Nursing Practice Related to Intermittent Catheterization: A Cross-Sectional Survey.

PURPOSE: The purpose of this study was to describe nursing practice and clinical decision-making related to intermittent catheterization (IC). DESIGN: Cross-sectional survey. SUBJECTS AND SETTING: Three hundred forty-three nurses responded to the survey, yielding a margin of error of 5.3%. The majority (70%; n = 240) indicated they were RNs, and 15.6% stated they practiced as advanced practice nurses (nurse practitioners or clinical nurse specialists). Most (75.9%; n = 260) held at least one certification in rehabilitation, WOC, or urologic nursing. Most nurses (70.5%; n = 242) indicated 11 or more years of experience in their specialty practice. METHODS: Data were collected via an electronic questionnaire that comprised 50 items and required 35 to 40 minutes to complete. Ten items queried demographic data and professional background, 13 queried facility policies and practice patterns related to use of IC, and 27 focused on various aspects of decision making regarding IC practice including 8 items related to catheter selection in 4 case scenarios. The questionnaire was completed online after viewing a written explanation of the purpose of the survey. Completion of the questionnaire acted as consent to study participation. RESULTS: All respondents indicated regularly teaching IC within their practice, and 61.2% (n = 210) stated they were confident that 70% or more of patients or caregivers understood the instructions. However, responses varied considerably when asked who they involved in IC education; less than half (48.1%; n = 165) responded that they included a lay caregiver or family member when teaching a patient to perform IC. Responses also varied when asked about who was included in this education; when asked about catheter selection in 4 clinical scenarios, 9.0% to 20.9% selected inappropriate catheters. Similarly, responses varied when they were asked about use of resources to guide IC practice; 25.4% (n = 87) indicated they relied on their own best practice. CONCLUSIONS: Findings from 343 nurses experienced in IC teaching showed considerable variability when asked about sources used to guide IC practice, who should be included in IC education, and catheter selection in 4 case scenarios. Additional research and evidence, and consensus-based resources such as clinical guidelines of a decision-making algorithm, are needed.

Fatores associados ao conhecimento de pacientes e cuidadores acerca do cateterismo vesical intermitente limpo: revisão integrativa / Factores asociados con el conocimiento de pacientes y cuidadores acerca del cateterismo vesical intermitente limpio: revisión integrativa / Factors associated with the knowledge of patients and caregivers about clean intermittent urethral catheterization: an integrative review

RESUMO Objetivo Identificar na literatura os fatores associados ao conhecimento de pacientes e cuidadores acerca do cateterismo vesical intermitente limpo que dificultam ou facilitam o procedimento. Método Revisão integrativa da literatura nas bases de dados MEDLINE/PubMed, CINAHL, Cochrane, Web of Science, SCOPUS e LILACS. Resultados Após a revisão por pares, 13 estudos primários compuseram a amostra. A síntese do conhecimento foi realizada em duas categorias: Fatores associados ao conhecimento de pacientes e cuidadores sobre o que dificultam o procedimento e Fatores associados ao conhecimento de pacientes e cuidadores acerca do que facilitam o procedimento. Os fatores que dificultam e facilitam o procedimento relacionaram-se, respectivamente, à necessidade de informação e a sentimentos negativos, uso de linguagem de fácil compreensão, aplicação de folhetos informativos, entre outros. Conclusão Há escassez de artigos publicados sobre a temática, e os que foram identificados apresentaram baixo nível de evidência, exigindo, portanto, maior empenho e compromisso por parte de profissionais de saúde e pesquisadores para utilizarem desenhos mais robustos.

RESUMEN Objetivo Identificar en la literatura los factores asociados con el conocimiento de pacientes y cuidadores acerca del cateterismo vesical intermitente limpio que dificultan o facilitan el procedimiento. Método Revisión integrativa de la literatura en las bases de MEDLINE/PubMed, CINAHL, Cochrane, Web of Science, SCOPUS y LILACS. Resultados Después de la revisión por pares, 13 estudios primarios compusieron la muestra. La síntesis del conocimiento fue realizada en dos categorías: Factores asociados con el conocimiento de pacientes y cuidadores acerca de lo que dificulta el procedimiento y Factores asociados con el conocimiento de pacientes y cuidadores acerca de lo que facilita el procedimiento. Los factores que dificultan y facilitan el procedimiento se relacionaron, respectivamente, con la necesidad de información y con sentimientos negativos, uso de lenguaje de fácil comprensión, aplicación de folletos informativos, entre otros. Conclusión Existe escasez de artículos publicados acerca de la temática, y los que fueron identificados presentaron bajo nivel de evidencia, por lo que se requiere mayor empeño y compromiso de la parte de los profesionales sanitarios e investigadores en la utilización de diseños más robustos.

