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Guidelines for clean intermittent catheterization in children
Zhao-Kai Zhou1, Yi-Bo Wen1, Qing-Wei Wang1
1Pediatric Urodynamic Center and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Henan Joint International Pediatric Urodynamic Laboratory, Zhengzhou, 450052, China.
Insights
This guideline provides standardized recommendations for clean intermittent catheterization (CIC) in children, improving bladder emptying for those with urinary difficulties. It emphasizes caregiver training and a multidisciplinary approach for effective management.
Area of Science:
- Pediatric Urology
- Nephrology
- Guideline Development
Background:
- Clean intermittent catheterization (CIC) is crucial for bladder emptying in pediatric patients with voiding dysfunction.
- Lack of standardized protocols for pediatric CIC necessitates expert consensus.
- This guideline aims to standardize CIC application in children.
Purpose of the Study:
- To establish evidence-based recommendations for the standardized application of CIC in pediatric populations.
- To provide a protocol for consistent and effective bladder management in children requiring CIC.
Main Methods:
- Systematic literature review of clinical trials, cohort studies, case series, and consensus statements.
- Searches conducted across major databases: PubMed, Embase, Cochrane Library, Web of Science.
- Guideline development followed the WHO Handbook for Guideline Development (2nd edition).
Main Results:
- CIC is recommended for children with increased post-void residual (PVR) posing upper urinary tract risk.
- Safe bladder capacity (SBC) and PVR measurements, alongside voiding diaries, guide CIC frequency.
- Specialized caregiver training, meticulous hygiene, and a collaborative multidisciplinary approach are essential for successful CIC implementation.
Conclusions:
- A standardized protocol for pediatric CIC has been established.
- This guideline facilitates consistent and effective bladder emptying in children.
- The protocol supports optimal management of lower urinary tract dysfunction in pediatric patients.
Background:
Clean intermittent catheterization (CIC) is an effective method of bladder emptying in children with neurogenic and non-neurogenic disorders that cause difficulty in urination. However, there is a lack of expert consensus on the standardized application of CIC in pediatric populations. This guideline intends to outline recommendations for standardizing CIC in children.
Methods:
A comprehensive literature review was performed by searching key academic databases, specifically PubMed, Embase, the Cochrane Library, and Web of Science. Eligible literature-including peer-reviewed clinical trials, cohort studies, case series, and expert consensus statements-was systematically identified, screened, and critically appraised. This guideline was developed according to the "WHO Handbook for Guideline Development (2nd edition)".
Results:
For children with symptoms of increased post-void residual (PVR) that may threaten the upper urinary tract, CIC is recommended regardless of the cause. Safe bladder capacity (SBC) and maximum bladder capacity measurement could guide optimal CIC frequency. When infants or young children require CIC, their caregivers should receive specialized training. The CIC procedure includes thorough hand and genital area cleansing, followed by careful catheter insertion to avoid contamination of surrounding tissues. Depending on the individual's ability to void, CIC will be either partial or complete. Partial CIC is recommended for individuals who are able to void partially. When implementing CIC, a collaborative model involving the patient, caregivers, and a multidisciplinary pediatric team specializing in lower urinary tract management should be adopted, and regular follow-up and efficacy assessments are required. Urodynamic study to determine the PVR and SBC in conjunction with a voiding/catheterization diary provides an objective basis for adjusting the frequency of catheterization and for determining whether to continue catheterization.
Conclusion:
This guideline established a standardized protocol for children who require CIC to facilitate bladder emptying.
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