What Is Intermittent Catheterization?

Clean intermittent urinary catheterization refers to: under clean conditions, the method of regularly inserting a urinary tube through the urethra into the bladder and regularly urinating urine is called clean intermittent urinary catheterization.

Clean intermittent home catheterization

Right!

Clean intermittent urinary catheterization refers to: under clean conditions, the method of regularly inserting a urinary tube through the urethra into the bladder and regularly urinating urine is called clean intermittent urinary catheterization.

Chinese name

Clean intermittent home catheterization

Foreign name

Clean intermittent self-catheterization

Short name

CIC

Presentation time

1972

The use of clean intermittent self-guided urinary catheterization has two important meanings for patients with emptying disorders: First, it solves the problem of safe urine discharge and effectively protects renal function. This is also a significant reduction in survival after spinal cord injury. One of the important reasons is that, only clean and intermittent urine catheterization, the patient does not need disinfection operation, and does not need to disinfect the urine tube, so that the patient can create conditions for return to society.

In 1972, Professor Lapides in the United States for the first time advocated the use of clean intermittent self-catheterization (CIC) for the treatment of neurogenic bladder patients such as spinal cord injury. Since then, the treatment of neurobladder and urethral dysfunction has fundamentally changed [ 13]. In the past, urinary diversion was mostly ileal bladder surgery. At present, more and more urinary diversions use controlled allantoic surgery, and the most important reason for these controlled allantoic surgery is that clean intermittent home urinary catheterization is Controlled allantoic emptying provides a safe and effective way.

In patients with urinary incontinence, CIC is mainly used for filling urinary incontinence caused by bladder emptying disorders, or secondary dysuria that occurs after urinary incontinence treatment. Clean intermittent home urinary catheterization first appeared to treat a female patient with multiple sclerosis. This patient has both acute urinary incontinence due to detrusor hyperreflexia and impaired detrusor emptying. Professor Lapides used anticholinergic drugs to suppress detrusor reflex in patients, while using sterile intermittent catheterization. The patient not only had good urine control, but also had no obvious infection. Later follow-up found that patients did not always use sterile urinary catheters, but repeatedly used clean urinary catheters. No significant infection occurred during follow-up. This phenomenon has attracted great attention from Professor Lapides. After a long-term clinical research, Professor Lapides proposed the possible mechanism that CIC is not easy to cause infection: the bladder itself has the ability to resist bacteria, regular urinary catheterization, relieve overfilling of the bladder and reduce bladder pressure, blood flow in the bladder wall can be restored, The infection ability is significantly improved. Regular catheterization can prevent the bacteria from multiplying to the extent that it can invade the bladder wall.

It was suggested that CIC was not accepted by doctors, and patients were more difficult to understand. The main concern for doctors is to increase the chance of urinary tract infections. For patients, they are not only worried about infections, but also do not understand the importance of intermittent urinary catheterization to relieve bladder pressure to protect renal function. The popularization of CIC has two important clinical significances. First, it solves the problem of safe urine discharge for patients with emptying disorders and effectively protects renal function. This is also an important reason for significantly shortened survival after spinal cord injury. One is that only clean and intermittent catheterization, the patient does not need disinfection operation, or disinfection of the urinary tube. In this way, the patient may truly master and conduct the catheterization anytime, anywhere, in order to take care of himself and create conditions for returning to society.

Clean intermittent home urinary catheterization is used for patients who need to keep the urinary tube for a long time due to dysuria. The bladder should have good compliance (urinary storage pressure should not exceed 40cmH2O), no bladder ureteral reflux, sufficient capacity (> 400ml), and good urine control. Usually no more than 4 hours of urinary catheterization, and the time is too long. Bacteria brought into the bladder by cleaning the urinary tube may multiply to the extent that it invades the bladder mucosa. The definition of cleaning is that the urinary tube used need only be cleaned, and hands can be washed before inserting the urinary tube. No need to sterilize the urinary tube and perform aseptic operations. However, it is not that disinfection and aseptic operation are not beneficial. Generally, patients need to perform sterile catheterization during hospitalization, but clean catheterization is sufficient to meet clinical needs, and only clean catheterization can be completely grasped by patients, and it is easy to perform anytime, anywhere. Catheterization is the only way for sick people to return to society. Clean catheterization can also significantly reduce the cost of care and avoid complications or inconveniences such as urethritis, testicular epididymitis, and inability to have sex caused by long-term indwelling of the ureter.