ABSTRACT Objective To identify the factors associated with the knowledge of patients and caregivers about Clean Intermittent Urethral Catheterization in the literature which hinder or facilitate the procedure. Method An integrative review of the literature conducted in the MEDLINE/PubMed, CINAHL, Cochrane, Web of Science, SCOPUS and LILACS databases. Results 13 primary studies were included in the sample after the peer review. A synthesis of knowledge was performed in two categories: Factors associated with the knowledge of patients and caregivers which hinder the procedure and Factors associated with the knowledge of patients and caregivers which facilitate the procedure. Factors that hinder and facilitate the procedure respectively related to the need of information and negative feelings, use of easy-to-understand language, and application of information leaflets, among others. Conclusion There is a shortage of published articles on the subject, and those which were identified had a low level of evidence, therefore requiring greater commitment and effort on the part of health professionals and researchers to use more robust designs.

Intermittent Urinary Catheterization: The Impact of Training on a Low-Fidelity Simulator on the Self-Confidence of Patients and Caregivers.

PURPOSE: The purpose of this study was to identify how training on a low-fidelity simulator impacts the confidence of caregivers and patients with neurogenic bladder who use clean intermittent urinary catheterization. DESIGN: Quasi-experimental study. METHODS: Developed in a rehabilitation center in Brazil including patients who use clean intermittent urinary catheterization and caregivers from September to November 2013. After Ethics approval (Opinion 146/2012) during the nursing consultation, data were collected before and after training on a low-fidelity simulator. FINDINGS: A total of 36 respondents (72.0%) patients and 14 (28.0%) caregivers participated. The self-confidence acquired after training on low-fidelity simulators was significant. CONCLUSIONS: In this study sample, low-fidelity simulation was demonstrated to be an effective strategy for the development of self-confidence. CLINICAL RELEVANCE: Low-fidelity simulation training enables patients and caregivers to increase their self-confidence when performing clean intermittent urinary catheterization and should be used as a training strategy by healthcare professionals.

Telenursing manual for providing care to patients using clean intermittent urinary catheterization / Manual de teleenfermería para la atención al usuario de cateterismo urinario intermitente limpio / Manual de telenfermagem para atendimento ao usuário de cateterismo urinário intermitente limpo

Objective: To develop and evaluate apparent and content validity of a telenursing manual to support nurses in the care delivery of patients using clean intermittent urinary catheterization. Methods: Methodological study addressing the development and validation of a telenursing manual. The expert group who validated the telenursing manual was composed of 11 nurses. An inter-rater level of agreement of 70% was considered for each aspect of the instrument. Results: The following levels of agreement were obtained for each aspect: Language 97%, Content 97.7% and Objectives, Relevance, Functionality and Usability 100% each. Conclusion: The manual is available for access and represents an important initiative for the field of telenursing in Brazil, assisting nurses in the telecare provided to patients using clean intermittent urinary catheterization.

Objetivo: Elaborar y validar la apariencia y el contenido de un manual de teleenfermería para apoyar al enfermero en la atención al cliente que usa catéter urinario intermitente limpio. Método: Estudio metodológico sobre la construcción y validación de manual de teleenfermería. La apariencia y el contenido del manual fueron validados por 11 enfermeros peritos, considerando para validación un nivel de concordancia del 70% entre los peritos para cada aspecto del instrumento utilizado. Resultados: El manual de teleenfermería fue validado en apariencia y contenido considerando el nivel de concordancia entre los peritos para cada uno de estos aspecto: Lenguaje 97%; Contenido 97,7%; y, Objetivos, Relevancia, Funcionalidad y Usabilidad 100% cada uno. Conclusiones: El manual está disponible para ser accedido y representa una iniciativa importante para el campo de la teleenfermería en Brasil, ayudando al enfermero en la práctica de la teleatención al usuario de cateterismo urinario intermitente limpio.

