“UM Standard CIC Protocol” and Its Variants

  • The University of Michigan is the site where Lapides first tried CIC in patients with neurogenic bladder. Over the years, the protocol has been modified (more details
  • The following instruction is the actual protocol for the nurse specialist to teach CIC to patients at the University of Michigan. Descriptions are written as if the medical professional is giving instructions to the patient.

Instruction of Intermittent Self-Catheterization (Common to both sexes)

About your Urinary Tract

  • Kidneys - Organs that excrete urine
  • Ureters - tubes that carry urine from kidneys to bladder
  • Bladder - Hollow pouch for storing urine
  • Catheter - hollow tube for passing through the urethra into the bladder to drain urine from the bladder
  • Sphincter - Circular muscle at entrance to bladder that tightens to hold urine in the bladder
  • Labia -soft skin folds around the vagina referred to as "lips". There is an inner fold and an outer fold.
  • Urine - Fluid and dissolved substances excreted from the kidneys
  • Urethra - A short tube from the bladder that drains urine to the outside; this is where urine comes out and where the catheter is inserted. (insertion of the picture needed)

Introduction to CIC

  • Intermittent catheterization is a safe and effective method of completely emptying the bladder if you are unable to do so otherwise. The purpose of intermittent catheterization is to improve or eliminate urinary incontinence as well as to control bladder and kidney infections.
  • Most people are able to catheterize themselves. If you are physically unable or too young to do so, however, your parent or someone else can do it for you.
  • To establish your individual routine, keep a daily record of the time you catheterize yourself, the amount of urine obtained, and if you were wet, damp, or dry. This is very important. When a satisfactory routine is established, it will no longer be necessary to measure your urine. This could take several weeks or several months.
  • The most important thing to remember is to empty your bladder completely and regularly. Never have more than 400cc in your bladder at any time.
  • A large amount of urine left in the bladder for an extended period of time can cause a urinary tract infection. By catheterizing regularly and completely your keep the bladder empty and decrease the chance of infection.
  • The most basic principles are to follow ‘careful (atraumatic)’ and ‘clean’ way of catheterization to prevent trauma and infection.

Materials Needed

  • Catheter
  • Small easy to carry container for your catheter. Zip lock bag works nicely because it will close and not open.
  • Catheter extension tube. If you catheterize yourself while sitting on the toilet this won’t be necessary.
  • Water soluble lubricant - small packets to take with you when you are not at home. Do not use mineral or petroleum lubricant. Lubricant must be water soluble

Steps in Performing Clean Intermittent Self-Catheterization

  1. Wash hands and catheter with soapy water.
  2. Rinse hands and catheter with tap water.
  3. Self-catheterize (without gloves).
  4. After use, wash reusable catheter with soapy water, rinse and store in ventilated container until dry.
  5. Place in plastic zipper bag or other clean container.

Important things to Remember

  • If for any reason you are unable to wash your catheter after using it, just put it away in a clean container until it is time to use it again. If you can wash it then you should do so. If not, catheterize anyway. It is more important to empty your bladder. You are more likely to get an infection from a bladder that is too full than from an unwashed catheter. If you will be out for an undetermined length of time, take a clean bag with 2 catheters. After you have used one catheter, place that catheter in a bag separate from your clean bag.
  • Catheterize every three to four hours during the day, just before you go to bed at night, as soon as you wake up in the morning. If you go to bed early it may be necessary to be catheterized during the night. It may also be necessary for you to be catheterized during the night if your first catheterize in the morning is consistently greater than 400 cc.
  • Catheterize regularly. Do not skip a catheterization for any reason.
  • If you increase your fluid intake, it will increase the need to catheterize more frequently. Remember the goal is to keep your bladder from getting too full.
  • Do not press down on the bladder to encourage emptying. The bladder will empty by gravity.
  • You may wish to have another person besides yourself taught to catheterize you. This could be a spouse, parent, grandparent, sibling, or friend. You and your family or friends should know why this is being done and what is happening so they can assist you or remind you to catheterize if needed.
  • More information

Helpful Hints

  • Keep several catheters on hand in different places as needed for your convenience. For example: glove compartment of car, bathroom, school bag, etc.
  • If by chance the catheter is dropped and cannot be washed, it should be wiped off before using it to catheterize. Always take your catheterization equipment with you.
  • (Female only) During menstrual cycle, blood in catheter is normal.
  • It is necessary to keep the catheter clean for repeated use.
  • If you are unable to pull your clothing down for catheterizing, you may wish to have your clothing adapted. Zippers or Velcro can be sewn into the side seams or Velcro can be inserted in the crotch of the pants.

