Self-intermittent catheterization is ordered by a healthcare prescriber.
The procedure may be taught to the child/family by the healthcare prescriber, a registered nurse, or a licensed vocational nurse. The procedure is performed by the child and the family members who have received education and training to perform selfcatheterization.
Intermittent self-catheterization may be necessary to implement for any number of reasons, including but not limited to the following:
Child has a neurogenic bladder
Child has an inability to void spontaneously
Child has an inability to empty the bladder properly
Child’s bladder leaks urine
Child has a need for bladder training
The goal of intermittent self-catheterization is to prevent urinary tract infections while still completely emptying the bladder.
For most children, intermittent self-catheterization is a clean procedure. The same catheter can be used for weeks at a time. When this procedure is completed in the acute care setting by healthcare staff, it is a sterile procedure and should follow the guidelines mentioned in Chapters 107 and 114.
Clean intermittent self-catheterization is contraindicated whenever the urethra cannot be safely catheterized. False passages or urethral stricture disease must first be managed to allow safe nontraumatic catheterization.
Assess the cognitive level, readiness, and the ability to process information of the child and the family. The readiness to learn and process information may be impaired as a result of age, stress, or anxiety. Most children and family members can be taught to perform this procedure. They must learn the basic location of urologic landmarks and have the ability to manipulate the equipment involved. (Those who cannot visualize the urethra may be taught how to feel for the proper location of the urethral meatus.)
Identify and discuss the risks and benefits of intermittent self-catheterization.
Determine whether the child has latex allergies or previous catheter complications.
Assure the family/child that the catheterization will not harm the child or damage the urethra or hymen.
Reinforce the need for intermittent self-catheterization, as appropriate, to both the child and the family. The program must be one the child can perform with the feeling that his or her quality of life is improved or maintained.
TABLE 109-1 Selection of Urinary Catheter for Self-Catheterization
Age (years)
Recommended Catheter Size (French/Charriere or Coudé Tip)
0-2
6 F
2-5
6-8 F or coudé tip
5-10
8-10 F or coudé tip
10-16
10-12 F or coudé tip
Urodynamic testing may be required before beginning intermittent self-catheterization to ensure there are no urethral strictures, false passages, vesical neck contractures, tumors, or stones that may interfere with catheterization.
Instruct the child on the times and intervals per day to catheterize. Instruct the child to catheterize, if it is time to do so, even if soap and water are unavailable.
KidKare Reassure the toddler and the older child that the catheter is flexible, will feel like a noodle, and will produce a feeling of pressure and a desire to urinate.
Instruct the child to try to urinate before self-catheterization, if possible.
PROCEDURE Assisting With Self-Intermittent Catheterization
Steps
Rationale/Points of Emphasis
1 Perform hand hygiene and collect all necessary equipment and supplies for catheterization. Selection of the catheter is based on the child’s age and gender, construction material of the catheter, patient preference, and the internal and external diameter of the catheter (Table 109-1 ).
Reduces transmission of microorganisms. Promotes efficient time management and provides an organized approach to the procedure. Actual catheter size is selected after the clinician has assessed the urethral opening. Catheters that are used for clean intermittent self-catheterization are slightly different from the catheters used for indwelling (long-term) catheterization.
Self-catheters are straight plastic tubes without the side balloon inflation port and balloon that are used to keep an indwelling catheter in place. They are more rigid than an indwelling catheter, making insertion a little easier. Use of shorter-length urinary catheters and basing length on gender and age can reduce the incidence of knotting (e.g., for toddler and younger females, insert 2 in; for males, insert 3 in; for male toddlers, insert 3-4 in).
The catheter should be prepared according to the manufacturer’s instruction.
Some catheters are pregelled, whereas some require water to activate and hydrate the hydrophilic coating.
2 Assist, as needed, the child or the family performing the procedure to perform hand hygiene. The healthcare provider dons nonsterile gloves and is ready to assist the child and family as needed to perform the procedure.
Reduces transmission of microorganisms.
3 Assist the child or the family to wash the genital area with warm water and soap.
• For males: With your nondominant hand, hold the penis on the sides, perpendicular to the body, while retracting the foreskin. Cleanse the penis and urethral opening and bladder.
