2026-04-22
Intermittent catheterization is divided into sterile intermittent catheterization and clean intermittent catheterization (CIC). In 1971, Lapides applied CIC to the treatment of bladder voiding dysfunction in patients with spinal cord injury (SCI), achieving good clinical results.
CIC refers to the method of inserting the urinary catheter through the urethra into the bladder at regular intervals under clean conditions, allowing the bladder to empty urine regularly. Many studies have shown that for patients with neurogenic urinary dysfunction, long-term application of CIC can eliminate the inconvenience of indwelling catheterization and significantly reduce the incidence of urinary tract infections (UTI) and other complications, enabling patients to live longer and improve their quality of life. Therefore, CIC has become the currently recognized scientific urinary management method for SCI patients.
This article mainly discusses the urinary tract infections caused by CIC and the effective measures for prevention and control, as follows.
1. Diagnostic criteria for UTI
1.1 Fever
1.2 Urine routine examination: white blood cells > 10 per high-power field
1.3 Bacterial culture shows pathogenic bacteria and bacterial count > 10 CFU/mL
The diagnostic criteria for bacteriuria are as follows: take 0.1 mL of midstream urine, inoculate it onto a 9-cm diameter plate, incubate at 37 degrees Celsius in a warm box for 24 hours to count bacteria. If the bacterial count is > 30,000 CFU/mL, it is considered bacteriuria.
Asymptomatic bacteriuria refers to a positive urine culture or urine routine test, but the patient has no elevated white blood cell count or fever and other signs of infection.
2. Analysis of CIC-related infection factors
2.1 Pathological research
Under normal circumstances, the urinary system is an aseptic environment. Due to the insertion or retention of urinary catheters, external pathogenic bacteria may be introduced; at the same time, due to the disruption of local mechanical defense functions, the resistance of the urethral mucosa to pathogenic bacteria is weakened, causing pathogenic bacteria to easily retrograde to the urinary system and cause infection. According to relevant data, the composition ratio of the pathogenic bacteria causing infection, from high to low, is Gram-negative bacilli, Gram-positive cocci, and fungi. Among them, Escherichia coli, Candida albicans, and Staphylococcus epidermidis are the main pathogenic bacteria causing urinary tract infections. The phenomenon of multiple bacterial infections in a single patient is also very common. Therefore, in the implementation of CIC nursing, in addition to continuously monitoring the occurrence of bacteriuria, the antibacterial drugs should also be selected or replaced according to the laboratory drug sensitivity test results to avoid frequent changes in the bacterial flora.
2.2 CIC Urinary Catheter Materials and Models
2.2.1 CIC Urinary Catheter Materials
In clinical practice, various implanted medical devices in the body, such as urinary catheters, deep vein catheters, and tracheal intubations, tend to form bacterial biofilms (biofilm, BM) on their surfaces, leading to catheter-related infections. The formation of biofilms on the surface of urinary catheters is the main cause of catheter-related infections. Currently, there are various materials available for urinary catheters, including rubber, latex, plastic, or silicone. Studies have shown that urinary tract infections occur in 22% of patients using rubber urinary catheters, while the rate is only 2% for silicone urinary catheters. Li Pengxiang et al. have demonstrated that silicone urinary catheters have good tissue compatibility, a hard tip, facilitating smooth insertion, a soft wall with minimal irritation to the mucosa, and very low toxicity. Silicone-treated latex urinary catheters and plastic urinary catheters have moderate toxicity; rubber, especially white rubber urinary catheters, have relatively high toxicity.
2.2.2 CIC Urinary Catheter Models
If the urinary catheter is too thick, it can increase irritation to the urethra or bladder, causing discomfort and bladder spasms; if it is too thin, it can easily get clogged, resulting in poor drainage and urethral obstruction. These are potential factors contributing to the occurrence of UTI. Therefore, we should choose an appropriate urinary catheter model based on the specific situation.
2.3 CIC Operation Process
As an invasive procedure, CIC actually provides a pathway for bacteria to enter the body. Therefore, during catheterization, it is essential to keep the area clean and eliminate any potential routes that may allow bacterial invasion. This is undoubtedly one of the key steps in preventing the occurrence of urinary tract infections. On the other hand, when performing the CIC operation, one must be gentle with the movements, as the mechanical stimulation of the catheter may damage the urethral mucosa and easily lead to lower urinary tract infections.
2.4 Measurement of Residual Urine Volume
Excessive residual urine volume, causing the bladder to remain in a state of prolonged non-emptying, is a risk factor for urinary tract infections in patients with SCI. The adjustment and control of intermittent catheterization time should be based on the residual urine volume situation to prevent infection caused by long-term retention of urine in the bladder.
2.5 Immune System of the Body
The infection caused by CIC is also closely related to the patient's own immunity. Some patients are elderly and weak, have low immune function, or have other underlying diseases such as chronic respiratory diseases and diabetes. During the implementation of CIC, these patients are prone to develop bacteriuria.
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