[Indications for clean intermittent home catheterization during urinary incontinence]

Urinary incontinence treatment requires CIC to have two main indications. One is that there is a large amount of residual urine or even filling urinary incontinence after medication or surgery. The cause of filling urinary incontinence may be detrusor contractility and detrusor reflex. No, or obstruction of bladder outlet. For patients with bladder outlet obstruction, the treatment principle is to perform the deobstruction treatment first. If there is still a large amount of residual urine after the obstruction is removed, or the detrusor contractility is significantly impaired and cannot be recovered, long-term clean intermittent home catheterization can be considered. .

In many cases of urinary incontinence, clean intermittent intermittent home urinary catheterization is required or partially required. Such as spinal cord injury, spinal cord dysplasia, multiple sclerosis and other neurogenic bladder can cause long-term bladder dysfunction. Insufficient detrusor reflex can cause filling urinary incontinence; hyperdetrusor reflex leads to urgency incontinence, and anticholinergic drugs often inhibit bladder emptying and residual urine after inhibiting hyperreflex detrusor. The amount increased, and even severe urinary incontinence occurred. During the treatment of the above diseases, CIC is often used to assist the emptying of the bladder and prevent damage to the upper urinary tract. For patients with lower urinary tract obstruction, especially benign prostatic hyperplasia, CIC is also a good treatment option if the patient refuses surgery or has severe surgical contraindications and the urinary catheter is not difficult to insert.

CIC is also often used as a treatment for urinary retention after bladder neck suspension. After bladder enlargement (or autologous bladder enlargement or intestinal bladder enlargement), a considerable number of patients cannot be completely empty, leaving a large amount of residual urine. To prevent urinary tract infections and protect upper urinary tract function, CIC is the best solution. Long-term follow-up of in situ bladder patients can find that a considerable part of the patients' residual urine gradually increases. CIC intervention should be considered when it exceeds 100ml to assist the bladder emptying, prevent urinary system infection, and protect upper urinary tract function. The popularity and recognition of total bladder resection plus controllable allantoic surgery is largely due to the knowledge of CIC, which is also the best emptying method for this type of controllable urinary diversion.

CIC contraindications are: narrowing of the urethra, difficulty in insertion of the catheter, or inability to pass safely, the presence of a false tract in the urethra; patients with loss of upper limb function or dementia, patients can not conduct urinary catheterization, and CIC also It has lost the significance of saving medical expenses and helping patients to return to society. Regardless of CIC, they usually use suprapubic bladder puncture fistula.

If a patient may need CIC to treat their urinary incontinence, a comprehensive urological examination should be performed, including medical history and physical examination. It should be recognized that the primary disease that causes urinary incontinence may also be the cause of repeated urinary tract infections and impaired upper urinary tract function. Neurogenic bladder examination should also include upper urography, cystoscopy, and urodynamic monitoring. Only a detailed examination can develop a safe and effective treatment plan, including CIC.

Adequate urinary incontinence should emphasize understanding of the causes of urinary incontinence and exclude factors that may cause upper urinary tract damage, such as low compliance bladder or bladder ureteral reflux. Every patient with suspected filling urinary incontinence should have a residual urine volume measurement, and if there is a large amount of residual urinary volume, it is a strong evidence of filling urinary incontinence. Also measure renal function and electrolytes such as potassium, sodium, and chloride. Ultrasound was performed to determine if there was water in the upper urinary tract. A comprehensive evaluation helps determine the treatment options that are appropriate for the patient's own condition, while also taking into account the patient's own requirements.

Each patient has a different level of education and understanding and acceptance of CIC. Therefore, an effective training plan should be developed for each patient's specific situation. Although text notes and videotapes are also effective educational tools, they cannot completely replace the training of trained medical staff.

Before conducting CIC operation training, patients should be comprehensively evaluated, and existing problems should be treated. A treatment plan suitable for the patient's condition has been developed. Such as the use of drugs and behavioral training to assist the bladder to store urine to determine the size of the bladder's safe capacity (ie, the bladder pressure during storage of bladder pressure does not exceed 40cmH2O capacity). Patients should fully understand that overfilling of the bladder may cause damage to the upper urinary tract, especially those with a pressure in the bladder exceeding 40cm2O for a long time. Only in this way can the patient understand the importance of regular urinary catheterization. Generally, urinary catheterization is required 4-6 times a day. Avoid overfilling the bladder.

The most commonly used urinary catheters for CIC are F14 ~ F16 transparent plastic urinary catheters. Female patients can use short urinary tubes specially designed for CIC. Catheters are made of plastic, rubber, and silicone. The transparent urinary tube can see whether the urine is flowing out as soon as possible, which helps the patient to determine the depth of the urethral insertion, reduces the pain caused by catheterization, and facilitates the cleaning of the catheter.