• For females: Spread the labia open with the fingers of one hand. Cleanse the vulva and urethral opening. Wipe from front to back to prevent contaminating the area with fecal contents. Rinse and dry the area.
Removes secretions and feces. Prevents contamination of the catheter by microorganisms on the skin and prevents introduction of organisms into the child’s urethra.
Note: Steps 4-15 are completed by the person performing the self-catheterization.
4 Lubricate approximately the first 3 inches of the tip of the catheter.
The lubricant is used to reduce discomfort and it decreases the friction between the catheter and the urinary tract during catheterization.
5 Hold the catheter as if it were a pencil or a dart, with your dominant hand, approximately 1 inch from its tip.
Enables manual insertion.
6 Locate the urethral opening.
6a For males: With your nondominant hand, hold the penis on the sides, perpendicular to the body, while retracting the foreskin.
Allows for exposure of the urethral opening during self-catheterization.
6b For females: Spread the labia open with the fingers of the nondominant hand, keeping a finger free to feel for the urinary meatus (located below the clitoris and above the vagina). Some females may be instructed to perform clean intermittent self-catheterization standing up with one foot on the toilet. This position is also recommended when there is a question about the cleanliness of the toilet, such as in public facilities.
caREminder
Because gentle pressure may cause an erection in an adolescent male, the penis should be held firmly but not tightly. If held tightly, pressure collapses the urethra and prevents advancement of the catheter. If the adolescent has an erection, stop the procedure until there is a nonerectile state, and then continue with the procedure.
7 With the dominant hand, begin to gently insert the lubricated catheter into the urethra, in an upward direction toward the umbilicus. Ask the child to take a deep breath while inserting the catheter.
Allows for catheterization to obtain urine. Taking a deep breath helps relax the urinary tract.
8 Insert the catheter until urine begins to flow. Continue to advance the catheter approximately 1 inch further and hold in place until the urine flow stops and the bladder is empty. Pressing down on the abdominal muscles may be required to assist in emptying the neurogenic bladder.
Allows for bladder emptying of urine.
When the catheter reaches the level of the prostate in boys or the striated sphincter (proximal urethra in males and midurethra in females), resistance may be met. Instruct the child to relax by deep breathing and continue to advance the catheter. Forcing the catheter can cause trauma, bleeding, and possible scar formation, which can lead to strictures and obstruction of the urethra.
9 Measure (if needed) and drain the urine into a waste container or lavatory.
Allows for disposal of expelled urine.
10 Withdraw the catheter in small increments and return the foreskin on the uncircumcised boy to its normal position.
Allows all urine to drain. Failure to return the foreskin can lead to swelling of the penis and impairment of circulation.
11 Wipe off any excess lubricant or urine from the perineal area. Assist the child to redress.
Keeps clothing clean and dry. Decreases medium for bacterial growth.
12 Remove gloves. Perform hand hygiene.
Reduces transmission of microorganisms.
13 Dispose of the catheter according to the manufacturer’s instructions.
Single-use catheters are not constructed to be reused and should be placed back in their sleeve and discarded in a trash receptacle.
Multiuse catheters may be washed with soap and water or following the manufacturer’s instructions. Forcefully rinse the catheter completely with tap water, by using a syringe to help flush the catheter and dry the outside of the catheter.
Washing and drying the catheter makes its environment less hospitable to microorganism growth.
14 Store the catheter in a clean, dry container in a secure location.
Allows for reuse at a later time.
15 Perform hand hygiene.
Reduces transmission of microorganisms.
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KidKare Reassure the toddler and the older child that the catheter is flexible, will feel like a noodle, and will produce a feeling of pressure and a desire to urinate.
PROCEDURE
When the catheter reaches the level of the prostate in boys or the striated sphincter (proximal urethra in males and midurethra in females), resistance may be met. Instruct the child to relax by deep breathing and continue to advance the catheter. Forcing the catheter can cause trauma, bleeding, and possible scar formation, which can lead to strictures and obstruction of the urethra.
