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Clean Intermittent Catheterization (CIC)

CIC be the most effective and practical means of attaining a catheter-free state in the
majority of patients
INDICATIONS :
 Acute spinal cord lesions
 Neuromuscular dysfunction of the lower urinary tract
RATIONALE
 Based on a theory proposed by Lapides that high intravesical pressure or bladder
overdistention I s primarily responsible for the development of UTI, not the
bacteruria itself.
 Theoretically, reduced blood flow to the bladder can lead to increased host
susceptibility to bacterial invasion and UTI.
 Bacteria introduced by CIC would be neutralized by the host, and relatively sterile
urine would be maintained as long as bladder distention and high intraluminal
pressures were avoided.
CRITERIA:
 A cooperative, well-motivated patient or family is a requirement for CIC.
 The patient must have adequate hand control, or a family member must be willing
to perform the catheterization.
 There must be adequate urethral exposure.
 CIC should be used cautiously in patients known to have autonomic dysreflexia.
TECHNIQUE
 Intermittent catheterization may be performed by clean, aseptic, or sterile
techniques
 Often includes reusing a catheter several times before disposal.
 It is washed, generally with soap and water, and allowed to air dry prior to storage.
 When reusing catheters, advocated boiling or microwaving for sterilization .
Timing
 For adult patients, catheterization is typically performed at a minimum of every 4
to 6 hours to minimize bacterial dwell time.
 CIC may need to be more frequent if large volumes of fluid are ingested.
 Timed to maintain bladder volumes below the normal 400- to 500-mL capacity to
minimize bladder wall pressure.
 Even smaller volumes may be required if they have poor detrusor compliance.

Catheter choice
 Variable, but a 12- to 16-Fr soft catheter may be used for males
 Short (6-inch “female”) 12- to 16-Fr catheters for females.
 Rigid catheters have the potential to injure the urethra in insensate males because
they may not “make the bend” at the prostate, causing a false passage
 Larger catheters may be required in patients with a prior bowel augmentation or
those who require bladder irrigation.
 In men, hydrophilic coated catheters -- reduce the incidence of UTI and hematuria
and have higher patient satisfaction rates than conventional plastic catheters
 Patients with recurrent UTIs, despite the use of single-use sterile catheters, may
obtain sterile catheter kits for sterile intermittent catheterization (IC).
 Anticholinergic medication should be considered when urine leakage occurs
between catheterization intervals or if high storage pressures develop.
COMPLICATIONS
 Trauma from catheterization occurs frequently, but effects are usually not long
standing
 Urethral stricture and false passages are more common the longer that CIC is
employed