Intermittent catheterisation in children September 2016 Chapter 4 Nursing interventions 4.1 Teaching self-catheterisation CIC/CISC is currently an important therapeutic procedure in paediatric urology, and is carried out in all age groups. The aim of CIC/CISC is to enable adequate and safe bladder management, which is necessary for children to be healthy, have self-esteem, and to promote independence as they grow up.7, 26-28 We know that, CIC/CISC does not cause any major emotional or behavioural problems.29,35,43 and that CIC/CISC can give children freedom and self-respect, which can facilitate an independent life. The positive experiences of CIC/CISC reported by Lopes et al 201130 may be as a result of achieving continence and no longer requiring incontinence products. A specialist nurse is indispensable when teaching a child CIC/CISC. He/she should be familiar with the emotional and psychological impact of CIC/CISC on children, adolescents and adults and also aware of the child’s level of development. The age at which a child can learn to self-catheterise ranges in the literature from 4 to 8 years.31-33 but is also dependant on the cognitive level of both child and the parents which must be considered when teaching children and parents. It is important to take account of any resistance to the procedure, concerns of embarrassment and fear of possible pain. The child and families existing knowledge of anatomy of the urinary tract, the reason for CIC/CISC and insight into the medical condition along with other possible treatment options is also important. 25, 2 8,33-38 Teaching CIC/CISC can take place individually or in a group.23, 28, 33, 34, 36 Taking a relaxed approach, giving them sufficient time, offering them privacy and respect for intimacy are needed to overcome embarrassment and anxiety, and make it easier to exchange and acquire information.33,34-35,38,39,3 The ideal place for teaching CIC/CISC is usually the home setting as it is familiar territory and the patient feels safer there.34 However, in daily practice this is this is not always possible. It is also very important to motivate and compliment parents and children in order to boost self-confidence.14, 27, 33-35 It is essential, when teaching catheterisation, that the healthcare professional is knowledgeable about the types of catheter available and can give advice and information regarding the most suitable options for the child and family depending on their underlying medical problem, individual circumstances and surgical procedures which the child may have undergone. 34, 36 These factors may dictate specific types or length of catheter which may be needed. Other factors such as frequency of catheterisation, hygiene issues, predisposition to UTIs, medication, physical problems such as dexterity, access due to wheelchairs, and additional need for continence aids may also influence the choice of catheter and teaching of CIC/CISC. The catheterisation technique should be discussed and practised with the child and family. 2, 40 A step by step teaching plan for teaching parents and for children is advised, examples of these can be seen in Appendices A to C. For healthcare professionals undertaking catheterisation in the hospital a similar procedure is shown in Appendices D and E. An instructional model or doll is a very useful aid for explaining things to children and parents. It improves accuracy31 and it reduces anxiety because it means the child can practise non-invasively and make errors without experiencing pain.24 Because children associate dolls with play this also encourages participation. 24, 34 The child can gain self-confidence through role-play, playing the role of the nurse with the doll being the patient.31, 34 Baby models may also be available for parents to learn catheterisation. For adolescents, sharing their experiences of catheterisation without their parents being present is also a good way of encouraging participation and promoting long term compliance.33, 37 41 4.2 Frequency of catheterisation The frequency of catheterisation depends on the indication for catheterisation, and on factors such as the volumes obtained during catheterisation26 and the fluid intake. It should take place with a frequency that is sufficient to prevent UTIs and overfilling of the bladder, while being socially acceptable. Each individual will
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