Bladder Managment for Adults with Spinal Cord Injury - 1
CLINICAL PRACTICE GUIDELINE
1
Summary of Recommendations
Intermittent Catheterization
1. Consider intermittent catheterization for individuals who have sufficient hand skills or a willing caregiver to perform the catheterization. 2. Consider avoiding intermittent catheterization in individuals with SCI who have one or more of the following: Inability to catheterize themselves. A caregiver who is unwilling to perform catheterization. Abnormal urethral anatomy such as stricture, false passages, and bladder neck obstruction. Bladder capacity less than 200 ml. Poor cognition, little motivation, or inability or unwillingness to adhere to the catheterization time schedule. High fluid intake regimen. Adverse reaction to passing a catheter into the genital area multiple times a day. Tendency to develop autonomic dysreflexia with bladder filling despite treatment. 3. Advise individuals with SCI of the potential for complications with intermittent catheterization, such as: Urinary tract infections. Bladder overdistention. Urinary incontinence. Urethral trauma with hematuria. Urethral false passages. Urethral stricture. Autonomic dysreflexia (in those with injuries at T6 and above). Bladder stones. 4. If bladder volumes consistently exceed 500 ml, adjust fluid intake, increase frequency of intermittent catheterization, or consider an alternative bladder management method. Incomplete bladder emptying. High intravesical pressure. Developing and/or worsening vesicoureteral reflux. Developing and/or worsening hydronephrosis. Abdominal bruising. Possible hernia, pelvic organ prolapse, or hemorrhoids. 5. Institute clean intermittent catheterization teaching and training for individuals prior to discharge from the acute phase of rehabilitation. 6. Consider sterile catheterization for individuals with recurrent symptomatic infections occurring with clean intermittent catheterization. 7. Investigate and provide treatment for individuals on intermittent catheterization who leak urine between catheterizations. 8. Monitor individuals using this method of bladder management.
Credé and Valsalva
1. Consider the use of Credé and Valsalva for individuals who have lower motor neuron injuries with low outlet resistance or who have had a sphincterotomy. 2. Consider avoiding Credé and Valsalva as primary methods of bladder emptying. 3. Consider avoiding Credé and Valsalva methods in individuals with: Detrusor sphincter dyssynergia. Bladder outlet obstruction. Vesicoureteral reflux. Hydronephrosis. 4. Advise individuals with SCI of the potential for complications with Credé and Valsalva, such as:
Bladder Managment for Adults with Spinal Cord Injury
Table of Contents for the Digital Edition of Bladder Managment for Adults with Spinal Cord Injury
Bladder Management for Adults with Spinal Cord Injury
Contents
Foreword
Preface
Acknowledgments
Panel Members
Contributors
Summary of Recommendations
The Consortium for Spinal Cord Medicine
Introduction
Recommendations
Recommendations for Future Research
Appendix A: Economic Considerations for Bladder Management Methods
References
Index
Bladder Managment for Adults with Spinal Cord Injury - Bladder Management for Adults with Spinal Cord Injury
Bladder Managment for Adults with Spinal Cord Injury - i
Bladder Managment for Adults with Spinal Cord Injury - ii
Bladder Managment for Adults with Spinal Cord Injury - Contents
Bladder Managment for Adults with Spinal Cord Injury - Foreword
Bladder Managment for Adults with Spinal Cord Injury - Preface
Bladder Managment for Adults with Spinal Cord Injury - Acknowledgments
Bladder Managment for Adults with Spinal Cord Injury - Panel Members
Bladder Managment for Adults with Spinal Cord Injury - Contributors
Bladder Managment for Adults with Spinal Cord Injury - ix
Bladder Managment for Adults with Spinal Cord Injury - Summary of Recommendations
Bladder Managment for Adults with Spinal Cord Injury - 2
Bladder Managment for Adults with Spinal Cord Injury - 3
Bladder Managment for Adults with Spinal Cord Injury - 4
Bladder Managment for Adults with Spinal Cord Injury - 5
Bladder Managment for Adults with Spinal Cord Injury - 6
Bladder Managment for Adults with Spinal Cord Injury - The Consortium for Spinal Cord Medicine
Bladder Managment for Adults with Spinal Cord Injury - 8
Bladder Managment for Adults with Spinal Cord Injury - 9
Bladder Managment for Adults with Spinal Cord Injury - 10
Bladder Managment for Adults with Spinal Cord Injury - 11
Bladder Managment for Adults with Spinal Cord Injury - 12
Bladder Managment for Adults with Spinal Cord Injury - Introduction
Bladder Managment for Adults with Spinal Cord Injury - 14
Bladder Managment for Adults with Spinal Cord Injury - 15
Bladder Managment for Adults with Spinal Cord Injury - 16
Bladder Managment for Adults with Spinal Cord Injury - Recommendations
Bladder Managment for Adults with Spinal Cord Injury - 18
Bladder Managment for Adults with Spinal Cord Injury - 19
Bladder Managment for Adults with Spinal Cord Injury - 20
Bladder Managment for Adults with Spinal Cord Injury - 21
Bladder Managment for Adults with Spinal Cord Injury - 22
Bladder Managment for Adults with Spinal Cord Injury - 23
Bladder Managment for Adults with Spinal Cord Injury - 24
Bladder Managment for Adults with Spinal Cord Injury - 25
Bladder Managment for Adults with Spinal Cord Injury - 26
Bladder Managment for Adults with Spinal Cord Injury - 27
Bladder Managment for Adults with Spinal Cord Injury - 28
Bladder Managment for Adults with Spinal Cord Injury - 29
Bladder Managment for Adults with Spinal Cord Injury - 30
Bladder Managment for Adults with Spinal Cord Injury - 31
Bladder Managment for Adults with Spinal Cord Injury - 32
Bladder Managment for Adults with Spinal Cord Injury - 33
Bladder Managment for Adults with Spinal Cord Injury - 34
Bladder Managment for Adults with Spinal Cord Injury - 35
Bladder Managment for Adults with Spinal Cord Injury - 36
Bladder Managment for Adults with Spinal Cord Injury - 37
Bladder Managment for Adults with Spinal Cord Injury - 38
Bladder Managment for Adults with Spinal Cord Injury - 39
Bladder Managment for Adults with Spinal Cord Injury - 40
Bladder Managment for Adults with Spinal Cord Injury - 41
Bladder Managment for Adults with Spinal Cord Injury - Recommendations for Future Research
Bladder Managment for Adults with Spinal Cord Injury - Appendix A: Economic Considerations for Bladder Management Methods
Bladder Managment for Adults with Spinal Cord Injury - 44
Bladder Managment for Adults with Spinal Cord Injury - References
Bladder Managment for Adults with Spinal Cord Injury - 46
Bladder Managment for Adults with Spinal Cord Injury - 47
Bladder Managment for Adults with Spinal Cord Injury - 48
Bladder Managment for Adults with Spinal Cord Injury - 49
Bladder Managment for Adults with Spinal Cord Injury - Index
Bladder Managment for Adults with Spinal Cord Injury - Cover4
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