Intermittent catheterisation in children September 2016 For irritation caused by the catheter: if necessary use additional lubrication and/or a catheter with a different coating, a different thickness, or different stiffness 4 C In case of pain due to vacuum suction on catheter removal , try using a catheter with a smaller Charrière or placing the finger on the end of the catheter during removal 4 C In children with both neurological and non-neurological disorders, additional paediatric pelvic floor physiotherapy can be helpful when if there is difficulty inserting or removing the catheter. Additional paediatric pelvic floor physiotherapy may also be helpful 4 C In the case of bladder spasms: check the urine for infection and if necessary prescribe antibiotics otherwise prescribe anticholinergics. 4 C A false passage should be treated by placement of an indwelling catheter and with antibiotics if necessary 4 C In CIC/CISC, only symptomatic UTIs should be treated 4 C Antibiotic prophylaxis may be recommended in case of reflux, congenital disorders of the urogenital tract, and recurring UTIs 1b A In case of mucous, the bladder can be washed out with a saline solution or acetylcysteine, or chondroitin sulphate can be instilled. Catheters with wider openings can also be used 4 C FOLLOW UP CARE Advise parents to discuss with school the integration of catheterisation into the school day and the prevention of teasing and bullying within school 4 C Advise parents to discuss with their child whether they want to inform people about CIC/CISC, and if so who to inform 4 C Annual follow-up with a nurse practitioner may well help to bring to light any cases of non-compliance 4 C Improve compliance by registering at every follow-up visit any problems that the patient might have (CIC/CISC in daily practice, stopping CIC/CISC) and discussing these issues with them 4 C Provide patients with contact details of any available patient organisations or peer support to enhance compliance 4 C Advise children/parents to take a medical travel document with them when travelling abroad TRANSITION SEXUALITY AND QUALITY OF LIFE From about the age of 12, children with a chronic physical disorder who require lifelong care should be supported by a structured transition protocol 4 C QoL is affected by many different factors; it is important to be aware of this and to discuss it during follow-up visits 4 C Offer children an individualised care plan, bearing in mind the patient’s and caregiver’s lifestyles, and the impact this will have on the patient’s QoL 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 As part of patient assessment, discuss sexuality and intimacy, and the impact that CISC/CIC has; if necessary refer to a psychologist or sexual counsellor in older children if available 4 C
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