Clean Intermittent Catheterization for Bladder Management in SCI Patients

Introduction to CIC

The American Urological Association and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction provide a strong recommendation that clinicians should recommend intermittent catheterization rather than indwelling catheters to facilitate bladder emptying in patients with neurogenic lower urinary tract dysfunction (NLUTD) 1, 2.

Clean intermittent catheterization (CIC) has the lowest percentage of patients experiencing urinary tract infections (UTIs) during follow-up periods compared to indwelling urethral catheters and suprapubic catheters 1, 2.
Intermittent catheterization is associated with a reduced incidence of urological complications compared with indwelling catheterization methods 3, 4, 5.
The best quality of life is associated with the ability to self-catheterize with CIC, while poorer quality of life is consistently associated with indwelling catheters 1, 2.
Indwelling catheters are associated with higher rates of bladder stones compared to CIC 1, 2.

The European Association of Urology recommends clean intermittent catheterization every 4-6 hours to keep urine volume below 500 mL per collection 3, 4, 5.
Single-use catheters should be used only once, as reusing catheters significantly increases UTI frequency 3, 4, 5, 6.
Clean hand hygiene with antibacterial soap or alcohol-based cleaners should be performed before and after catheterization, with clean perineal preparation 3, 4, 5, 7, 6.
Hydrophilic catheters are preferred as they are associated with fewer UTIs and less hematuria 3, 4, 6, 8.

If a patient cannot perform or receive CIC due to physical limitations, cognitive impairment, or lack of caregiver support, and an indwelling catheter is unavoidable, then suprapubic catheterization should be recommended over an indwelling urethral catheter 1, 2.
Delaying transition from indwelling to CIC should be avoided, and indwelling catheters should be removed as early as possible once the patient is medically stable 6.
Asymptomatic bacteriuria in catheterized patients should not be treated, as this leads to antimicrobial resistance without clinical benefit 6.
Inadequate catheterization frequency, such as less frequent intervals, results in bladder overdistension and increased complications 3, 4, 5, 7.

The British Medical Journal recommends using gel reservoir (prelubricated) catheters as an acceptable alternative to hydrophilic-coated catheters if they are unavailable 9, 10