Clean Intermittent Catheterisation

Intermittent catheterisation means inserting a narrow tube (catheter) along the usual passage (urethra) into the bladder. The urine flows out through the tube into the lavatory or a container until the bladder is completely empty and the tube is then removed. This procedure is called catheterisation and is done several times in a day

The advantages of CIC is as follows

• You will have better control of your bladder ? and your life
• You will have a healthier bladder and healthier kidneys
• You possibly will not need any other appliances such as pads, catheters and urine bags, sheaths etc.
• The risk of urinary infections will be reduced.
• Normal sexual relations.
• Less anxiety ? improved social relationship.

• You can catheterise 4-6 times in a day.
• Regulate the amount of fluids that you drink to the timing of cathaterisation. Measure the quantities drunk and obtained on catheteisation. (< 500 cc)
• Between catheterisations drink no more than your bladder will hold.
• Prevent the bladder from filling above 300-350 ml. (pressure < 40 cc) between each catheterisation.
• Avoid drinking at bedtime unless you are prepared to catheterise during the night
• A daily intake of 1-1.5 liters of fluid is sufficient.

CIC is a safe gentle technique that is being used by thousands of people all over the world.

However, if NOT used properly, using a larger size catheter, use of excessive force, stiffer catheters, inadequate lubrication can cause trauma to the urethra. Therefore you should learn it properly under supervision of your doctor or nurse before self practicing at home.

• Always bathe, shower, or wash each day.
• Always wash your genitals immediately before CIC, i.e. after adjusting clothes, and after dealing with your catheter.
• Wash the area around the catheter from front to back as this prevents spread of bacteria from the anal area thus reducing the risk of infection.
• Always expel all the urine from the bladder;
• Wash catheter in running water after use, dry it and replace it in its container
• Change catheter after one week. Silicon coated catheter can be used for 2 weeks

Catheters can be either: 

• Disposable catheter
• Reusable Red rubber catheter 
• Foley's catheter.

The reusable catheters should be stored in a clean wooden container. Should be kept dry. Before use, the catheter should be washed in running water and flick dry Take care of not letting any dust accumulate in the wooden box.

Box of tissues or cotton swabs and small gauze pieces. A dish to collect the urine This would not be required when you catherise on or besides the lavatory.

Soap and water. If there is no conveniently placed washbasin, use a bowl of water on a chair or table. Your hands and urethral opening should be washed before catherising.

A mirror (e.g. a shaving mirror) A mirror is helpful when a female has to find her urethral opening. It can be stood on the bed or stool or hooked over the front of the lavatory.

Lubricant (water soluble, not Vaseline) This is important for males to enable the catheter to slide easily and negotiate the bends. KY jelly, Lidojel or an anesthetic gel such as lignocaine (XYLOCAINE?2%) can be used. Women generally find they do not need a lubricant once they become skilled in catherisating.

Dry your catheter and stored it in a clean cotton cloth bag or a wooden container. Take care the either of these should be cleaned once a day. You could change you cloth bag daily.

There is no method of bladder drainage that is absolutely free of infection. CIC however if done properly is quite safe as has been the experience of users over nearly last 30 years.

• Collect the equipment needed: Catheter, clean cottons swab clean tissue or gauge pieces, dish for urine collection, lubricant, clean water and soap to wash hands, waterproofing and towel.
  
• Get into the position you find comfortable. sitting on the toilet, wheelchair or bed.
  
• Get the clothing out of the way. Spread the waterproof protection.
• Wash hands and the end of the penis drawing back the foreskin if possible.
  
• Squeeze out two blobs of Xylocaine jelly on clean tissue or gauge pieces; discard the first blob. For anyone with a sensitive urethra it may also be advisable to squeeze some lignocaine gel directly into the urethra.
  Allow 4 minutes for the local anesthetic to take effect before passing the catheter. Once you are good at catheterisation, the anesthetic effect of lignocaine may not be needed.

• Place the dish between the legs to collect the urine.
  
• With your left hand (if you are right handed) hold the penis out straight, away from the body to help straighten the urethra. Do not grip the penis too tightly as this may prevent the catheter passing.
  
• Take the catheter out of its container, dip the tip into the second blob of lubricant, taking care not to let the jelly block the holes in the catheter
  
• Insert the catheter slowly into the opening of the urethra and continue pushing gently until the urine flows into a dish. If the catheter sticks just before it enters the bladder, wait a minute for the sphincter muscle to relax and then gently push it in a little further.

• When the urine stops flowing strain to try to push out any remaining urine and insert the catheter one or two cm, further.
  
• Remove the catheter slowly. If at any stage more urine starts to flow, wait until it finishes.
  
• Rinse through the catheter with running water and return it to its container.

• Collect the equipment needed: Catheter, clean cottons swab clean tissue or gauge pieces, dish for urine collection, lubricant, mirror if required, clean water and soap to wash hands, mackintosh and towel.
  
• Get into the position you find comfortable: sitting on the toilet, wheelchair or reclining on bed. (lie on back or sit with legs apart and knees bent.)
  
• Get the clothing out of the way.
  
• Spread the waterproof protection.
  
• Wash hands

• Squeeze out two blobs of Xylocaine/KY jelly on clean tissue or gauge pieces, discard the first blob. For anyone with a sensitive urethra it may also be advisable to squeeze some jelly directly into the urethra.

• Separate and clean the lips (labia) using tissue or cotton swab, with a mild antiseptic solution. (In case you have a heavy menstrual flow, it might be a good idea to use a tampon or tissue to control the flow.
  
• Place the dish between the legs ready to catch the urine.
  
• Adjust the mirror.
  
• Take the catheter out of its container, wash in running water and flick dry. Dip the tip into the second blob of lubricant jelly, taking care that the jelly does not block the holes in the catheter.

• If you need to let go of the catheter while finding the opening to the urethra, lay it on a clean tissue or return it to its container.

• Without a mirror by sliding the finger back along the ridge from the clitoris in front to the vagina behind. For anyone who has not lost sensation in this area, the urethral opening is a very sensitive spot so that you soon learn to recognise the feel when the catheter touches the opening.
  
• Having located the opening hold the catheter about 2 cms from its tip and insert it about 5 cms or so until the urine flows. If the catheter has slipped into the vagina no harm is done, just try again to find the hole in front of the vagina.
  
• When urine stops flowing make sure that the bladder has completely emptied by bearing down, inserting the catheter a little further and twisting it gently.

• Take out the catheter slowly and if more urine starts to flow, stop and wait until it has finished before removing the catheter.
• Rinse through the catheter with running water, flick dry and return it to its container.