Intermittent catheterisation in children September 2016 they are performing CIC in school to ensure competence and for insurance purposes if they are performing the catheterisation for the child. Health care professionals need to be aware when developing catheterisation routines with children and their families that this may impact on the whole family with parents reporting having less time to spend with their other children.29 A study of children with myelomeningocele showed that sex, age and IQ were not factors associated with successful independent catheterisation but that the length of time needed to complete the toilet activity was significant. 45It is therefore important to consider the time the procedure takes and keep it as quick and simple as possible whilst still being safe. A medical travel document/letter can be helpful when travelling abroad particularly for customs employees (example in Appendix I). This should provide information regarding the products the patient is carrying with them and details of the healthcare provider should there be any queries. Some catheter companies produce travel cards containing information in a variety of languages and individual patients information can be added in 4.3.8 Promoting Compliance The potential complications and difficulties previously mentioned all influence compliance especially during puberty and early adolescence. Good communication, support and positive attitudes from healthcare professionals can help patients to overcome any resistance.13, 23, 35 Poor compliance is also shown to be associated with higher incidence of UTI and Epididymitis. Compliance may be improved by providing information and contacts with patient support organisations and/or peer counsellors. Motivational interviewing and group therapy interventions may also be useful.13 Patients should be made aware of these possibilities and of relevant patient organisations, websites and booklets. Starting catheterisation during infancy for children who may need CIC in later life e.g. children with neurogenic bladder, bladder extrophy, boys with severe epispadias with absent bladder neck and girls with epispadias. This can be done twice a day during the first few years and frequency increased when surgery is considered. This improves compliance and reduces oppositional behaviours. 4.4 Documentation /Patient Information Depending on the country, there are a variety of booklets and aids available such as DVDs. Information can also be found via websites (examples provided in Appendix F) and on YouTube. These should be considered with caution as they are not always clear or accurate may represent a personal opinion or experience. Non-commercial information booklets are available for adults and these may be suitable for adolescents and some young adults. There are many information booklets specifically for children which have been developed by suppliers of catheter products and by hospitals. When selecting or formulating information booklets it is important that information leaflets should be clear about why intermittent catheterisation is necessary, and how this procedure should be carried out. They should contain an explanation of the anatomy involved (in plain language) and include frequently asked questions and common problems. It is also considered advantageous for healthcare professionals to use a checklist to ensure the children and parents have received all the necessary information about CIC/CISC. An example is shown in appendix G Patient organisations also have their own patient information materials and websites. They may also help to provide peer support by organising meetings and online contact. More recently 'voiding diary apps' have become available for smart phones, developed by suppliers and/or hospitals. 4.5 Follow-up care After catheterisation has been learned, short-term follow-up is needed in the beginning to coach the child and its parents, to ensure that the procedure is being carried out properly, and to provide advice in case of any problems.13, 27 This can take place in an outpatient clinic, by telephone, by email or using Skype.
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