please tell us.

Most catheters are disposable ‘single use’ catheters. Please do not re-use single use catheters as it can increase the risk of infection. Used catheters can be disposed of in your household rubbish.

If you are going abroad on holiday, it can be helpful to carry a letter from your child’s consultant explaining why you are carrying catheters. Remember to keep a few days’ supply in your hand luggage just in case your suitcases go astray.

1. Collect all the equipment needed.

2. Wash your hands with soap and water.

3. Get your child into a comfortable position.

• Sitting on the toilet.
• Lying on their back.
• Sitting in their wheelchair.

4. Clean your child’s genital area.5. Wash your hands again with soap and water.

• Girls – clean the outside area first, then part their labia to clean thoroughly from front to back.
• Boys – clean the tip of the penis using an inwards circular motion towards the urethra, gently pulling back their foreskin to clean underneath.

6. Open the catheter packaging – avoid touching the end of the catheter.

7. Add a small amount of lubricant to the outside surface of the catheter (unless it is a lubricated type).

8. Gently insert the tip of the catheter into the urethra.

9. Use gentle pressure to pass the catheter through the sphincter (ring of muscle) at the neck of the bladder.

10. Continue to insert the catheter into the bladder until urine starts to flow.

11. Hold the other end of the catheter over the container or toilet.

12. Keep the catheter in place until the flow of urine stops.

13. Slowly remove the catheter, pausing if urine starts to flow again.

14. Dispose of the catheter as instructed.

15. Wash your hands again with soap and water.

Cloudy or smelly urine:

• This may be a sign of infection.
• Take a sample of urine using the catheter and take it to your family doctor (GP) for testing.
• A course of antibiotics may be needed. 
• Drinking plenty of fluids will also help.

Pain when inserting the catheter:Blood in the urine:

• This usually improves in time.
• If pain continues, talk to your clinical nurse specialist. 
• This may be a sign of infection.
• Take a sample of urine using the catheter and take to your family doctor (GP) for testing.
• A course of antibiotics may be needed.
• Drinking plenty of fluids will also help.
• It may also be a sign of bladder irritation.
• If it does not improve in a few days, talk to your clinical nurse specialist.