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EFFECTIVE PREPARATION USING A CARE PATHWAY (CP) IN CHILDREN
REQUIRING URETHRAL CLEAN INTERMITTENT CATHETERISATION (CIC)
Keisha HEPBURN, Joan MCKENZIE, Claire FOSTER, Cathy GILL, Anne WRIGHT and Joanna CLOTHIER
Evelina London Children's Hospital, Paediatric Nephro-urology, London, UNITED KINGDOM
PURPOSE
Clean Intermittent Catetherisationo (CIC) can cause fear and apprehension in children, families and some health care
professionals. We have developed a Care Pathway (CP) to address this issue which includes discussion/agreement in the
multidisciplinary team meeting, consultant provision of explanation plus written information for parents and child,
preparation sessions with nurse and play specialist, final attendance for an intensive day of CIC training. We aim to
present CIC training outcomes following this CP.
MATERIAL AND METHODS
We retrospectively reviewed data regarding all patients referred for CIC training over a two year period (2013-2014).
Outcome measures were success of CIC and complications.
RESULTS
76 patients (35 boys, 41 girls) were referred for CIC training, median age 7 years (3months-17 years). Reasons for CIC
included neuropathic bladder, incomplete emptying in non-neuropathic bladders, dysfunctional voiding and/or recurrent
urinary tract infections. At 1 month follow-up CIC was successfully performed by 67 patients (88%). Among those who
didn’t succeed 2/9 were unable to tolerate the procedure, 2/9 had some anatomical anomaly, 4/9 had learning
disability/neurobehavioural difficulties and in 1 case parent felt unable to perform the procedure. Four out of nine who
didn’t succeed were under 5 years age. No complications were recorded.
CONCLUSIONS
Use of the proposed CIC CP has been demonstrated to be highly successful for children and families. However, age,
neurodevelopmental/behavioural conditions and parental approach to CIC can contribute significantly to the success
despite effective preparation.