Clean intermittent catheterization is a method of catheterization in which a urinary catheter is inserted from the urethral opening into the bladder for a predetermined period of time, and the urine is expelled from the bladder, and the catheter is removed without staying in the body. This procedure is repeated several times a day and is determined by the patient’s urinary function. This method is performed with a clean method and does not require aseptic technique.
I. Purpose
By regular or timely catheterization when bladder distension is found can empty the bladder and avoid over distension of the bladder, thus reducing complications, such as reducing the rate of infection, reducing the incidence of urinary stones, promoting early recovery of the forced urinary muscles, avoiding bladder contracture, reducing complications of the penis and scrotum, and reducing autonomic reflex disorders.
II. Indications
It can be considered for any patient who cannot empty the bladder by himself
1, Temporary or permanent urinary retention.
2.Low intravesical pressure, no hyperreflexia of the forced urinary muscles, no significant urinary incontinence and ureteral reflux.
3, hyperreflexia of the forced urinary muscles and incoordination of the bladder forced urinary muscles and external urethral sphincter.
4, Motor paralytic bladder dysfunction with normal external sphincter function.
5, Patients with cauda equina, sacral medullary lesions, bladder denervation state, pelvic nerve injury, demyelinating lesions, uninhibited contraction of the detrusor muscle and external urethral sphincter dysfunction.
6, to prevent urinary incontinence after bladder reconstructive surgery.
Third, contraindications
1.Urethral malformation.
2.Urethral stricture.
3.Pseudo-tract formation in the urethra.
4.Significant enlargement of the prostate or tumor.
5.Severe urethritis and periurethral abscess.
6, Patients with hyperreflexia of the forced urinary muscles accompanied by synergistic disorders of the forced urinary muscles are not suitable for clean interstitial catheterization. Because of the uninhibited contraction of the bladder forceps, the pressure in the bladder increases significantly, which can cause urinary reflux from the vesicoureter and the occurrence of hydronephrosis, and long-term hydronephrosis will affect kidney function and predispose to urinary tract infection.
7, patients with upper limb function loss or dementia without the help of others are also not suitable for clean interstitial catheterization.
8, Systemic infection or extremely low immunity.
9.There is a significant bleeding tendency.
IV. Advantages
1.The urinary catheter is not placed in the bladder for a long time, so there is no need to carry a urine bag, which increases the freedom of the patient and maintains self-esteem.
2.Avoid urinary incontinence.
3.Reduce the chance of urinary tract infection. There is experimental evidence that the normal bladder has the ability to resist infection, and the integrity of the bladder mucosa and the emptying of the bladder itself is a defense mechanism of the body. Therefore, even if bacteria may enter the bladder due to the catheter or during the catheterization process, it is possible to rely on this mechanism as well as intermittent catheterization to eliminate or remove them, thus avoiding urinary tract infections to the greatest extent.
4.Avoid having urinary retention and urine reflux to the kidneys.
5.It can self-control the toileting situation.
6.Normal sexual life can be maintained.
7.No age or location restrictions, but must have a certain degree of vision and hand mobility.
V. Complications CISC is a very good method, but should be alert to the occurrence of complications. Long-term patients doing CISC, the incidence of infection is 13.6% per day; urinary complications, urethral bleeding occurs frequently; prostatitis incidence is about 5% -18%.
1, urethral injury: In order not to cause urethral injury, it is necessary to choose standard size, good quality catheter and high quality lubricant, and also need skilled and gentle manipulation.
2, urinary tract infection: in order to prevent infection, the urethral opening must be cleaned, neutral soap can be used to clean the perineum, the catheter must be clean, preferably sterile or sterilized, and the operator himself should operate with washed hands. Take care to hold the urinary catheter during insertion of the official to prevent soiling. The bladder must be completely emptied. A frequency of 6 daily catheterizations has been shown to be optimal if the patient maintains regular water intake habits.
VI. Patient assessment
1.Patients can voluntarily accept this method through the guidance of medical staff, and can seriously learn the relevant knowledge and techniques, and through repeated practice, can correctly master the methods and skills of use.
2.The patient has flexible hand function, generally good condition and can reach the urethral opening.
3.The patient’s financial ability can afford to buy the catheter and related required supplies.
Operation method
1.Prepare all supplies: catheter 14-16 for adult female, 12-14 for adult male, 8 for children, 14-18 for expansion; cleaning items; water-soluble lubricant; mirror (for female) urine receptacle.
2.Unlock or remove the pants.
3.Wash and dry your hands with soap.
4.Take an appropriate position, such as sitting on a toilet, chair, or you can also use a standing position.
5.Pull back the foreskin to reveal the urethral opening, wash the urethral opening and the surrounding area with soapy water and a small towel, then wash with water, lubricate the catheter by 2-3 inches, pull the penis upward with the other hand at an angle of about 60 degrees with the abdominal wall, slowly insert the urethral opening with the other hand by about 15-20 cm until urine flows out, stop inserting when urine starts to flow out, fix the urethral tube in the position When the urine starts to flow, stop the insertion and fix the urethral tube in that position, then you can put the penis down and pull out the urethral tube slowly when the urine flows.
Women should first learn to touch the urethra with their hands, so as to feel the location of the urethra, you can also use a mirror to show the location of the urethra, clean the urethra and around the urethra, lubricate the urethra with lubricant about 1 inch, use one hand to separate the labia, the other hand holding the urethra, insert it by the urethra about 4-6cm, see the urine appears and then into 1-2cm, when the urine begins to flow, then stop the insertion, the urethra fixed in the position When the urine starts to flow, stop inserting and fix the urinary catheter in that position until the urine flows clear, then pull out the urinary catheter.
6, the urinary catheter will be washed with soapy water, and then rinsed under the faucet with clean water.
7, the outside of the urinary catheter can be wiped dry with clean tissue, the inner surface can be blown dry or waved dry, and then placed in a clean transparent bag.
Observation items Observe the bladder sensation, urination and the amount of urine released by the catheter, and the amount of residual urine. Pay attention to the daily in and out volume, control the daily fluid to 1500~1800ml, prevent overfilling of the bladder, and maintain the bladder volume below 500 ml. Generally, patients without incontinence and spontaneous urination can be catheterized every 4~6 hours, and after the appearance of spontaneous urination, it can be extended to every 6~8 hours, and when the residual urine is less than 100 ml, catheterization can be stopped for continued observation. If you find foul-smelling urine, obvious turbidity, lower abdominal pain, fever, lumbar pain and shortness of breath during catheterization, it indicates possible cystitis or upper urinary tract infection, and you should consult a doctor promptly.
The hands are the main way to spread diseases, so it is emphasized that the hands should be washed carefully before and after catheterization, and the hand washing time should be >5 min, followed by keeping clean during the whole process of catheterization. Maintain a regular catheterization gap.
X. Precautions
1.Patients must have a system of regular and quantitative drinking and regular urination so that the timing of catheterization can be reasonably selected.
2.Patients generally do not need to consume more than 2000 ml of water per day and maintain a urine volume of about 800~1000 ml/d.
3.Although the catheter does not emphasize strict sterilization, it is still important to emphasize adequate cleaning and reasonable preservation.
4.The insertion action must be gentle and non-violent to avoid urethral injury.
5.The whole process should be relaxed, and the catheter should be withdrawn slowly to ensure that the urine is drained.