FAQ from the Patients Who Should Perform CIC  

  • The patients should learn the correct technique and should have a chance to discuss with their physicians or nurses when specific questions and problems are encountered.
  • The followings are the frequently asked questions from the patients and each answer. Answers are written as if the medical professional is giving the answer to the patient.

Catheter and supplies

  • What will happen if the patient does not wash the catheter after use for a reusable catheter?:

If for any reason you are unable to wash his/her catheter after using it, just put it away in a clean container until it is time to use it again. If the patient can wash it then the patient should do so. If not, catheterize anyway. It is most important to empty the patient’s bladder. The patient is more likely to get an infection from a bladder that is too full than from an unwashed catheter.

  • From the practical viewpoint, do you recommend patient keep several catheters on hand in different places as needed for your convenience, for example, glove compartment of car, bathroom, school bag, etc?:

Yes. Our best advice is that it's better to take too many catheters than too few! Here’s a tip: leave some extra catheters at places where the patient often go, such as friends’ homes, workout facilities, summer homes, or relatives' homes.

  • What is the difference in the size of the catheter?:

The diameter of the catheter is measured in a unit called French (Fr). When prescribing a 14 Fr catheter, the physician is requesting a specific tube diameter size. The smaller the number, the smaller the diameter. Regarding the size of the catheters, for adults 10-14 Fr for males and 14-16 Fr for females are mostly used but bigger size/lumen may be necessary for those with bladder augmentation or cloudy urine from other origin. No studies on IC compared sizes in a randomized way. (International Consultation 2002)

  • What kind of supplies will the patient need?:

The patient will need a catheter and soap and water to wash his/her hands before and after his/her catheterization. The patient may use a water-soluble lubricant to help the catheter slide into the urethra more easily. Some people like to use moist towelettes (like "Wash ‘N Dry") to clean the area around the urethral opening before catheterizing. Use a plastic zip-lock baggie, a travel toothbrush holder, or a Mentor travel case to carry his/her catheters with the patient at all times.

CIC in Daily Life

  • What if the patient by chance drops the catheter and it cannot be washed?:

It should be wiped off before using it to catheterize but catheterize anyway (Dr McGuire).

  • What kind of preparation should the patient do if the patient plans travel?:

If the patient will be out for an undetermined length of time, take a clean bag with 2 catheters. After the patient has used one catheter, place that in a bag separate from his/her clean bag.

  • Should the patient do catheterization during the night?:

Catheterize every three to four hours during the day, just before the patient goes to bed at night, and as soon as the patient wakes up in the morning. If the patient goes to bed early it may be necessary to be catheterized during the night It may also be necessary for the patient to be catheterized during the night if his/her first catheterize in the morning is consistently greater than 400 cc. Catheterize regularly. Do not skip a catheterization for any reason (Dr McGuire).

  • If the patient is planning to have traveling abroad, what do you advise?

The patient can ask his/her doctor to write a note about the purpose of the catheters. That way the patient will avoid any problems with customs. If the patient does not trust the quality of water in the country the patient is visiting, use bottled water, saline or sterile water. The patient can also use LoFric® Ready-Kit which comes with both a sterile water sachet and urine collection bag.

  • Is the bathing related to CIC? Personal hygiene matters in doing CIC?:

It is recommended to wash the genital area with mild soap once a day. Wash him/her-self gently in order to avoid washing away the natural bacterial flora that protects against infections.

  • Where can catheterization be done?:

Anywhere the patient can find some privacy. Many individuals prefer to use the toilet; however, the patient may drain the catheter into any other container for disposal (such as: a leg bag, night drain bag, empty milk carton, coffee can or plastic bag).

  • What about sexual activity and catheterization?:

CIC should not interfere with sexual activity. The patient may discuss sexual concerns with his/her doctor or nurse. It is generally advised to empty the bladder before and after having sexual intercourse.

CIC related to water intake

  • What instruction should I give to the patient if the patient usually likes drinking lots of water?:

If the patient increases his/her fluid intake, it will increase the need to cath more frequently. Remember the goal is to keep his/her bladder from getting too full. Keep Bladder Pressures Low. While the patient needs to drink the recommended amount of fluids, the patient also needs to empty his/her bladder on a regular schedule. With ICP, his/her goal is to limit the amount of fluid that collects in the bladder to 8 ounces or less (400cc). This means the patient can intake about 4 oz each hour while awake. Drinking more than this causes the bladder to overstretch, making the patient more susceptible to infection or reflux. The patient needs to catheterize more frequently if the patient drinks more.

