Clean intermittent cathe­teri­zation: a reminder for parents

This page is a reminder of what you were taught in the hospital. It does not replace hands-on training, and the individual instructions from your doctor or nurse always come first.

Why catheterization?

When the bladder does not empty fully on its own, for example in neurogenic bladder, it is emptied regularly with a thin catheter. The catheter is passed through the urethra into the bladder and removed once the urine has drained. In babies with spina bifida, catheterization is usually started as soon as possible after birth.

Clean, not sterile

For long-term intermittent catheterization at home, the clean technique you were taught is enough; in hospital, the way a catheter is placed depends on the procedure and on infection-control rules. The clean technique means:

• wash your hands with soap and water and dry them well before and after each catheterization,
• clean the genital area the way you were taught: in girls, separate the labia and wipe from top to bottom; in boys, start at the opening of the urethra and work outward,
• use a new catheter each time; reuse a catheter only if it is a special reusable type and a nurse has shown you how,
• unless the catheter is hydrophilic, use a water-soluble lubricating gel.

Lay a baby on their back. An older child is usually most comfortable sitting on the toilet.

How many times a day?

Your doctor sets the number and timing of catheterizations. If your child cannot pee at all, it is usually 4–6 times a day; if your child can partly pee on their own, often 1–3 times a day. Do not change the schedule yourself. During a urinary tract infection, the doctor may advise catheterizing more often for a while.

Constipation makes it harder to pass the catheter. Regular bowel emptying is part of bladder care.

Daycare and school

• Plan training for daycare or school staff in advance with your doctor or nurse.
• Agree on a clean, discreet place to store catheters and supplies.
• Keep the procedure as quick and simple as possible, without cutting corners on safety, so your child misses less class time.
• If your child has spina bifida, tell the teachers about the risk of latex allergy.

Latex allergy

Children with spina bifida have a high risk of latex allergy. From infancy, avoid latex catheters, gloves and other latex medical products, as well as rubber balloons. A reaction can be mild (skin irritation, rash, hives, itchy eyes, sneezing) or severe (widespread hives, wheezing, coughing, swelling around the eyes, vomiting). For a severe reaction, call emergency services right away.

Problems and what to do

• The catheter will not go in. Do not force it. Ask your child to take a deep breath. Change their position, hold the catheter with light pressure and wait 1–2 minutes: the sphincter often relaxes. If it still will not pass, call your doctor or nurse without waiting for the next scheduled catheterization.
• Blood in the urine or on the catheter. If bleeding is heavy, does not stop or keeps coming back, see your doctor: persistent bleeding can be a sign of infection.
• Cloudy, bad-smelling urine. If it comes with fever or pain, there may be an infection: contact your doctor as soon as possible.
• Germs in the urine without symptoms. This is common in children who use a catheter and usually does not need treatment. Give antibiotics only if your doctor prescribes them.