[VIDEO]

Signs and Symptoms That May Indicate Infection

  • Foul smelling urine
  • Cloudy urine
  • Change in color of urine
  • Low-grade fever
  • Unusual dribbling of urine
  • If you experience any of the above symptoms, notify your doctor. You may also at this time increase your fluid intake. If you increase your fluid intake, remember you will need to increase the number of times you cath yourself as well.
  • A bladder that is too full can also cause autonomic hyperreflexia in people with high spinal cord injuries. This causes an extremely high blood pressure and headache and can lead to severe complications. If you have a high spinal cord injury and get a severe headache, empty your bladder immediately

Medications

  • Listed below are several medications you may be taking while on the catheterization program.
  • These are an important part of the whole program and must be taken as prescribed by your doctor.
  • Do not run out of medications.
  • Ditropan:
    • Helps control bladder spasms by relaxing the bladder muscles
    • May make your mouth dry and your skin flushed, blurred vision and possible constipation
  • Imipramine:
    • Helps control bladder spasms by relaxing the muscles
    • May make your mouth dry and skin flushed.
    • May cause sleepiness (usually taken at night to counter effect)
  • This information does not cover all the uses, side effects or interactions of these medications. If you have further questions, please ask your physician.

Preparation and Procedure for Intermittent Self-Catheterization for Females

  1. Wash your hands.
  2. You may sit in a comfortable position with your knees apart. If someone else is catheterizing you, it would be easier if you lie or semi-recline. You may catherize while sitting on the toilet.
  3. Spread the labia apart with one hand.
  4. At first you may need a mirror to locate the urethral opening where you will insert the catheter. You can locate it by learning its position.
  5. It is located a little bit above or in front of the vagina. It is sometime helpful to hold your finger over the vagina and direct the catheter above your finger.
  6. Hold the catheter about an inch from the tip and insert it into the urethra, pushing it in until the urine flows. Holding the catheter in your hand, keep the catheter in your bladder until the urine stops flowing. The urine container should be lower than your bladder to help the urine-drain.
  7. When the urine stops draining, push the catheter in about another inch to be sure all the urine has drained.
  8. Slowly pull the catheter out, stopping anytime the urine flows to be sure the bladder is empty.
  9. Wash the catheter with soap, using soapy lather on your hands. Do not rub the catheter on bar soap, as this may be hard to remove because of the oil. Rinse the catheter with tap water, inside and out, then dry and store. This cleaning will also help with odor control. One catheter can be used for about a month
  10. One catheter may used repeatedly, if washed and stored properly.

Preparation and Procedure for Intermittent Self-Catheterization for Males

  1. Wash your hands
  2. You may sit or stand - whatever is most comfortable
  3. Clean the meatus prior to inserting catheter.
  4. Lubricate several inches of the tip of the catheter.
  5. Hold your penis on both sides just behind the head.
  6. Insert the catheter into the urethra, using a steady gentle pressure. When you have inserted the catheter about six inches, you may find it a bit harder to push. This means you have reached the sphincter muscle. Use gentle but firm pressure on the catheter until the muscle relaxes and the catheter becomes easier to advance. It will be necessary to pass the catheter another two or three inches before it enters the bladder.
  7. Insert the catheter and wait until urine stops draining, then remove slowly, stopping anytime urine flows so as to empty the bladder completely.
  8. Wash the catheter with soap, using soapy lather on your hands. Do not rub the catheter on bar soap, as this may be hard to remove because of the oil. Rinse the catheter with tap water, inside and out, then dry and store. This cleaning will also help with odor control.

Other Techniques for Different Situations

  • CISC in the public toilet by an ambulant female
  • CISC in the public toilet by a paraplegic female
  • CISC through neourethral urinary diversion
Key Points of This Section
  • To a medical professional CIC is a useful technique.
  • To patients it is a source of anxiety and seems only remotely possible at first.
  • Patients need a good deal of instruction in the technique and time to perfect it.
  • The patient guidelines printed here are those we have used for many years and we have found them safe and effective.

©2007 University of Michigan - CISC

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