Objetivo: Elaborar e validar em aparência e conteúdo um manual de telenfermagem para subsidiar o enfermeiro no atendimento ao cliente com bexiga neurogênica, usuário de cateterismo urinário intermitente limpo. Método: Estudo metodológico sobre a construção e validação de manual de telenfermagem. O manual foi validado em aparência e conteúdo por 11 enfermeiros peritos; para tanto, considerou-se válido cada aspecto do instrumento que atingiu o nível mínimo de concordância de 70% entre os peritos. Resultados: O manual obteve, para cada aspecto avaliado, os seguintes níveis de concordância - Linguagem: 97%; Conteúdo: 97,7%; e Objetivos, Funcionalidade, Usabilidade e Relevância: 100% cada. Conclusão: O manual encontra-se disponível para acesso e representa uma iniciativa importante para o campo da telenfermagem no Brasil, auxiliando o enfermeiro na realização do teleatendimento e atendimento ao usuário de cateterismo urinário intermitente limpo.

Qualidade e segurança do cuidado de enfermagem ao paciente usuário de cateterismo urinário intermitente / Quality and safety of nursing care for patients using intermittent urinary catheterization

Objetivo: Descrever os riscos e a vulnerabilidade dos pacientes e as intervenções oriundas do trabalho do enfermeiro junto ao paciente com bexiga neurogênica usuário do cateterismo urinário intermitente. Métodos: Estudo realizado no Centro de Reabilitação de um hospital universitário do interior do estado de São Paulo em duas fases. Fase 1:estudo descritivo com pacientes usuários de cateterismo urinário intermitente, entre novembro de 2011 a fevereiro de 2013. Fase 2, estudo de caso, com implementações de intervenções de enfermagem com estes pacientes. Resultados: A fase 1 consistiu na coleta de dados de 168 pacientes. Na fase 2, foram inseridas no serviço as seguintes práticas: capacitação de equipe, grupos educativos com pacientes, distribuição de diários miccionais, auxílio na obtenção de materiais, treino simulado e telenfermagem. Conclusão: As intervenções implementadas são atividades promissoras para alcançar um impacto positivo no tratamento desses pacientes, oferecendo qualidade e segurança aos cuidados de enfermagem.

Tradução dos sentimentos de familiares no cuidar da criança dependente do cateterismo intermitente limpo / Translation of family members' feelings in caring for children dependent on clean intermittent catheterization / Traducción dos sentimientos de los miembros de la familia en el cuidado de los niños a cargo de la cateterización intermitente limpia

Objetivo: compreender os sentimentos vivenciados pelos familiares ao cuidar da criança com bexiga neurogênica dependente do cateterismo. Método: pesquisa qualitativa desenvolvida em um ambulatório de pediatria de um hospital universitário, com 12 familiares. Para análise dos resultados utilizou-se a análise de conteúdo na modalidade temática. Resultados: emergiram três categorias analíticas: os medos no processo de cuidar da criança dependente do cateterismo; a negação da nova realidade; e a preocupação com a saúde futura da criança. Assim, a pesquisa aponta o quão complexo é o processo de cuidar dos familiares, pois não engloba apenas os aspectos técnicos, mas todo o envolvimento emocional dos mesmos diante da nova realidade de cuidar. Conclusão: é indispensável reconhecer e compreender os sentimentos dos familiares no processo de cuidar das crianças com bexiga neurogênica, aceitando suas fragilidades e dificuldades.

Objective: to understand the feelings experienced by family members caring for children with neurogenic bladder dependent on catheterization. Method: qualitative study of 12 family members at a university hospital pediatric clinic. Thematic content analysis was used. Results: three analytical categories emerged: fears in caring for children dependent on catheterization; denial of the new situation; and concern for the children's future health. The research thus shows how complex the process of caring for the family is, because it comprises not only technical aspects, but all their emotional involvement in the new care situation. conclusion: it is essential to recognize and understand the fears and difficulties of families caring for children with neurogenic bladder, and to accept their weaknesses and difficulties.

Objetivo: comprender los sentimientos experimentados por los miembros de la familia para cuidar del niño con vejiga neurogénica cateterismo dependientes. Método: investigación cualitativa realizada en una clínica pediátrica de un hospital universitario, con 12 miembros de la familia. Se utilizó el análisis de contenido en la modalidad temática. Resultados: surgieron tres categorías analíticas: temores en el cuidado de cateterismo hijo a cargo; la negación de la nueva realidad; y la preocupación por la salud futura del niño. Así, la investigación muestra lo complejo que es el proceso de cuidar a la familia, ya que no cubre sólo los aspectos técnicos, pero todos la implicación emocional de la misma en la nueva realidad de cuidar. Conclusión: es esencial reconocer y comprender los miedos y las dificultades de la familia en el cuidado de los niños con vejiga neurogénica, aceptar sus debilidades y dificultades.

