Bladder Managment for Adults with Spinal Cord Injury - 24

BLADDER MANAGEMENT FOR ADULTS WITH SPINAL CORD INJURY

Squamous cell carcinoma, which is a more aggressive type of cancer than transitional cell carcinoma, tends to occur more frequently in the SCI population using indwelling catheters compared with the non-SCI population, although it is not necessarily the predominant histologic type of bladder cancer in people with SCI who develop bladder cancer (Groah et al., 2002; West et al., 1999). Typically, squamous cell cancer is more common in underdeveloped countries where schistosomiasis infection (bilharzia) is endemic. The pathologic process involved in the development of squamous cell carcinoma of the bladder after schistosomiasis infection could also be due to recurrent bladder stones resulting from the parasitic infection or nitrates released in persons infected causing chronic inflammation. Hence, there may be similarities between the squamous cell cancer seen in individuals who manage their bladders with indwelling catheters and that seen in people infected with schistosomiasis, which can further help us understand the pathologic process after SCI. 7. Consider the use of anticholinergics in individuals with suprasacral lesions using chronic indwelling catheterization.
(Scientific evidence–III; Grade of recommendation–C; Strength of panel opinion–Strong)

(For types of catheters and economic considerations, see appendix A.) Urethral catheters. For urethral catheters #14Fr–16Fr is recommended. The balloon is gently filled with 5 to 10 ml of sterile water. Silicone catheters need to have the full 10 ml placed in their balloons because they are more porous in a drained bladder. Indwelling urethral catheters are replaced every 2 to 4 weeks by the individual or a knowledgeable caregiver. The longer a catheter is left in place the greater risk of catheter encrustation. Therefore in those with a history of catheter encrustation or bladder stones, strong consideration should be given to catheter changes every 1 to 2 weeks. Suprapubic catheters. Suprapubic catheters (#22Fr–24Fr is recommended) are inserted by a qualified physician or other health-care provider who is trained in changing suprapubic catheters. There should be strong consideration to increasing the frequency of catheter change to every 1 to 2 weeks in those who develop catheter encrustation or stones. After that, the catheter is changed every 4 weeks by a knowledgeable caregiver. Suprapubic tubes are replaced immediately upon removal so that the tract to the bladder is not allowed to close. Anchoring the catheter. A belt, tape, or other device is used to secure the catheter to the abdomen or thigh. Alternating sides to which the catheter is attached prevents urethral erosion and irritation of the legs and abdomen. A gauze tracheostomy pad or two folded 4x4s can be placed on either side of the suprapubic site to provide cushioning and prevent loose gauze fibers from entering into the suprapubic opening. Clogged catheters. If concretions cause blockage and impede drainage, a silicone catheter can be used, or 30 mls of Renacidin can be instilled daily for 20–30 minutes and then allowed to drain to keep the catheter patent. Irrigation. Daily irrigation of the catheter with normal saline or sterile water is not recommended because irrigation denudes the uroepithelium (Elliot et al., 1989). Intolerance to inflated catheter balloon. If the stimulus of the catheter balloon causes autonomic dysreflexia, an anticholinergic medication may help suppress the uninhibited contractions and autonomic dysreflexia.

Rationale: Regular use of anticholinergics may be associated with improved bladder compliance, lower bladder leak point pressures, and less hydronephrosis, while infection rate, vesicoureteral reflux, renal scars, stones, and serum creatinine levels are not altered (Kim et al., 1997). Kim et al. reported that fewer individuals who managed their bladders with indwelling catheters and used oxybutynin had abnormal bladder compliance, abnormal bladder leak point pressures, and hydronephrosis.

Nursing Considerations for Indwellin g Catheters
Individuals who choose indwelling catheterization for bladder management will need education on catheter care as well as routine follow-up to detect potential complications. There are many variations to indwelling catheter technique and care. One example follows: Catheter selection. The type of catheter to be used will depend on the individual’s needs and condition. Individuals should be asked if they are allergic to latex, though nonlatex catheters are preferred to prevent a latex allergy from developing. Most catheters have 5 ml or 30 ml balloons.

Bladder Managment for Adults with Spinal Cord Injury

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