  • Should the patient limit the fluids he/she drinks?:

Every person needs daily fluids to maintain health. Eight, 8 oz. glasses of liquid a day are recommended. His/her doctor or nurse will advise the patient on his/her special fluid needs as they relate to his/her catheterization program. For example, they may advise the patient to limit his/her fluid intake several hours before bedtime to help the patient stay dry during the night. Beverages containing caffeine (cola drinks, coffee and tea) may irritate the bladder, so the patient may want to limit them to two or three cups a day.

  • Do you advise the patients to reduce the amount of drink in order to reduce the number of CIC?

How much to drink is ideal? It is important to drink at least 6-8 cups of fluid every day which helps reduce the risk of developing UTIs. Keep coffee and tea consumption to a minimum, since caffeine can irritate his/her bladder. Drink plenty of liquids. Steady intake of fluids helps "wash out" bacteria and waste materials. Drinking the recommended amount of liquids helps avoid problems and lessens the chance of stones forming. How much fluid the patient need to drink each day depends on his/her bladder management program. With an indwelling catheter, the patient needs to keep his/her fluid intake high. This means drinking 15 - 8 oz. glasses or 3 quarts of liquids each day. If the patient do intermittent catheterization, the patient need to drink 8 to 10 - 8 oz. glasses or 2 quarts between breakfast and dinner. The recommendation is to make water his/her "beverage of choice". Make it his/her #1 beverage and drink all other beverages in moderation. Limit carbonated beverages to 1 per day.

Practical method of CIC

  • Should the patient press suprapubic area to facilitate emptying the bladder while CIC?:

Do not press down on the bladder to encourage emptying. The bladder will empty by gravity (Dr McGuire).

  • If the patient always meets some difficulty in pulling his/her clothing down for catheterizing what do you recommend?:

The patient may wish to have his/her clothing adapted. Zippers or Velcro can be sewn into the side seams or Velcro can be inserted in the crotch of the pants.

  • How often does the patient have to catheterize?:

The number of times the patient need to catheterize varies a lot from person to person, depending on his/her type of bladder condition, the amount the patient drink, and the different medications he/she may be taking.

  • Does the patient always have to catheterize using a mirror?:

Female patients may use a mirror or a specially designed catheter to visualize the meatus.18 After a while most women do not need these aids anymore.

  • Do you advice the patient to try voiding before catheterization?

If voiding is possible, always try to urinate in the normal way before using the catheter. Relax the pelvic floor and avoid pressing down with abdominal muscles (Dr McGuire).

  • If, for example, the patient’s safe bladder capacity was proven to be 350ml by urodynamic study and the patient can void 200ml by his/her own, do you advise the patient that he/she still need to do CIC after voiding?:

No. But a catheterization must be done after two or three voids to be certain the residual remains 50 mls. Sometimes the residual continues to climb (Dr McGuire).

  • What is the cutoff volume or volume ratio (void vol/ PVR) in above decision making?:

50 to 60 mls is reasonable or about 2 ounces. This is applicable when patients can void on their own and the purpose of the CIC is to facilitate recovery of normal voiding after surgery, over distention, a lumbar disc problem and the like (Dr McGuire).

  • The patient complains of some difficulty inserting the catheter, what usually happens in these patient and what is the solution?:

This usually occurs because the sphincter muscle is closed. If the patients are tense and find it hard to relax, try coughing a couple of times so that the catheter can pass the obstruction. He/she can also apply a light but firm pressure on the catheter. A COude catheter may help here as well, and waiting a few seconds after the sphincter closes with the catheter just back from the obstruction may allow the sphincter to relax (Dr McGuire).

  • What situations do the patient contact immediately to the nurse or doctor while doing CIC?:

If the patient experience chills, high fever, or cloudy or foul-smelling urine. Have the patient drink plenty of fluids and contact the doctor or nurse immediately. And the following situations also have to be considered: The urine has a strong odor, becomes cloudy or gets red. The urine coming through the catheter should be light yellow. There may be occasional blood clots normally in some patients but continuous bleeding should be reported. If the patient gets chills, fever above 99.4 F, lower back pain, and/or autonomic dysreflexia, or the catheter is not draining any urine (Dr McGuire).

