Importance of the CIC  

1. Concept

  • CIC is to empty the bladder intermittently by catheterization with a clean technique in patients with emptying dysfunction. Thereby, patient can achieve regular, volume-adapted, low-pressure emptying of the bladder with a low risk of UTI

2. History

  • In 1972, Lapides developed CIC. It was a revolutionary method of emptying the bladder in the patients with neurogenic voiding dysfunction.
  • More information

3. Terminology

  • Clean Intermittent Self Catheterization (CISC): if the patient himself/herself can perform CIC

4. Purpose of this procedure

  • To empty bladder
  • To prevent bladder overdistention
  • To avoid urinary incontinence
  • To enhance urological function
  • To control bladder pressur

5. Indications

  • Patients with acute SCI in spinal shock phase
  • Children or adult patients with emptying failure either caused by poor bladder contractility or a failed attempt to decrease bladder outlet resistance.
  • CIC is applied to the patients having a good bladder capacity or converted from poor capacity either by medical treatment or by surgery, for example, augmentation enterocystoplasty.

6. Original technique

[VIDEO1 - VIDEO2]

  • Patient washes his/her hands with soap and water.
  • Urethral meatus can be cleaned.
  • Patient takes out the catheter from a bag.
  • Patient inserts the catheter into his/her urethral meatus with hand without wearing gloves (no aseptic technique). Then the patient can empty his/her bladder.
  • After use, catheter can be washed with soap in the water and dried (no aseptic sterilization).
  • The patient can carry the catheters stored in the bag.
  • 10-14 Fr for adult males and 14-16 Fr for adult females are mostly used. But bigger size/lumen may be necessary for those with bladder augmentation.
  • For actual instruction to the patients, please refer to instruction part male [VIDEO] or female. [VIDEO]

7. Technical variants

  • One best technique for CIC does not exist. A variety of techniques are available according to the catheter designs, lubricant, methods of cleaning catheters, IC by caregiver or self CIC (CICS) and etc. [VIDEO1 - VIDEO2]
  • Please refer to instruction part

8. Advantages

  • Impact of CIC on the QOL of the patients:
    • CIC in properly selected patients has been shown to significantly improve QOL.
    • CIC enabled the patients to be free of continuous indwelling of a urinary catheter and having a collecting bag. This enables patients to live a more normal life, for example, bathing, sex life, mobility, etc.
    • CIC does not require an aseptic technique; it does not need strict sterilization of the catheter, and can be done without skin preparation if necessary. This enabled patients to be independent and to perform catheterization anywhere. Frequent bladder emptying is more important than the techniques used to do so, in conjunction with bladder pressure management. CIC also is much less expensive to perform, and the advantages of sterile intermittent catheterization are yet to be demonstrated. In the short term the incidence of bacterial colonization is less with a sterile technique, but that is not, at the moment, a determined risk factor. It would take a huge study measuring variables other that bacterial colonization to determine whether sterile catheterization was worth the expenses and trouble.
  • Impact of CIC on the Bladder management
    • CIC has been shown beyond a shadow of doubt to be the safest method of bladder management, even in the very long term but that implies that bladder pressures are measured and controlled.
      • CIC is the safest bladder management method for SCI patients in terms of urological complications [Weld 2000].
    • Decreased risk of symptomatic UTI, dramatically decreased risk of urosepsis
    • Decreased residual urine volume
    • Decreased morbidity related to neurogenic bladder in the SCI patients
    • Dramatically decreased the mortality in SCI patients from the leading cause of death: a genitourinary complication
    • CIC protects bladder compliance in spinal cord injured patients regardless of the level or completeness of injury and helps to prevent low compliance (thus preventing the upper tract complications) with time [Weld 2000].

9. Disadvantages or Limitations

10. Clinical Outcomes

  • Most patients are rather reluctant to perform CISC either they are not familiar with CISC or for fear of possible injury or pain. However, after performing a few times of CISC, the patients realize the simplicity of the technique and safety and resultant compensations from the catheter-free status.
  • It is already proved by numerous literatures that CIC is the most effective, safe, practical method of emptying bladder.
  • A recent Swedish study clearly showed that the overall rate of long-term complications was low with CIC [Lindehall 2004]

11. Current significance

  • There is no doubt that CIC is the safest bladder management method for SCI patients in terms of urological complications.
Key Points of This Section
  • Clean intermittent catheterization is safe and effective in the management of the neuropathic bladder provided: it is done on a regular basis, and bladder pressures at the maximum volume encountered by a given bladder, treated with the technique, are known to be less than 30cmH2O by urodynamic testing.
  • A single sterile catheterization of a bladder with unknown storage behavior, and unknown voiding function is much more dangerous than frequent, clean, non sterile, intermittent catheterization done over many years.
  • Patients with symptoms suggestive of a “UTI” on CIC protocols need an evaluation of bladder function as well as a short course of antibiotics.

References

  • Lapides J, Diokno AC, Silber SJ, Lowe BS. Clean, intermittent self-catheterization in the treatment of urinary tract disease. J Urol. 1972 Mar;107(3):458-61.
  • Lindehall B, Abrahamsson K, Hjalmas K, Jodal U, Olsson I, Sillen U. Complications of clean intermittent catheterization in boys and young males with neurogenic bladder dysfunction. J Urol. 2004 Oct;172(4 Pt 2):1686-8.
  • Weld KJ, Dmochowski RR. Effect of bladder management on urological complications in spinal cord injured patients. J Urol. 2000 Mar;163(3):768-72.
  • Weld KJ, Graney MJ, Dmochowski RR. Differences in bladder compliance with time and associations of bladder management with compliance in spinal cord injured patients. J Urol. 2000 Apr;163(4):1228-33.

©2007 University of Michigan - CISC

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