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CIC AND BLADDER MANAGEMENT

CCHU, 2009

Department of Nursing

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OBJECTIVES

Describe briefly how the urinary system works.

Identify the different types of bladder in MM

patients. Criteria for CIC.

Management of neurogenic bladders

Procedure for carrying out CIC.

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AVERAGE 24 HOURLY URINE OUTPUT

IN INFANTS & CHILDREN.

AGE OUTPUT IN CC

Birth to 48hrs 15-60

3 to 10 days 100 to 300 10 days to 2 months 250 to 450

2 months to 1 year 400 to 500

1 to 3 years 500 to 600

3 to 5yrs 600 to 700

5 to 8yrs 650 to 1000

8 to 14 yrs 800 to 1400

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NORMALE BLADDER CAPACITY

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NEUROGENIC BLADDER

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CATEGORIES OF DYSFUNCTIONALCATEGORIES OF DYSFUNCTIONAL

BLADDERBLADDER

Detrusor muscle Urethral Sphincter

Inactive Overactive safe with CIC

Inactive Inactive safe & dry with CIC + sling + oxybutynin.

Overactive Overactive safe & dry with oxybutynin + bCIC

Overactive Inactive safe & dry with oxybutynin, CIC + sling

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NEUROGENIC BLADDER

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OXYBUTYNIN

Dosage is 0.2mg/kg/dose and should be

administered everyday

Reason for admin- Makes bladder grow andbecome calm.

When to start oxybut;

1.A

bnormal Renal Ultrasound Scan2. Repeated infections

3. Not gaining continence inspite of gd CIC

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BLADDER EVALUATION

Should be done 1 week or 2-3 days before

discharge and not 2-3 days after surgery as this

may cause spinal shock.

MM should be kept in prone position 3-4 days

post-op.

Its better to start CIC as soon as possible, so

that the child can get used to it.

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BLADDER EVALUATION CONTINUED

Criteria used to initiate a child on CIC.

LPP Above 30cm

Res. Urine (PVR); Above 10cc in infants

Above 10/100 of 30 x(age in yrs+2)

Done 3hrly in such patients

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CONTINUED.

LPP Below 30cm

Residual urine

Above 10cc in infants:

Above 10/100 of 30( age in years +2)

CIC done 4 times.

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CONTINUED

LPP above 30 cm.

Residual urine

Below 10cc in infantsBelow 10/100 of 30 (age in years + 2)

For pt over 1 year

CIC done 3 hourly

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TEACHING MOTHERS /CARETAKERS ON

CIC

Always wash hands with soap and water beforecatheterising.

Use a clean piece of cloth to clean the genital area,

wash & dry after procedure. Use the appropriate size of catheter depending on

childs age. (explain to care taker the rationale)

Always use the given transparent container to collect

& observe the urine: color, amount & odour.

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In case of any abnormal observation, report to healthworker.

Always wash used catheter with soap & water andshake to dry then keep in clean dry piece of cloth.dont place used catheter in the container to preventinfection

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Use one catheter for a month.

ALWAYS & ALWAYS CATHETERISE for the givennumber of times per day as directed!

Rationale for catheterization:Rationale for catheterization:

Prevent infection to bladder & kidneys

To become continent

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CIC is for life.

Allow mother to perform a returndemonstration and feedback by asking

questions to evaluate understanding i.e

Why is CIC done?

What is the use of transparent container?

How many times are you going to catheteriseyour child per day? e.t.c