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 performing catheterization, 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 over time.

Intermittent catheterization is not a difficult procedure. You cannot hurt the bladder if you follow the directions. Almost anyone can learn the technique, 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 filled beyond normal size.

Catheter

A tube used for emptying urine from the bladder.

Foreskin

A fold of skin covering the tip of the penis.

Lubricant

A water soluble, jelly-like substance used to 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 in the body that carries urine from the bladder to the outside.

Void

To urinate or pee; 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 and the sphincter muscle remains tight to prevent leakage of urine.

Needed Supplies

Assemble after washing hands:

• Lubricant (K-Y Jelly or E-Z Lubricating Jelly)
• Paper towel
• Catheter (our healthcare provider can recommend which size)
• Diaper (for infants)
• Plastic cup (if a specimen is needed)
• Betadine or BZK wipes or swabs
• Soap and water (a mild soap, such as liquid Ivory or Dial)
• Urinal or other container to drain urine into

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 if it is soiled and place a new diaper under them.
4. Clean the penis. Hold both sides of the penis, with nondominant hand. Holding it away from the body, pull back on the foreskin (if necessary). Wash the tip of penis well with Betadine or BZK wipes or swabs. Continue to hold foreskin back.
5. Locate urinary opening at the tip of penis. Insert catheter gently. You may meet resistance about ¾ of the way in (a tightened muscle). If this occurs, hold firm, steady pressure against the muscle. You may need to hold this pressure for up to a minute or more for the muscle to relax. Do not force the catheter. You should feel a “release” and then find that the catheter slips in easily. If you can't get the muscle to relax, try changing the angle of the penis. If this doesn't help, stop and try again in 30 minutes.
6. Let urine drain into urinal, toilet or diaper for an infant, 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 the Betadine, BZK or soap off the penis 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. If you must sterilize your catheters after use, follow instructions given by your doctor or nurse.

Possible Problems During Catheterization

Leaking Urine

• The catheter may not be inserted all the way into the bladder.
• The catheter may be blocked.
• The bladder may be having a spasm.

No Urine During Catheterization

The catheter may not be inserted far enough (especially in boys). Your 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 associated with difficulty in 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

Watch 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, crying with urination, or an unusual discharge from urethra or around catheter.

For Older Children

Watch for cloudy or dark urine, blood in urine, nausea or vomiting, chills or fever, side pain, feeling very tired or sleepy, frequent need 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, or noticeable decrease in the amount of urine.

Special Hints for Infants

• Offer your baby a pacifier, comforting toy, or turn on a musical mobile to distract them.
• Hold and comfort baby afterward.

Special Hints for Children

• It is very important that you catheterize your child on time, every time, and that you do not skip it. You should evenly space catheter times from morning to night. The first catheterization should be upon waking and the last right before bedtime.
• Have your child drink a lot of liquids to improve the flow of urine through the kidneys.

History of Intermittent Catheterization

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