Clean Intermittent Catheterization (CIC) is a urological procedure used to manage bladder function when the body cannot empty it effectively. It involves the temporary insertion of a thin, flexible tube, known as a catheter, into the bladder to allow urine to drain. This technique is often recommended as the preferred method for individuals who experience certain types of bladder dysfunction. The primary goal of CIC is to prevent the buildup of urine that can otherwise damage the kidneys and urinary tract.
What Clean Intermittent Cateterization Means
Clean Intermittent Catheterization is defined by its two core concepts: “intermittent” and “clean.” The term “intermittent” signifies that the catheter is inserted only periodically, typically several times a day, just long enough to drain the bladder completely, and then immediately removed. This differs significantly from an indwelling catheter, which is designed to remain in the bladder continuously for an extended duration.
The “clean” aspect refers to the level of hygiene required, which is a meticulous, yet non-sterile, technique. CIC is commonly performed by the patient themselves or a caregiver in a home or public setting. This method emphasizes thorough handwashing, clean supplies, and careful handling to minimize the introduction of bacteria. Removing the catheter after each use contributes to a lower risk of certain complications compared to long-term indwelling devices.
Medical Conditions Treated by CIC
CIC is frequently referred to as the standard therapeutic approach for individuals who cannot fully empty their bladder due to functional or neurological issues. The inability to void completely, known as urinary retention, allows residual urine to pool in the bladder, which can lead to increased pressure and potential harm to the upper urinary tract and kidneys. This retention is a common symptom in several chronic medical conditions that disrupt the normal nerve signals to the bladder.
The most common diagnostic category requiring CIC is neurogenic bladder, a dysfunction caused by damage to the nerves that control bladder and sphincter function. Conditions like spinal cord injury, spina bifida, multiple sclerosis, stroke, and Parkinson’s disease can all impair the detrusor muscle, which is responsible for bladder contraction. When the detrusor muscle is underactive or the sphincter muscle fails to relax appropriately, urine remains in the bladder even after an attempt to void.
CIC is also used to manage severe urinary retention that occurs in non-neurological contexts, such as following certain surgeries or in cases where the detrusor muscle is temporarily weakened. In these instances, the intervention is often temporary, allowing the bladder to rest and recover its function while preventing overdistension. The regular and complete emptying of the bladder via CIC helps maintain low pressure within the urinary system, which is protective against subsequent kidney damage.
Performing the Procedure Safely
The successful and safe performance of Clean Intermittent Catheterization relies heavily on adherence to a prescribed protocol and rigorous hygiene practices. The procedure begins with meticulous preparation, which includes washing hands thoroughly with soap and water for at least 20 seconds. All necessary supplies, such as the catheter, water-soluble lubricating jelly, and a receptacle for urine, must be gathered and placed within easy reach before starting.
The patient or caregiver prepares the catheter by applying lubricating jelly generously to the tip and the first few inches of the tube, unless a pre-lubricated hydrophilic catheter is being used. Positioning is also important; many people find it easiest to sit on the toilet or stand in front of it to facilitate drainage. For male anatomy, the penis is typically held straight and upward to straighten the urethra. For female anatomy, the labia are gently parted to locate the urethral opening.
The catheter is then inserted slowly and gently into the urethra until urine begins to flow, indicating that the tip has reached the bladder. Once the flow starts, the catheter is advanced a little further, usually one to two centimeters, to ensure the drainage eyes are fully inside the bladder. It is essential to hold the catheter in place until the flow completely stops.
The catheter is then withdrawn slowly, pausing if any more urine drains out, to ensure the bladder is fully emptied. After the procedure, single-use catheters are disposed of. Reusable catheters require careful cleaning with mild soap and warm water, followed by thorough rinsing and air-drying on a clean surface.
The physician determines the frequency of catheterization, which is often around four to six times a day, based on the patient’s individual bladder capacity and fluid intake. Consistent and correct technique is paramount, as it maintains the health of the urinary tract and significantly reduces the potential for developing urinary tract infections, which remains the most common complication associated with this method.