Intermittent catheterisation in children September 2016 Chapter 2 Indications for Catheterisation The technique of clean intermittent catheterisation was introduced by Lapides et al in 19723 for patients with different diagnoses of bladder emptying disorders. Several years later, Hannigan et al4,5 revised the technique for use in children. Intermittent catheterisation is applied in the case of persistent, recurring residual urine and/or an inability to empty the bladder. This may occur in the following disorders: Neurogenic bladder dysfunction. Combined with the administration of anticholinergic medication, CIC/CISC maintains a low pressure bladder which grows along with the child . CIC/CISC, combined if necessary with a maintenance dose of antibiotics, also reduces the risk of urinary tract infections and preserves renal function.6, 7 Bladder dysfunction caused either by an anatomical or functional disorder or by urethral pathology. CIC/CISC prevents both recurrent obstruction and urinary tract infections.8 Operations to improve continence also carry a risk of temporary or permanent bladder emptying impairment for which CIC/CISC may be indicated. Complications and Management 2.1 Infections 2.1.1 Urinary tract infection (UTI) The most common complication of intermittent catheterisation is a catheter-related UTI.9 Asymptomatic UTI is seen in 42-76% of children who catheterise. The true incidence is difficult to determine, however, because of the variety between studies with regard to the different catheter techniques, the different types and sizes of catheters, and levels of hygiene. In specific cases (vesico-urethral reflux, congenital disorders of the genital tract and recurring UTIs), antibiotic prophylaxis may be given.10 However, antibiotic prophylaxis does not reduce the frequency of symptomatic UTIs in children with neurogenic bladder dysfunction, relative to those not receiving prophylaxis.11 In adults performing intermittent catheterisation there are a number of identified factors that can increase the risk of UTI (see Table1). There is no equivalent data in children however it is pertinent to expect it may be very similar, if not the same, in children. Table 3 Risk factor for UTI Level of Evidence (LE) Low frequency of IC 2b Bladder over distension 1b Female 1b Poor fluid intake 3 Non-hydrophilic coating 1b Poor technique 3 Poor instruction 2b Recommendations LE GR In CIC/CISC, only symptomatic UTIs should be treated 4 C Antibiotic prophylaxis in case of reflux, congenital disorders of the urogenital tract, and recurring UTIs 1b A
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