Clean Intermittent Catheterisation ( CIC ) in Infants under 1 year old with Spina Bifida - Standard Operating Procedure

Publication: 28/04/2014  --
Last review: 21/04/2017  
Next review: 21/04/2020  
Standard Operating Procedure
CURRENT 
ID: 3837 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2017  

 

This Standard Operating Procedure is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

SOP for Clean Intermittent Catheterisation (CIC) in Infants under 1 year old with Spina Bifida

This standard operating procedure is designed for nurses and parents/carers who look after infants who may require clean intermittent catheterisation (CIC).

Intermittent catheterisation may be a short or long term intervention. It is implemented when infants are unable to empty the bladder effectively.

The procedure involves the episodic introduction of a catheter into the bladder to remove urine. After this, the catheter is removed, leaving the infant catheter free between catheterisations. Catheterisations are performed as often as necessary to prevent incontinence or to prevent prolonged retention of urine, to promote bladder emptying avoiding renal damage and prevent urinary tract infections.

Background and indications for standard operating procedure/protocol

Indications for Intermittent Catheterisation:

  • To provide continence by ensuring the bladder is completely emptied
  • To prevent chronic retention and over distension of the bladder
  • Reduction of risk of damage to upper renal tracts
  • Estimation of residual urine, in the absence of a bladder scanner
  • Management of overflow urinary incontinence

Advantages of Intermittent Catheterisation:

  • To achieve urinary continence
  • To preserve renal function
  • To reduce the incidence of urinary tract infections due to high residual urine volumes
  • To improve quality of life

Exclusions and contra-indications:

  • Lack of consent, written, verbal or implied
  • Patient specific medical instructions that catheterisation is not to take place
    Known urethral obstruction and unsuitability for urethral catheterisation

Precautionary measures:
Caution should be exercised when undertaking intermittent catheterisation in patients with the following conditions:

  • Urinary Tract Infection
  • Cystitis
  • Urethritis
  • Recent surgery to lower urinary tract
  • Trauma to the pelvis or abdomen
  • Recent radiotherapy to the lower urinary tract
  • Vaginal pain / bleeding / discharge
  • Haematuria
  • Congenital abnormalities

When to discontinue the procedure:

  • When it is no longer required ( i.e. complete bladder emptying)
  • Doubt over the position of the catheter
  • Obstruction is felt on insertion
  • Severe sphincter spasm is felt causing obstruction on insertion
  • Bleeding per urethra which is of concern

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Procedure

No.

Action

Rationale

1

Technique should be demonstrated by a professional first who should treat the procedure as sterile, but teach it as a clean technique to the nurse, parent or carer

While infection remains low when an individual carries out CIC, the risk is increased when carried out by a professional who is in contact with other clients, hence the need for sterile technique (Getliffe & Dolman 2003)

2

CIC should be practised under supervision until the nurse/parent/carer is confident

To ensure a safe and successful outcome and ensure competency

3

Thorough handwashing technique as per LTHT hand washing guideline

To minimise risk of infection.

4

Washing the genital area

To minimise risk of infection

5

Size 6 fg lubricated catheter, speedicath compact for females or speedicath for males

To minimise urethral damage and maximise patient comfort

6

Always use a self-lubricating catheter

Reduces the likelihood of strictures (Hellstrom et al 1991)

7

The type and size should always be recorded in the patient’s notes

To promote communication and fulfil Trust policy

8

The manufacturers instructions should be followed

To ensure effective use of product

9

A frequency volume chart should be kept so that CIC frequency can be established

To provide correct information in order to plan treatment effectively

10

Drain into clean bowl, urine bag or nappy when stability allows

To observe colour, smell and volume of urine

11

Following the location of the urethra (see booklet to help), the catheter should be inserted gently until urine is passed and then inserted another centimetre. It should be left insitu until no more urine is passed

To ensure the bladder is empty

12

The catheter should be gently removed using a rotating action.

To promote comfortable withdrawal of the catheter

13

Dispose of the catheter into clinical waste. Disinfect and wash hands as per LTHT guidelines

To minimise cross infection

14

Document procedure and outcome, including details of catheter type

To enable clear communications and meet legal requirements

15

Discuss result and plan of care with nurse, parent/carer. Provide appropriate literature if first time procedure

To involve and empower patient

16

Infant should be reassessed according to clinical need, to evaluate the plan of catheterisations

The frequency of CIC depends on the amount of residual in the bladder

17

On discharge from hospital ensure family has enough supplies and is registered with appropriate supplier

To enable clear communication and ensure  client safety

18

Inform patient’s GP for repeat prescriptions and monitoring.

As above

19

Ensure patient has an outpatient follow up appointment preceded with renal ultrasound scan booked prior to discharge

To review patient progress and frequency of CIC

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Algorithms

Frequency of Clean Intermittent Catheterisation for infants
NB   (All parents taught CIC prior to discharge home even if not required at time of discharge).

<10 mls

None:

  • Residual urine <10mls
  • No thick walled bladder
  • No upper tract dilation
  • No dribbling of urine irrespective of USS finding

>10-15mls

Two times a day

>20mls

Three times a day

>30mls

Before each feed 4 hourly

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Provenance

Record: 3837
Objective:

To facilitate the nurse, parent or carer in the clinical skill of intermittent catheterisation and to understand the reasons for this procedure

Clinical condition:

Urinary catheterisation

Target patient group: Neonates, infants up to one year with spina bifida or medical condition requiring catheterisation advised by Consultant.
Target professional group(s): Primary Care Doctors
Primary Care Nurses
Secondary Care Doctors
Secondary Care Nurses
Adapted from:

Evidence base

  • Kaye I, Payan M, Vemulakanda V (2016) Association between clean intermittent catheterisation and urinary tract infection in infants and toddlers with spina bifida. Journal of Pediatric Urology. Vol 12, Iss5, p284 e1 -284-e6
  • Getliffe,K & Dolman,M. (2003) Promoting confidence. A clinical research resource. B
  • Hellstrom et al (1991) Efficacy & Safety of clean intermittent catherterization in adults. European Urology. Pp117-121. C
  • Naish,W. (2003) Intermittent Self Catheterisation for managing urinary problems. Professional Nurse. Pp585-587.
  • NMC (2002) Code of Conduct. NMC. C
  • Pellowe C, Rogers J (2007) Preventing healthcare-associated infections when using urinary catheters. Infant. Vol 3, Iss 4 C
  • Pratt R, Pellowe C, Wilson J et al (2007) National evidence based guidelines for preventing healthcare associated infections in NHS hospitals in England
    Journal of Hospital Infections 65 (1) A

Evidence levels:
A. Meta-analyses, randomised controlled trials/systematic reviews of RCTs
B. Robust experimental or observational studies
C. Expert consensus.
D. Leeds consensus. (where no national guidance exists or there is wide disagreement with a level C recommendation or where national guidance documents contradict each other)

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Approved By

Trust Clinical Guidelines Group

Document history

LHP version 1.0

Related information

Not supplied

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