Ensuring patient adherence to clean intermittent self-catheterization

Figures & data

Table 1 Barriers to clean intermittent catheterization and proposed suggestions to improve adherence

Barriers	Suggestions for improving adherence
Internal factors (patient related)
Physical disabilities	• Face to face instructions with a nurse with experience in teaching CISC
• Positioning	• Choosing the appropriate catheter
• Dexterity	• Use of catheter appliances to help locate the urethra
• Visual impairment	○ Thigh abductors
• Anatomical	○ Mirrors
• Cognition	○ Labia spreaders
Psychological factors	• Seek advice from a urologist regarding surgical management for anatomical obstructions
• Misconceptions and anxiety
• Embarrassment and poor confidence	• Use of visual aids, leaflets, videos
• Stigma
• Fears
External factors
• Access to public toilets	• Providing adequate time for teaching
• Inadequate facilities in public toilets	• Ensuring regular follow-up when required
• Availability of appropriate catheters and assistance appliances	• Engaging with carer/partner when appropriate
• Quality of teaching and the training environment	• Standardized training of continence nurses
• Community follow-up access to help or advice	• Adequate budgetary provision for catheters and appliances
• Availability of experienced nurse specialists	• Efficient catheter delivery system in the community
	• Optimizing communication between primary and secondary/tertiary care
	• Engaging with district nurses for optimizing support in the community
	• Role for industry in improving community support
	• Access to locked disabled toilets (eg, National Key Scheme)
	• Smartphone app to help locate toilet facilities

Abbreviation: CISC, clean intermittent self-catheterization.

Figure 1 A range of single use catheters, and a catheter holder for patients having difficulties with fine finger coordination.

Figure 2 Appliances available to help facilitate clean intermittent self-catheterization.

Note: Shown are thigh abductors, mirrors, and labial spreaders.