Bladder Managment for Adults with Spinal Cord Injury - 19

CLINICAL PRACTICE GUIDELINE

urethra. If a latex allergy is present, nonlatex catheters must be used. A nonlatex product with straight tip is recommended. (For types of catheters and economic considerations, see appendix A.) Hand washing. Hands should be washed or aseptic towelettes used both before and after catheterization. Technique. Follow the procedure recommended by the prescribing institution, health-care professional, national guideline, or health-care organization. Catheter care. To control introduction of bacteria into the bladder, catheters must be washed after every use. Rinsing and allowing catheters to air-dry between each use was found to be the most effective means of keeping the bacteria count low on catheters (Lavallee et al., 1995). Catheters should be cleaned with mild soap and water, air-dried, and placed in a paper bag until ready to reuse. If recurrent urinary tract infections are a problem, latex catheters can be sterilized by heating them in a microwave oven (Mervine and Temple, 1997). Recurrent urinary tract infections. Symptoms of UTIs need to be investigated and documented as follows: Technique and bladder check: The catheterization technique should be assessed and the bladder checked for stones, mucus, or other debris. Single-use catheter: If no reason for UTIs can be found, a single-use catheter may be used to see if UTIs subside. Single-use hydrophilic catheter: If urethral irritation appears to be the cause, a single-use hydrophilic catheter may be tried. Sterile water for injection, which may or may not be included with the catheter, needs to be used to activate this type of catheter. Antibacterial catheter: If UTIs continue, a single-use catheter impregnated with an antibacterial substance may be tried. Touchless catheter. When toilet facilities are not readily available, such as during sports activities or travel, a touchless catheter with a collection device may be a good alternative. These catheters, which are contained within the collection device, lubricate themselves as they are introduced into the urethra by a prelubricated outlet on the bag. When the bladder is drained, the catheter is with-

drawn from the urethra and returned to the collection device, the top is capped, and the entire device discarded without ever being touched directly by the hands. Fluids. Fluid consumption should be moderate and spaced throughout the day. Timing. Catheterization typically occurs every 4–6 hours so that the amount of urine obtained with each collection is less than 500 ml. Individuals may need to awaken at night to catheterize. Assistance required. Adequate hand function and sufficient cognitive ability are needed to insert the catheter or else a caregiver must be available to do so. Cosmesis. No changes will be noted. Interference with social/sexual functioning. None. Medications. If urinary leakage and a highpressure bladder (as determined by urodynamic studies) are creating difficulties, medications will be prescribed to help with overactive bladder. If urinary leakage is the result of an incompetent sphincter, additional medication may be prescribed. If the problem is catheterization at the bladder neck, an alpha-blocker may be prescribed to relax the bladder neck and facilitate catheterization. Reversibility. This method can be discontinued at any time.
Adapted from Joseph, A.C., A. Hixon, J. Giroux, D. Briggs, M. Gardenhire, D. Diaz, and J. Wells. Nursing clinical practice guideline: neurogenic bladder management. Spinal Cord Injury Nursing 15 (2) (1998): 21–56.

Credé and Valsalva
Credé is a method of applying suprapubic pressure to express urine from the bladder. Credé is usually used when the bladder is flaccid or a bladder contraction needs to be augmented. The effectiveness of Credé is limited by sphincter pressure. Valsalva is a method in which an individual uses the abdominal muscles and the diaphragm to empty the bladder. Valsalva is used when the bladder is flaccid from spinal cord injury affecting the sacral reflex arc or when the bladder contracts but does not empty completely. Valsalva increases intraabdominal pressure but does not ensure complete bladder emptying.

Bladder Managment for Adults with Spinal Cord Injury

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