The cleaning principle is that the urinary tubes used should be cleaned and dried with soap and water. Prepare 6 clean urinary tubes every day and put them in clean and dry pockets for going out and using at night. Male patients should understand their own feeling when the urethra passes through the urethral membrane sphincter and prostate, and the resistance of the hand to prevent urinary tract damage caused by forced insertion. Wash your hands before catheterization. After applying a certain amount of paraffin oil to the top of the urinary catheter, insert the urethra through the urethra into the bladder with your bare hands. When urine is flowing out, insert 1 ~ 2cm deep. After the urine is drained out, slowly remove the catheter. , So that urine accumulated in the bottom of the bladder is also excreted.

The key to training female patients is to understand the anatomical location of the urethra, which can be touched with a mirror or hand to understand the exact location of the urethral opening. Knowing the anatomy of the urethral orifice, the patient can sit or step on the toilet with one foot, separate the two legs, separate the labia with one hand and touch the position of the urethral orifice, and hold the tip of the urinary canal to insert into the urethra. After the urine has been drained, slowly remove the urinary tube.

If CIC is difficult due to anatomical factors, further examination is needed, especially to lower the lower urinary tract obstruction such as urethral stricture. For those who have difficulty with two-handed movements, although there is currently a device to assist such patients with urinary catheterization, the use of CIC is not recommended. Just 2 to 4 weeks before the start of CIC, low-dose antibiotics can be taken appropriately to prevent infection without the need for long-term use of antibiotics. Patients should be regularly followed up with urine routine and urine culture.

[Complications of Clean Intermittent Catheterization and Follow-up]

CIC rarely has local complications. Occasionally urethral hemorrhage or gross hematuria can heal more. Occurrence of bladder stones. Urinary tract damage can lead to urethral strictures, making CIC difficult. The above conditions are relatively simple and rarely occur in urological treatment.

Urinary tract infections are the most common complication of CIC. CIC patients often find asymptomatic bacteriuria, such as patients without fever, hematuria, urine turbidity, urine foul odor, lower abdominal pain and other signs of serious urinary tract infections, without special treatment [14]. Urinary tract infections with clinical symptoms generally require anti-infective treatment. The symptoms and signs of urinary tract infections are also different in patients with spinal cord injuries. They usually show increased muscle spasms, hyperautonomic reflexes, fever, hematuria, urine odor, and turbid urine. Because patients with spinal cord injury have a marked decrease in spontaneous sensation, it is necessary to observe whether there is a urinary tract infection from the aspect of signs. Urinary tract infections with clinical symptoms or signs generally require short-term anti-infective treatment. A 10-year clinical follow-up study using CIC adjuvant therapy showed that the incidence of asymptomatic bacteriuria is approximately 74%, and it is rare with fever or pyelonephritis [15]. Long-term use of low-dose antibiotics may help some people with recurrent urinary tract infections.

Those with bladder ureteral reflux can significantly increase the risk of CIC leading to upper urinary tract infection. If there is sufficient bladder safety capacity by urodynamic evaluation before the start of CIC, the volume of CIC catheterization is also limited to the bladder safety capacity, and acquired bladder ureteral reflux is rarely seen. However, the bladder's compliance will gradually decrease over time. Therefore, patients with neurogenic bladder should be evaluated regularly for urodynamics every year to see if they are suitable for CIC adjuvant therapy. Such as long-term CIC, newly recurrent urinary tract infection or hydronephrosis, the patient should be re-evaluated for bladder ureteral reflux and bladder urethral function. Mild bladder ureteral reflux, and low-dose antibiotics may be helpful for long-term patients with repeated infections. For patients with obvious bladder ureteral reflux and severe repeated urinary tract infections, usually with a low compliance bladder, cystomegaly (autologous or intestinal bladder enlargement) and regurgitated ureter are required for anastomosis before CIC catheterization. May effectively protect upper urinary tract function.

Patients treated with CIC usually require regular annual follow-up after stable conditions. The review includes urine analysis, urine culture and drug sensitivity tests, the number of urinary catheters per day, the volume of each urinary catheter, renal function, renal ultrasound, etc. If there is hydronephrosis, intravenous pyelography and bladder ureteral reflux angiography should be performed. And urodynamic examination (or imaging urodynamic examination), if there is hematuria, cystoscopy should be performed to exclude bladder stones and even bladder tumors.

In short, clean intermittent home catheterization has become the most basic treatment for emptying the bladder. In the treatment of urinary incontinence, CIC is used for filling urinary incontinence, and some complications of bladder emptying disorder after urinary incontinence treatment. Long-term clinical observations have confirmed that CIC has good safety, effectiveness and tolerability. And CIC is easy to grasp by patients or their families. With proper follow-up, the popularity of CIC technology will significantly improve the survival and quality of life of patients with bladder and urinary tract dysfunction and urinary incontinence.