Intermittent urethral catheterisation: the reality of the lubricants and catheters in the clinical practice of a Brazilian service.

AIMS AND OBJECTIVES: To identify how catheters and lubricants have been used among patients using intermittent urinary catheterisation in rehabilitation. BACKGROUND: The clean intermittent urinary catheterisation technique is an invasive procedure can cause discomfort, pain and urethral traumas. The use of lubricants and lubricated urinary catheters reduces the friction between the catheter and the urethral mucosa, minimising the risks. DESIGN: A descriptive exploratory design was used. METHODS: Quantitative and descriptive study developed at a rehabilitation centre of a University Hospital in the interior of the state of São Paulo, Brazil, at the Intermittent Urinary Catheterisation Outpatient Clinic, between June 2012-December 2014. After ethical approval, the data were collected through an interview with the support of a semistructured questionnaire, held during the nursing consultation. Among the users, patients using intermittent urinary catheterisation were interviewed, over 18 years of age and minors younger than eight years accompanied. Descriptive statistical analysis was applied. RESULTS: Most of 214 (100·0%) patients were interviewed were male, single, young adults and with a primary medical diagnosis of bone marrow injury and myelomeningocele. Most patients perform the urinary catheterisation between four and six times per day. For the procedure, the majority uses polyethylene (polyvinyl chloride) catheter and, as a lubricant, 2·0% lidocaine hydrochloride on the catheter itself. Many mention lack of sensitivity when passing the catheter. CONCLUSION: In the study sample, a risk of urethral traumas was evidenced, related to the inappropriate use of catheters and lubricants. For the patients' safety, the professionals need to acknowledge the importance of the appropriate use of lubricants and lubricated catheters to implement evidence-based practices that mobilise public policies. RELEVANCE TO CLINICAL PRACTICE: The use of evidences demonstrates that the appropriate use of lubricants for intermittent urinary catheterisation is fundamental for patient safety and the performance of the best practices.

Cateterismo intermitente limpo em crianças com bexiga urinária neurogênica: o cuidado do familiar no domicílio / Clean intermittent catheterization in children with neurogenic urinary bladder: home care by relatives / Cateterismo intermitente limpio en niños con vejiga urinaria neurogénica: el cuidado de la familia en casa

A pesquisa buscou conhecer os cuidados realizados pelo familiar à criança portadora de bexiga neurogênica que necessita de cateterismo vesical intermitente limpo, no domicilio. Trata-se de um estudo qualitativo, realizado em ambulatório de pediatria de um hospital universitário, localizado na cidade do Rio de Janeiro. A coleta dos dados deu-se com 12 familiares através de entrevistas semiestruturadas, no período de janeiro a julho de 2014. Para o tratamento dos dados foi utilizada a análise de conteúdo de Bardin, dando origem a três categorias analíticas: Organizando o ambiente e a criança para o cateterismo; Preparo das mãos para a realização do cateterismo; A realização da técnica pelo familiar. Conclui-se que o cateterismo é realizado conforme a técnica descrita em literatura, mas existem determinados familiares que realizam inadequadamente certos passos da técnica. Sugere-se a realização de protocolos de orientação aos familiares para uniformização de condutas e grupos de apoio aos mesmos.

This qualitative study to examine care provided by family members to children with neurogenic bladder needing clean intermittent catheterization at home was conducted at a pediatric outpatient department of a university hospital in Rio de Janeiro City. Data was collected by semi-structured interviews of 12 family members, between January and July 2014. Data were examined using Bardin content analysis, resulting in three categories: organizing the environment and the child for the catheterization; preparing hands to perform the catheterization; and the technique performed by the family member. It was concluded that catheterization is performed according to the technique described in the literature, but certain family members perform some steps of the technique inappropriately. We suggest producing guidance protocols for family members to standardize conduct, and holding support groups for them.

