18 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. 4.3 Complications/difficulties associated with catheterisation Problems sometimes occur during learning and adherence to catheterisation or self-catheterisation. Despite this, it appears that most children tolerate catheterisation with few complications. Even in children who are sensitive, it appears that they (or their caregivers) are also able to learn the technique rapidly and with good long-term results.36 Success of catheterisation, however, can be affected by numerous factors, including: 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 an inability or complete refusal to perform catheterisation or difficulty with long-term compliance. Below are 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 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. 19 … 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, another catheter or other tip 4 C 4.3.2 Pain/discomfort Pain may be felt during insertion and 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 catheters may cause possible discomfort and stinging due to the type of coatings, lubrication, and stiffness, which may irritate some individuals. Vacuum suction caused by “tenting “of the bladder may also cause discomfort on withdrawal of the catheter, and a smaller Charrière, less deeply inserted catheter, may help to overcome this. Trying different types of catheters will help individual children to select the most comfortable one for them. Nowadays Coloplast, with the ‘luja’ catheter that has multiple small eyelets, claims that vacuum is no problem with this catheter. (see Appendix I). But look out in case of mucus!
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