Bladder Managment for Adults with Spinal Cord Injury - 18

BLADDER MANAGEMENT FOR ADULTS WITH SPINAL CORD INJURY

Urethral trauma with hematuria. Urethral false passages. Urethral stricture. Autonomic dysreflexia (in those with injuries at T6 and above). Bladder stones.
(Scientific evidence–None; Grade of recommendation–None; Strength of panel opinion–Strong)

Rationale: Lower infection rates can be achieved with sterile techniques and with prelubricated self-contained catheter sets (Giannantoni et al., 2001; Waller et al., 1995). 7. Investigate and provide treatment for individuals on intermittent catheterization who leak urine between catheterizations.
(Scientific evidence–III; Grade of recommendation–C; Strength of panel opinion–Strong)

Rationale: The normal capacity of the bladder is less than 500 ml. Catheterizing the bladder every 4–6 hours prevents overdistention of the bladder. 4. If bladder volumes consistently exceed 500 ml, adjust fluid intake, increase frequency of intermittent catheterization, or consider alternative bladder management method.
(Scientific evidence–None; Grade of recommendation–None; Strength of panel opinion–Strong)

Rationale: Keeping bladder volumes below 500 ml will usually prevent overdistention of the bladder. Limiting fluid intake will decrease the amount of urine produced and can be helpful in decreasing the frequency needed for intermittent catheterization. Limiting fluids after dinner may prevent the need for intermittent catheterization in the middle of the night. 5. Institute clean intermittent catheterization teaching and training for individuals prior to discharge from the acute phase of rehabilitation.
(Scientific evidence–III; Grade of recommendation–C; Strength of panel opinion–Strong)

Rationale: Individuals may leak urine between catheterizations for various reasons, such as urinary tract infections, problems with the bladder or sphincter, or problems with fluid intake. Upper tract complications 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). Bladder capacity can be increased, and uninhibited contractions can be decreased, with the use of anticholinergic medications or with botulinum toxin injections (see Botulinum Toxin Injection). 8. Monitor individuals using this method of bladder management.
(Scientific evidence–None; Grade of recommendation–None; Strength of panel opinion–Strong)

Rationale: Waiting until fluid resuscitation is complete before starting intermittent catheterization will prevent overdistention of the bladder. Clean intermittent catheterization provides a successful long-term option that is less cumbersome and costly than the sterile technique (Chang et al., 2000; Chua, Tow, and Tan, 1996; Dmochowski, Ganabathi, and Leach, 1995; Giannantoni et al., 1998; Mitsui et al., 2000; Perkash and Giroux, 1993; Weld and Dmochowski, 2000; Weld, Graney, and Dmochowski, 2000). 6. Consider sterile catheterization for individuals with recurrent symptomatic infections occurring with clean intermittent catheterization.
(Scientific evidence–III; Grade of recommendation–C; Strength of panel opinion–Strong)

Rationale: Routine urologic follow-up is central to any bladder-management program to monitor complications, such as urinary tract infections, bladder or kidney stones, hydronephrosis, vesicoureteral reflux, and autonomic dysreflexia. The specific tests for monitoring and the frequency of those tests vary among practitioners. One approach is suggested by the VA SCI annual examination recommendations (VHA Handbook 1176.1 Spinal Cord Injury and Disorders System of Care). Many centers evaluate the upper and lower tracts of a person with a neurogenic bladder on a yearly basis. This may be done more frequently if a person is having a problem.

Nursing Considerations for Intermittent Catheterization
Individuals who choose intermittent catheterization for bladder management will need education on proper techniques and care as well as routine follow-up to detect potential complications. There are many variations on intermittent catheter technique and care. One example follows. Catheter selection: The catheter should be easy to insert without trauma or curling in the

Bladder Managment for Adults with Spinal Cord Injury

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