La investigación tuvo como objetivo conocer la atención realizada por la familia al niño portador de vejiga neurogénica que necesita cateterismo vesical intermitente limpio en su residencia. Se trata de un estudio cualitativo, realizado en una clínica pediátrica ambulatoria de un hospital universitario ubicado en la ciudad de Río de Janeiro. La recolección de datos se llevó a cabo con 12 familias a través de entrevistas semiestructuradas, en el período de enero a julio de 2014. Para estudio de datos se utilizó el análisis de contenido de Bardin, dando lugar a tres categorías de análisis: La organización del ambiente y del niño al cateterismo; Preparación de las manos para la realización del cateterismo; La realización de la técnica por la familia. Se concluye que el cateterismo se realiza según la técnica descrita en la literatura, pero hay algunos miembros de la familia que realizan inadecuadamente algunos pasos de la técnica. Se sugiere la realización de protocolos de orientación a los familiares con vistas a uniformizar las conductas y grupos de apoyo a los mismos.

Práticas de cuidado e desafios do autocateterismo intermitente limpo: as vozes dos escolares / Healthcare practices and challenges of the clean intermittent catheterization: the voices of the children

As crianças portadoras de disfunções miccionais, sendo de ordem neurológica (bexiga neurogênica) ou funcionais, necessitam de cuidados especiais para evitar a deterioração do sistema urinário inferior e insuficiência renal. Na maioria dos casos de bexiga neurogênica, indica-se, o cateterismo intermitente limpo. Também indicado para as disfunções não neurogênicas quando não se consegue bons resultados com outros tratamentos. São crianças com necessidades especiais de saúde (CRIANES), com mudanças na sua vida cotidiana e necessidade de cuidados especiais. O enfermeiro necessita interagir com as mesmas, de forma que, na fase escolar, possam juntos, planejar e administrar o autocuidado, necessários para facilitar o processo de viver saudável. Objeto de estudo: o autocateterismo intermitente limpo realizado pelo escolar portador de disfunção miccional. Objetivos: descrever as práticas de cuidados concernentes ao autocateterismo intermitente limpo realizado pelo escolar portador de disfunção miccional e analisar os desafios para a realização dessa prática de cuidado por esse escolar nos diversos espaços de socialização. Metodologia: estudo de natureza qualitativa, desenvolvido sob o método criativo sensível, através das dinâmicas de criatividade e sensibilidade Corpo Saber e Mapa Falante. Os participantes da pesquisa foram sete crianças portadoras de disfunção miccional, com idade entre 9-11 anos. O cenário de estudo foi um ambulatório de pediatria, situado em um hospital de ensino e pesquisa no estado do Rio de Janeiro. Os dados foram coletados no período entre fevereiro e março de 2015, e foram analisados a partir da análise de discurso em sua corrente francesa, sendo interpretados à luz do autocuidado de acordo com o conceito de Orem, a Teoria do Desenvolvimento Psicossocial de Erik Erikson e da educação em saúde com as concepções freirianas para a educação. Resultados:através da análise da prática de cuidados desses escolares, evidenciamos a preocupação com a higienização das mãos, da região íntima e do óstio de Mitrofanoff e, cuidados com o esvaziamento completo da bexiga. Quanto aos desafios, foram evidenciados a necessidade do uso de dispositivos para a visualização do meato urinário, dificuldades para a visualização do meato uretral feminino no período matutino, no posicionamento para a realização do autocateterismo, a presença de desconfortos com a sondagem uretral, a irregularidade na frequência do autocateterismo, as dificuldades para brincar em função da realização do autocateterismo, a (in) dependência no autocateterismo e o (des)velamento do autocateterismo nos diversos espaços de socialização. Conclusão: Revelou-se uma consciência ingênua na prática de cuidados, assim como fatores ambientais interferindo no autocuidado e riscos de infecção do trato urinário. Os diversos desafios enfrentados pelos escolares, na realização do autocateterismo, apontam para a necessidade de aproximação com estes de forma dinâmica e criativa, facilitando a exposição de suas dúvidas, medos e anseios, e para a promoção da conscientização crítica e a socialização dos saberes, capacitando-os para o autocuidado. Também na divulgação junto aos órgãos competentes, para a adequação social, com vistas à inclusão destas CRIANES nos diversos espaços de socialização.

