Intermittent catheterisation in children September 2016 make a decision together with the urologist, paediatric urologist or nurse practitioner. In adolescents (with an adult bladder capacity) a general rule is that the bladder capacity should not exceed 500 mL and catheterisation should take place on average 4 to 6 times a day, if this is the only or recommended method of voiding. If spontaneous voiding is still possible, catheterisation is usually 1 to 3 times a day.42 4.3 Complications/difficulties associated with catheterisation During learning and adherence with catheterisation or self-catheterisation, problems do sometimes occur. Despite this, it appears that most children tolerate catheterisation with few complications.15, 43 Even in children who are sensate it appears that they (or their caregivers) are also able to learn the technique rapidly and with good long-term results.44 Success of catheterisation however can be affected by numerous factors these include; Difficulties with insertion and/or removal of the catheter Pain/discomfort Constipation/faecal incontinence Cognitive ability Physical difficulties Psychological and emotional Practical/social considerations Such problems can lead to inability or complete refusal to perform catheterisation or difficulty with long term compliance. Below describes a number of practical problems and solutions that may have an impact on successful catheterisation. 4.3.1 Problems with insertion Difficult insertion In children, particularly those with neurogenic bladder dysfunction, it is sometimes difficult or impossible to get a catheter past the sphincter especially if they are unable to relax the sphincter muscle due to sphincter dyssynergia. It can help to ask the child to take a deep breath or to change position (sitting, standing, lying). It can sometimes help to hold the catheter against the sphincter using light pressure and to wait a little while. Often the sphincter will relax after a while. If the problem only occurs when the bladder is full, it can be helpful to catheterise a bit earlier or more regularly. A change of catheter to one with a different tip can also help ease of insertion and if there is difficulty opening the packaging, or if the catheter is too slippery preventing a good grip a change of catheter type may also be beneficial .20, 46 Recommendation LE GR When there are problems inserting a catheter, discuss and practise alternative options (deep breaths, changing position, applying light pressure to the sphincter, catheterising earlier, other catheter or other tip 4 C 4.3.2 Pain/discomfort Pain may be felt during insertion and during removal of the catheter. This can be the result of bladder spasms or a urinary tract infection, but can also be related to insufficient relaxation of the pelvic floor when inserting or removing the catheter. Different types of catheter may cause possible discomfort and stinging due to type of coatings, lubrication and stiffness which may irritate for some individuals. Vacuum suction caused by “tenting “of the bladder may also cause discomfort on withdrawal of the catheter and a larger Charrière less deeply inserted catheter may help to overcome this. Trying different types of catheter will help individual children to select the most comfortable one for them. Anxiety and a fear of pain (justified or not) can hamper the learning process. It is important to discuss fears and how they can be overcome. Additional psychological support may be used if available .23
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