Intermittent catheterisation in children September 2016 It is important to inform the child and the parents about the different ways of contacting help and advice should they need it getting in touch.44 It can sometimes be necessary to involve homecare services or the school nurse. Once catheterisation has become routine, follow-up care can be reduced. As integrating intermittent catheterisation into daily life can be difficult regular follow-up visits are still a necessity. However, such visits are usually combined with medical appointments. The development and prevention of urinary tract infections can be influenced by the following factors: – Knowledge: discussion of types, sizes, suitability of catheters, new developments on the market, possible medications 50,19,2 – Technique: demonstrating catheterisation, practising skills2, 27, 40, 51 – Motivation, perseverance, self-management: 13, 52, 53 Follow up should include discussion around these three areas to maximize outcomes.26 Recommendations LE GR Support for the child and its parents must be available during the entire catheterisation period 4 C Ensure regular follow-up (in the outpatient clinic, by telephone or via internet) in order to improve QOL with regard to CIC/CISC 4 C Annual follow-up with a nurse practitioner may well help to bring to light any cases of non-compliance 4 C 4.6 Transition Many adolescents with urological disorders need lifelong urological care.54 In recent years, a number of studies have been published about the transition from paediatric urology to adult urology.55-58 These studies have demonstrated that part of the paediatric urology population still consists of adolescents/adults suggesting that some patients are reluctant to be transferred to adult urology care. General studies have also shown that poor planning/ poorly implemented transfer of care leads to avoidance of consultations and non-compliance. A negative effect on morbidity, mortality and social and educational performance has also been demonstrated.53, 59, 60 Transition is part of growing up and refers to the process of an adolescent patient becoming independent. Transition is defined as a purposeful, planned process aimed at meeting the medical, psychosocial and educational needs of adolescents with chronic physical and medical conditions when they move from childcentred to adult-oriented healthcare systems61. The actual time-point at which a patient moves to adult care is just one part of the transition process and is known as 'transfer'. As adolescents develop into adults, there is a shift in social roles. They form stronger bonds with their peers and become less dependent on their family circle, this shift also takes place with regard to medical care. For young people, letting go of their parents is a developmental milestone. However, having a chronic disorder often reinforces both dependence on parents and parents protective behaviour, which make it harder to reach this milestone and can sometimes create tension. 53 59 Professionals and parents should work in collaboration to ensure the transition process maximises the independence of the patient. Clear communication and good collaboration between specialists, patients and parents is essential to achieve effective transition and insufficient preparation and confusion around transition is common.58 62, 63 The age to start the transition process varies from country to country but the ideal is generally considered to be around age 12yrs. It is recognised that patients should have an individualised transition plan. There are several examples of transition documentation including the 3 step ready steady go and the Individual transition plan Appendix H, It is also recommended that each service should have a transition coordinator, and that there should be combined paediatric and adult urologist consultations. Healthcare professionals should be actively engaged in developing and improving transition programmes for children who catheterise Recommendation LE GR
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