Children suffering from voiding dysfunction, which stems from a neurological (neurogenic bladder) or a functional disorder, need special care to prevent deterioration of the lower urinary tract and kidney failure. In most cases of neurogenic bladder it is indicated clean intermittent catheterization. Also suitable for non-neurogenic dysfunction when you don`t get good results with other treatments. These are children with special health care needs(CSHCN), with changes in their daily lives. The nurse needs to interact with them, so that, at school age, they can together plan and manage the self-care necessary to facilitate the process of healthy living. Subject: clean intermittent catheterization performed by the children that suffers from voiding dysfunction. Objectives: To describe the practices from care concerning the clean intermittent catheterization performed by the children that suffers from voiding dysfunction and analyze the challenges for the realization of this practice by that children in the various spaces of socialization. Methodology: qualitative study developed under the sensitive creative method, through the dynamics of creativity and sensitivity "Corpo Saber e Mapa Falante". The survey participants were seven children with voiding dysfunction, aged 9-11 years.The study setting was an outpatient pediatric clinic located in a teaching hospital in the state of Rio de Janeiro. Data were collected between February and March 2015 and were analyzed from the speech analysis in its French stream being interpreted in the lightof the self-care according to the Orem concept, the Psychosocial Development Theory of Erik Erikson and of health education with Freirian concepts for education. Results: by analyzing the practice of these children we noted the concern on hands, genitals and the Mitrofanoff ostium hygienization, and, the complete evacuation of the bladder.Regarding the challenges, were highlighted the necessity of devices for visualizing the urinary meatus, difficulties in the visualization of the feminine urethral meatus in the morning, the position to perform the catheterization, the discomfort with the urethral probe, the irregularity in the frequency of catheterization, the difficulties to play due the realization of catheterization, the (in)dependence on autocatheterism and the (un)veiling of autocatheterism in various spaces of socialization. Conclusion: It was revealed an ingenuous consciousness in the practice of cares, as well as environmental factors interfering in the self-care and risk of urinary tract infection.The various challenges faced by the children in performing the catheterization point to the necessity of closer ties in a dynamic and creative way, facilitating the exposure of their doubts, fears and desires, to promote critical awareness and the socialization of knowledge, enabling them for self-care. Also, in the disclosure with the competent organs, to social adaptation, aiming to incorporate such CSHCN in various spaces of socialization.

Community nursing and intermittent self-catheterisation.

Clean intermittent self-catheterisation (CISC) is a treatment option for people with urinary incontinence-particularly those with neurogenic bladder dysfunction. When used for appropriate patients it has been shown to promote continence, maintain safe bladder function and improve quality of life. There is a range of different products available on prescription for patients, and community nurses are ideally placed to advise them regarding products and to offer choice to those performing CISC. CISC can promote privacy and dignity for patients with urinary incontinence due to impaired bladder emptying, and community nurses should offer this intervention to patients for whom it is suitable and support them in learning the technique.

Review of intermittent catheterization and current best practices.

Intermittent catheterization is the insertion and removal of a catheter several times a day to empty the bladder. This type of catheterization Is used to drain urine from a bladder that is not emptying adequately or from a surgically created channel that connects the bladder with the abdominal surface (such as Mitrofanoff continent urinary diversion). Intermittent catheterization is widely advocated as an effective bladder management strategy for patients with incomplete bladder emptying due to idiopathic or neurogenic bladder dysfunction. Urologic nurses are at the forefront of educating and teaching patients how to self-catheterize. Catheterizations performed in institutions, such as acute and rehabilitation hospitals and nursing homes, are done aseptically. Historically, however, intermittent catheterization has been performed by the patient in the home environment using a clean technique involving the re-use of catheters. New guidelines released in the past three years have recommended changes to the practice of re-using catheters. Currently, nurses use their clinical judgment to determine which technique and type of catheter to use, in conjunction with patient preference. Differential costs and insurance coverage of catheters/echniques may also influence decision making. The authors provide an overview of the indications, use, and complications associated with intermittent catheterization, present current guidelines on self-catheterization and treatment of catheter-associated complications, detail types of catheters, and review clinical practice of intermittent catheterization.

Enabling school staff to undertake clean intermittent catheterisation.

Successful clean intermittent catheterisation depends on the ability of the child, parents and carers to undertake the procedure and effectively integrate it into both home and school life. Paediatric continence nurses need to support this process by addressing the concerns and anxieties of school staff. Inconsistencies in practice and the absence of local policy can exacerbate concerns and anxiety. This article highlights the main issues surrounding use of CIC in schools and discusses them in the light of current legislation and guidance.