Intermittent catheterization means removing urine (pee) from the bladder by placing a tube into the bladder. This is done when a child or adult is unable to empty their bladder on their own, when a child's bladder leaks urine, or when very high pressures have developed in the bladder.

When doing catheterizations, it is important to prevent urinary tract infections. Extra urine in the bladder can grow germs. Chronic infections and high bladder pressures can damage the kidney.

Intermittent catheterization is not a hard procedure. You cannot hurt the bladder if you follow the directions. Almost anyone can learn to do this the right way, even a 7- or 8-year-old child.

Commonly Used Terms

Bladder

A muscular sac that holds urine until it is emptied from the body

Bladder over-distention

A bladder that is too full

Catheter

A tube used for emptying urine from the bladder

Labia

Folds of skin covering the urethral and vaginal openings

Lubricant

A water soluble, jelly-like substance used to help the catheter go in easily and prevent irritation. (Do not use a petroleum-based product, such as Vaseline. Use a product such as K-Y Jelly, which will not damage the catheter.)

Urethra

The tube that carries urine from the bladder to the outside

Vagina

The canal leading from the uterus to the outside

Void

To urinate; to empty the bladder

Normal Function of the Urinary Tract

Urine (the body's liquid waste) is made in the kidneys through a blood filtering process. Urine passes from the kidneys, down through the ureters and into the bladder. The bladder is an elastic muscle that acts as a storage tank. As the bladder fills, its walls relax to hold more urine. The sphincter muscle remains tight to prevent leakage of urine.

Needed Supplies

Assemble after washing hands:

• Lubricant (K-Y Jelly, E-Z Lubricating Jelly)
• Paper towel
• Diaper (for infants)
• Container for urine collection or be near the toilet
• Plastic cup (if a specimen is needed)
• Cotton balls, gauze squares, Betadine or BZK wipes or swabs
• Soap and water (a mild soap, such as liquid Ivory or Dial)
• Catheter (your healthcare provider can recommend which size)

Catheterization Procedure

(May vary according to your doctor's preference.)

1. Wash hands well with soap and water.
2. Open catheter pack; roll the tip and the first one to two inches of the catheter in lubricant. Place back in the catheter pack. If using self-sterilized catheters, place catheter tip back in plastic bag after rolling it in lubricant.
3. For babies, take off old diaper and clean the bottom if they have stooled, then place on a new diaper.
4. Separate the labia (the skin around the vagina) with nondominant hand. With the other hand, wash area well with antiseptic as directed by your doctor. Always wash from front to back. Continue holding labia open. Use three cleaning swabs, wiping only one time from front to back with each.
5. Locate urinary opening above vagina. Insert catheter until urine flows freely, then advance catheter one additional inch. If you meet resistance, try changing the angle of the catheter. Do not force the catheter.
6. Allow urine to flow into the diaper (for infants), toilet or a cup if a specimen is needed. Sometimes, your healthcare provider will want you to measure the amount of urine that comes out of the bladder with the catheterization.
7. When urine stops flowing, slowly remove the catheter, allowing all urine to drain.
8. Rinse off antiseptic with water.
9. Note appearance and amount of urine. If something unusual happens, report it to your doctor.
10. Follow your healthcare provider's instructions for how many times a day you should do this.
11. To self-sterilize catheters, follow instructions given by your doctor or nurse.

Possible Problems with the Catheterization

Urine Leaking during Catheterization

• The catheter may not be inserted far enough
• The catheter may be blocked
• The bladder may be having a contraction

Little or No Urine during Catheterization

• The catheter may not be inserted far enough
• The child may not be drinking adequate fluids
• The catheter may be blocked
• Urine may already have leaked out

Blood in the Catheter

It usually indicates a mild bladder or urethral irritation. It will usually clear by itself. If blood persists or is linked to trouble passing the catheter, contact your doctor. You should never have to force a catheter into the bladder.

When to Call Your Child's Doctor

For Infants

Look out for:

• Cloudy or dark urine
• Blood in urine
• Vomiting
• Chills or fever
• Fussiness
• Increase in sleeping
• Swelling or redness around urethral opening
• Change in smell of urine
• Painful urination
• Unusual discharge from urethra or around catheter

For Older Children

Look out for:

• Cloudy or dark urine
• Blood in urine
• Nausea or vomiting
• Chills or fever
• Side pain
• Feeling very tired or sleepy
• Frequent urge to urinate
• Urgency (a need to quickly get to the bathroom)
• Swelling or redness around urethral opening
• Change in smell of urine
• Burning and pain when urinating or during catheterization
• An unusual discharge from the urethra or around catheter
• Noticeable decrease in the amount of urine

Special Tips for Infants

• Offer the baby a pacifier, comforting toy, or turn on a musical mobile to distract them
• Hold and comfort the baby afterwards

Special Tips for Children

• It is vital that you catheterize your child on time, every time, and that you do not skip it. Evenly space catheter times from morning to night.
• Have your child drink plenty of liquids to improve the flow of urine through the kidneys.

History of Intermittent Catheterization

Intermittent catheterization was first used in 1970 as a home non-sterile self-technique. Its effectiveness and safety have since been proven. It is used worldwide by thousands of people to manage bladder function.