  • How often should the patient catheterize?:

His/her doctor or nurse will help the patient establish a regular schedule that best suits his/her needs. When the patient begins the catheterization, they may ask the patient to keep a record of his/her catheterizations so that his/her schedule can be adjusted to what works best for the patient. Usually it is recommended that the patient catheterize at least every 3 to 6 hours; however, his/her physician or nurse should determine the frequency. The important thing is to follow his/her schedule without fail! Remember not to let the bladder become distended.

  • How do the patient know when to catheterize?:

The patient should catheterize every 3 to 6 hours as prescribed by his/her doctor. The following signs may be an indication that it is time to catheterize: restlessness, perspiration, chills, headache, distended bladder, and feelings of fullness.

  • Can the patient perform CIC in standing position?:

Self-catheterization can be performed in many different positions: supine, sitting or standing.

Introduction to the first-timer

  • If the patient is a near-complete high quad, who can catheterize for the patient?:

The patient may wish to have another person besides his/herself taught to catheterize the patient. This could be a spouse, parent, grandparent, sibling, or friend. The patient and family or friends should know why this is being done and what is happening so they can assist the patient or remind the patient to catheterize if needed. If this can not be done, early creation of a continent catheterizable abdominal neourethra is a reasonable step. It greatly facilitates self catheterization but also catheterization by a care provider (Dr McGuire).

  • If the patient is a first-timer to the CIC, how long does it take for them to settle on a practical schedule of intermittent cathetrization?:

Usually about two to three days, but longer in high quads, and in those with limited mobility, those who can not locate the urethra easily, and in cases where urine output is erratic or occurs mainly at night (Dr. McGuire). This is dependent on each patient. Each patient will demonstrate catheterization prior to leaving. The goal is for the patient to become proficient in catheterization prior to leaving the clinic. Demonstrations of independent catheterizing are needed. Also having a family member or a friend learn the catheterization procedure is helpful. It allows for backup for the patient, if the patient forgets or becomes frustrated with the procedure (Mrs. Brown, RN).

  • What is your personally-preferable follow-up schedule for CIC when you starts CIC for the first time in his/her life?:

We normally follow them rather closely for the first week or so. Complications are common when converting persons from and indwelling catheter to CIC or IC by a caregiver (Dr McGuire). The patient is sent out with all needed supplies. The patient is also given phone numbers of the nurses in clinic and told if they have problems they should call. Often doing a review over the phone can allow the patient to be successful. If the patient continues t have problems they will be brought back into clinic for a hands-on review of the catheterization. It may be necessary to change the type of catheter the patient is using. Usually support is the need. Sometimes patient just need to know they are doing things correctly. It may be necessary for the nurse to catheterize the patient to be sure that problems with a possible false passage may not have occurred. If the catheter passes easily and the patient is still having problems we will contact a Home Care Agency to make visits to the patient bid to reinforce teaching (Mrs. Brown, RN).

  • Did you often have patients who are reluctant to accept the method when you start to teach CIC?:

Yes but it is best to proceed as if this is a well recognized quite natural technique which they can certainly master as have thousands of others (Dr McGuire). No patient wants to catheterize themselves. They also express concern about how this will affect their lifestyle and of course infection. Once they are given the control of managing the procedure themselves they soon find that the pain is not the issue. Education is done on infection, and finally an explanation is given about lifestyle concerns (Mrs. Brown, RN).

  • What points do you usually emphasize most out of many important technical points when you help the patient to start CIC?:

In males put the penis on stretch and insert the catheter slowly. This prevents false passages. The latter are more common in males catheterized by others rather than by the patient himself. For men and women: catheterize often to keep the bladder empty and to keep bladder pressure low (Dr McGuire). Cleanness- to address infection, volumes to keep good bladder health as well as kidney health (Mrs. Brown, RN)

  • Do you think patient can understand better with an anatomical model or pictures? And do you personally use these in your practice?:

Pictures are exact. Each of us is made differently. My preference with females as well as males is to sit and talk about anatomy and the procedure before actual attempting. Allow the patient to ask questions. Be honest and do not hurry. This only increases the anxiety for the patients. In the female patient, I use a mirror to point out their own personal anatomy. I do use models to help with the bladder as well as the kidney. Pointing out how increasing fluid in the bladder can push to the kidneys if not empties on a regular basis (Mrs. Brown, RN)

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