Objectives of intermittent catheterization.
1.Regular storage and discharge of urine to restore bladder function
2.To avoid various complications caused by long-term indwelling urinary catheter such as urinary tract infection, bladder stone, urethral injury, urine retention after extubation, ulceration of the external urethra, etc.
Indications for intermittent catheterization.
1. Any neuropathy causing bladder failure to empty effectively
2, combined with urodynamic examination
3, Motor paralysis bladder dysfunction.
(1)good compliance
(2) normal bladder capacity of 400 ml
(3) low bladder storage period pressure of 40 cm water column
(4)no ureteral reflux
(5) Effective sphincter function for urinary control between catheterizations
(4) No reflex of the forced urinary muscle caused by spinal cord, cauda equina or pelvic nerve injury
5.Suprasacral neuropathy has hyperreflexia of the detrusor muscle but can be suppressed with drugs to reduce the pressure within the bladder storage period to increase bladder capacity
6, certain demyelinating lesions, cerebrovascular disease and spinal cord injury during the shock period loss of activity of the forced urinary muscle or significantly low
Drinking water guidance.
Daily fluid intake of 1500-2000ml; uniform intake of 150ml/hour for 12 hours (including the amount of water drunk during three meals); control the amount of urinary catheterization at 400-500ml each time; avoid drinking large amounts of water in a short period of time to prevent excessive bladder expansion and filling
Frequency guidance.
Depends on bladder capacity, water intake, post-void residual urine volume and urodynamic examination
4-6 times/day in early SCI
1-3 times/day during recovery from SCI
Intermittent catheterization can be terminated if the residual urine volume is less than 100 ml or only 10-20% of the bladder capacity and always free of infection
Strictly control the intermittent catheterization time 4-6 hours/time, not more than 6 times a day
Complications and prevention.
1, urinary tract infection: strict implementation of aseptic operation of catheterization; pay attention to keep the perineum clean and dry; diligent change of urine pads in case of leakage; each catheterization volume less than 500ml.
2.Urethral injury: gentle movements and correct posture during operation. Remarks: record assessment: water consumption, catheterized urine volume, catheterization time, bladder volume changes thus adjusting frequency. Regular review: urine routine urine culture urodynamic.