Direct actions of professionals involved in primary care services and secondary to health, with regard to identifying, evaluating, training and monitoring patients with chronic urinary retention or incomplete bladder emptying, in questions regarding Clean Intermittent Catheterization.

This is an experience report on the construction of the care flow for patients in need of CIC by the Brazilian unified health system, since there is a gap in this care. In the Brazilian scenario, there has been an advance in the care of this profile of patients after the publication of nº37, of July 24, 2019 of the "Secretária de Ciência, Tecnologia e Insumos Estratégicos"(1), but so far there is no established standard flow that helps the health professional in this service.
The construction of the flow was based on the lack of knowledge of the primary care nurse, evidenced by the doctoral thesis that developed a training program with a view to the role of the Primary Health Care nurse in the prevention and treatment of Lower Urinary Tract Dysfunction (2). This flow is part of an CIC manual for nurses built by a Danish company that works with products for stomas, incontinence, urology and wound skin and care.

The sample consisted of 145 nurses working in primary care and who participated in the sample, most had already treated people with incontinence or maintained retention, but only 19.7% had carried out some type of CIC guidance. 
The flow begins with the identification of the patient with voiding symptoms, and the post-voiding residue test is performed. If there is already a high post-voiding residue, it is necessary to validate whether the patient has guidance and is motivated to perform the CIC, if an awareness consultation is not necessary. If the patient is motivated, support is needed for choosing the catheter and guiding the procedure. After orientation, the patient should feel safe in relation to the CIC, if not, the nurse should demonstrate the procedure. If the patient is confident to start the procedure, it is essential to guide and supervise the steps, followed by the definition of the CIC frequency with the support of completing the bladder diary, being essential to provide the patient with material for the CIC for a week. In the return consultation, the CIC frequency must be adjusted, if it is not necessary to discuss again. If you agree, the next step is to review the guidelines checklist and request the material to the system, reinforcing how to acquire the materials and follow up with the service.
After all these steps, the patient must be released with permanent support in the service.

The health team must be prepared to identify cases of chronic urinary retention or incomplete bladder emptying, with a view to acting in the control of risk factors and establishing effective emptying, acting in the prevention of related complications. Since the CIC is the gold standard in preventing complications related to incomplete bladder emptying, the health system must provide a team prepared to train the patient for the CIC, with strategies for long-term adherence, in addition to having a dispensing scheme that guarantees the availability of the ideal catheter for each case, without interruption in delivery and directed to individual needs.

This flow aims to support the care provided by primary health care nurses, so that when identifying the patient with emptying symptoms, they know the fundamental steps to structure their care and seek a better quality of life for the patient.

BRASIL. Portaria n.º37, de 24 de julho de 2019. Torna pública a decisão de incorporar o cateter hidrofílico para cateterismo vesical intermitente em indivíduos com  lesão medular e bexiga neurogênica, conforme estabelecido pelo Ministério da Saúde, no âmbito do Sistema Único  de Saúde - SUS. Diário Oficial da República Federativa do Brasil.
ASSIS, Gisela Maria. O uso do Design Thinking na proposição de soluções para o cenário brasileiro de Disfunção do Trato Urinário Inferior. 2021. 178 f., il. Tese (Doutorado em Enfermagem)—Universidade de Brasília, Brasília, 2021.
KAVANAGH, A. et al. Canadian Urological Association guideline: Diagnosis, management,  and surveillance of neurogenic lower urinary tract dysfunction – Full text. Canadian  Urological Association Journal, v. 13, n. 6, p. E157–E176, 2019. DOI:  https://doi.org/10.5489/cuaj.5912