Bladder Management for Spinal Cord Injured Persons Presented by: Colleen Casey, RN, ADN, WCC & Jessica Marshall, RN, ADN

Objectives Understand normal bladder function Understand the effects of SCI on bladder function Identify the goals in bladder management in SCI Describe the methods of bladder management or bladder emptying techniques Identify the nursing interventions in order to prevent bladder & kidney infections, hydronephrosis, urinary stones, and autonomic dysreflexia

Urinary System Kidneys Ureters Bladder Sphincter Urethra

Bladder Management in Spinal Cord Injury Almost all persons with spinal cord injury have some loss of bladder function…

Changes in Bladder Function after Spinal Cord Injury Flaccid or Areflexic Bladder (lower motor neuron injury) Reflex or Spastic Bladder (upper motor neuron injury) Mixed Bladder (combination of upper & lower motor neuron injury)

Extent of SCI related to Bladder Management With SCI bladder management, the extent of injury needs to be considered. Incomplete injury: with time, the person may regain some voluntary control of the bladder Complete injury: a combination of the bladder emptying techniques will become part of the bladder management program.

Goals in Bladder Management Keep skin dry Keep bladder volumes low Keep bladder pressure low Avoid infection

How do spinal cord injured persons attain the goals of bladder management? Bladder Emptying Techniques Intermittent Catheterization Program (ICP): a small rubber or plastic tube is inserted into the bladder to drain urine several times per day. Goal with ICP is to keep the bladder volume around 250cc-350cc/cath.

Important to note that more than 500cc in the bladder overstretches it and infection or reflux is more likely. Try to maintain intermittent catheterizations of 250cc-350cc/cath.

Indwelling Catheters Urethral foley Suprapubic catheter

Bladder Emptying Techniques Stimulated Voiding Spontaneous Voiding Detrusor-Sphincter Dyssynergia Incontinence Devices

Nursing Interventions Ways to prevent kidney & bladder infections, hydronephrosis, kidney stones, and autonomic dysreflexia include: Maintain consistent fluid intake Empty bladder routinely (prevent overdistension) Sterile catheterizations in hospital and clean technique for home management Wear appropriate continence devices

More Nursing Interventions If medications for bladder management are ordered, person should take them. Keep skin clean and dry (change clothes as soon as they become wet).

Signs & Symptoms of Pyelonephritis chills hematuria (bloody urine) increased spasticity fever dysuria (painful urination) autonomic dysreflexia flank pain foul smelling urine sediment Cloudy, thick urine

Signs & Symptoms of Cystitis Same as pyelonephritis except fever and chills usually not present.

Signs & Symptoms of Urinary Stones Low back pain Low abdomen pain Nausea Vomiting Fever Chills Hematuria Frequent urinary tract infections

The End