When Your Child Needs Clean Intermittent Catheterization (CIC)
Children with urinary tract problems may require clean intermittent catheterization (CIC). This is the temporary placement of a tube (catheter) to help drain the bladder. A parent or another adult does CIC until the child learns how to do it. Children as young as 5 years old can do their own CICs.
How is CIC done?
CIC is done by passing a catheter into the urethra (tube that carries urine from the bladder out of the body). Once the tube reaches the bladder, urine starts to drain. CIC allows the bladder to empty completely. Once the bladder is empty, the catheter is removed.
Why is CIC needed?
CIC helps your child empty his or her bladder. CIC done regularly also helps prevent the following:
Urinary tract infections
Kidney or bladder damage
Wetting accidents (incontinence)
Feeling nervous is normal
At first, inserting the catheter into your child’s urethra may seem scary for both you and your child. But you will have help from your child’s healthcare team. They will teach you how to perform CIC. And as your child becomes more independent, he or she can start to help with CICs. Start by letting your child wash his or her hands and gather the catheter and other supplies. When your child feels ready, the healthcare provider can teach him or her how to do CIC.
How often is CIC done?
Do CIC as often as instructed. Do not wake your child during sleeping hours to do CIC unless you are instructed to do so. For your child, do CIC every 3 to 4 hours.
Your child’s catheter
Catheters are made of soft, flexible plastic. They come in many shapes and sizes. Some are disposable and are used once and thrown away. Others may be used multiple times if cleaned properly. Your child’s healthcare provider will choose the best catheter for your child. If your child uses reusable catheters, ask how often they should be replaced. Follow the healthcare provider’s instructions carefully.
Using a catheter
Follow these steps when doing a CIC:
Step 1: Get ready
Gather your supplies. You’ll need the following:
Lubricant or sterile water
Disposable wipes or a washcloth
A container to put the used catheter in
Wash your hands. Use soap and warm water. Talk with your doctor about whether you should use sterile or disposable gloves.
Step 2: Lubricate the catheter if needed
Squeeze lubricant on to a paper towel and roll the first 6" to 8" of the catheter in the lubricant.
Step 3: Insert the catheter
Have your son stand over the toilet, or sit in a chair across from the toilet, or sit upright in bed
If your son is circumcised, pull back the foreskin and keep it back during the catheterization. Clean the tip of the penis with a disposable wipe or washcloth.
Hold the penis on both sides, straight away from the body.
Gently insert the tube until urine starts to drain into the toilet. Then continue inserting the catheter about an inch more.
Hold the tube in place until the urine stops draining.
Have your daughter sit on the toilet, or sit in a chair across from the toilet, stand with one foot on the toilet rim, or lay in bed
Find the two folds of skin that surround the vagina (called the labia) and separate them with your dominant hand. Find the urethral opening. It is located below the clitoris and above the vagina.
Once the urethral opening is found, clean the area with a disposable wipe or washcloth. Wipe from the urethral opening towards the vagina.
Keep the labia separated and gently insert the tube until urine begins to drain. Then continue inserting the catheter about an inch more.
Hold the tube in place until the urine stops draining.
Step 4: Withdraw the catheter
Remove the catheter slowly. There may be some urine that will drain as you remove the catheter.
Step 5: After the CIC
Wipe the area between your child's legs and wash your hands.
If your child used a disposable catheter, throw it away.
If your child used a reusable catheter, wash it with soap and water, rinse it and dry it off. Then put it into a container, such as a plastic resealable bag.
Wash your hands with soap and warm water.
Tips for successful CICs
Place two resealable plastic bags in your child’s backpack. Label one “Clean” and the other “Dirty” so your child can store reusable catheters accordingly.
Children capable of doing so should learn to do CIC beginning in kindergarten. Then your child won’t have to rely on the nurse for help with CICs.
Girls should avoid relying on mirrors to find the urethra if possible.
Keep in mind that your child may have some discomfort at first. This often lasts about 3 days for boys and 1 to 2 days for girls, but it depends on the child.
Stick closely to the catheterization schedule.
Make sure your child drinks plenty of liquids and does not avoid them in an attempt to avoid catheterization. The schedule needs to be followed no matter how little fluid the child drinks.
The thought of having to regularly catheterize your child can be overwhelming. You may be feeling angry or sad about your child’s need for CIC. You may view it as a loss of freedom or normalcy for your child and your family. This is to be expected. But as you begin doing CICs, you will likely become more comfortable with it. And for your child, CICs will become a normal part of his or her daily activities. Also, keep in mind that you’re not alone. Your child’s healthcare provider will teach you how to do CICs. When your child feels ready, he or she will be taught how to do his or her own CICs. In the meantime, it’s vital for your child’s treatment and emotional development that you be supportive and patient. Encourage your child’s success by seeing to it that he or she follows the voiding schedule.
Call the healthcare provider if your child has any of the following:
Fever (see Fever and children, below)
Blood in the urine (a small trace of blood is normal)
Sand-like material (sediment) in the urine
Pain in the lower back or lower abdomen
Trouble inserting the catheter
Increased pain when inserting the catheter
Fever and children
Always use a digital thermometer to check your child’s temperature. Never use a mercury thermometer.
For infants and toddlers, be sure to use a rectal thermometer correctly. A rectal thermometer may accidentally poke a hole in (perforate) the rectum. It may also pass on germs from the stool. Always follow the product maker’s directions for proper use. If you don’t feel comfortable taking a rectal temperature, use another method. When you talk to your child’s healthcare provider, tell him or her which method you used to take your child’s temperature.
Here are guidelines for fever temperature. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.
Infant under 3 months old:
Ask your child’s healthcare provider how you should take the temperature.
Rectal or forehead (temporal artery) temperature of 100.4°F (38°C) or higher, or as directed by the provider
Armpit temperature of 99°F (37.2°C) or higher, or as directed by the provider
Child age 3 to 36 months:
Rectal, forehead (temporal artery), or ear temperature of 102°F (38.9°C) or higher, or as directed by the provider
Armpit temperature of 101°F (38.3°C) or higher, or as directed by the provider
Child of any age:
Repeated temperature of 104°F (40°C) or higher, or as directed by the provider
Fever that lasts more than 24 hours in a child under 2 years old. Or a fever that lasts for 3 days in a child 2 years or older.
March 21, 2017
Self-catheterization in Kozier and Erb's Fundamentals of Nursing Concepts, Process, and Practice, Urinary elimination, in Kozier and Erb's Fundamentals of Nursing Concepts, Process, and Practice
Adler, Liora, C., MD,Bass, Pat F., III, MD, MPH,Turley, Ray, BSN, MSN