Bladder Managment for Adults with Spinal Cord Injury - 17

CLINICAL PRACTICE GUIDELINE

Recommendations
Intermittent Catheterization
Intermittent catheterization is a method by which an individual with SCI or his or her caregiver empty the bladder at a specified time frequency by inserting a catheter into the bladder, draining the bladder, and then removing the catheter. Intermittent catheterization does not require an intact sacral micturition reflex to be present. The method is an effective alternative during spinal shock when the bladder is not contracting. Intermittent catheterization provides complete bladder emptying and offers a practical means of obtaining a catheter-free state. 1. Consider intermittent catheterization for individuals who have sufficient hand skills or a willing caregiver to perform the catheterization.
(Scientific evidence–III; Grade of recommendation–C; Strength of panel opinion–Strong).

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.
(Scientific evidence–III; Grade of recommendation–C; Strength of panel opinion–Strong)

Rationale: Intermittent catheterization provides a method of emptying the neurogenic bladder without leaving an indwelling catheter and lessens the frequency of long-term complications such as hydronephrosis, bladder and renal calculi, and autonomic dysreflexia encountered with other methods of neurogenic bladder management (Bennett et al., 1995; Chai et al., 1995; Chua, Tow, and Tan, 1996; Dmochowski, Ganabathi, and Leach, 1995; Giannantoni et al., 1998; Perkash and Giroux, 1993). Intermittent catheterization should not be used in individuals who do not have adequate hand function to perform the procedure themselves or who do not have a caregiver willing and able to perform this function. Additionally, an alternative to intermittent catheterization may be needed in individuals with: Abnormal urethral anatomy such as stricture, false passages, and bladder neck obstruction. Bladder capacity less than 200 ml. Poor cognition, little motivation, inability or unwillingness to adhere to the catheterization time schedule or the fluid intake regimen, or adverse reaction toward having to pass the catheter into the genital area multiple times a day.

Rationale: Intermittent catheterization requires insertion of a catheter into the bladder at a routine time interval to prevent overdistention of the bladder. Inability to catheterize oneself and/or lack of a willing caregiver to perform the catheterization may lead to bladder overdistention. Urethral abnormalities may make it difficult to pass the catheter into the bladder to prevent bladder overdistention. High fluid intake may require frequent catheterization, which may not be practical. Aversion to passing a catheter into the bladder may lead to overdistention. Upper tract complications can still occur with intermittent catheterization in the presence of high bladder pressures (Dmochowski, Ganabathi, and Leach, 1995; Giannantoni et al., 1998; Weld and Dmochowski, 2000; Weld et al., 2000; Zermann et al., 2000). 3. Advise individuals with SCI of the potential for complications with intermittent catheterization, such as: Urinary tract infections. Bladder overdistention. Urinary incontinence.

Bladder Managment for Adults with Spinal Cord Injury

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