Bladder management

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BLADDER MANAGE
FOR FOR SPINAL
CORD INJURYMENT

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Damage to any part of the spinal cord or nerves at the end of the
Spinal canal.Often it causes Permanent changes in strength and
other body functions below the site of the injury.
DEFINITION:

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COMMON CAUSES:
1. Motor vehicle accidents
2. Falls
3. Acts of violence
4. Sports and recreation injury
5. Diseases ( cancer, Arthritis, Osteoporosis, Inflammation of the
spinal cord)

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SIGNS AND SYMPTOMS
1. Extreme back pain or pressure in your neck, head or back.
2. Weakness,Inco ordination or Paralysis in your neck,head or
back.
3. Numbness, tingling or loss of sensation below the level of
injury.
4. Loss of Bladder and Bowel control.
5. Difficulty with balance and walking.
6. Impaired breathing.

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COMPLICATIONS
1. Bladder and Bowel Incontinence.
2. Skin sensation.
3. Circulatory control.
4. Respiratory system (Pneumonia).
5. Muscle tone.
6. Sexual health.
7. Pressure ulcer.
8. Depression.
9. Pain.
10. Fitness and wellness.

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BLADDER MANAGEMENT:
1. Indwelling cathetar.
2. Suprapubic cathetar.
3. Intermittent clean cathetarization.
4. Condom cathetar.
5. Spontaneous voiding.
 Normal voiding.
 Spincterotomy.
 Condom cathetar.

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Stimulated Voiding:
 Anal or Rectal stretch.
 Crede’s method.
 Tapping.
 Valsalva.

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INDWELLING CATHETAR:

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SUPRAPUBIC CATHETAR:

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INTERMITTENT CLEAN CATHETAR:

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CONDOM CATHETAR:

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CREDE’S
MANEUVER:
Crede is a method of applying
suprapubic pressure to express
urine from the Bladder.It is
usually used when the bladder is
flaccid.The effectiveness is
limited by sphincter pressure.

13. z
1. Fever with chills.
2. Headache.
3. Cloudy urine due to Pus.
4. Blood in urine.
5. Foul smelling urine.
6. Leaking of the urine from the cathetar.
7. Sediments in urine.
Potential Complications for IDC:

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VALSALVA
MANEUVER:
Valsalva is a method in which an
individual uses the abdominal
muscles and the diaphragm to
empty the Bladder.Passive
collection device like condom for
male and pads for females are
use.

15. z
EQUIPMENTS:
 Foley’s cathetar.
 2%Xylocaine Jelly.
 Soap.
 Cotton balls.
 Plastic mug.
 Plastic basin small- to collect urine.
 Plastic basin big-to wash hands and cathetar.
 Cloth cathetar bag-to keep the cathetar after procedure.
INTERMITTENT CLEAN
CATHETARIZATION:

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Procedure:
 Position the patient in sitting or side lying.
 Collect and keep needed equipments.
 Provide privacy.
 Wash hands with soap and water.
 Use soap and water to clean the Perineum.
 Remove the Foley’s cathetar from the bag.

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 Wash the cathetar with soap and water.
 Apply 2%xylocaine jelly to the tip of the cathetar.
 Introduce the cathetar into the bladder through the urethra gently.
 Drain the urine into the small plastic basin and wait till all the urine
drains out.
 Remove the cathetar gently,wash with soap and water and replace it in
the cloth cathetar bag and hang it.
 To check for the colour of the urine and if sediments present.
 Replace the things, measure the urine.
 Wash hands with soap and water.
 Position the patient comfortably.

18. z
Special Precautions:
 ICC is not a sterile procedure,but a clean procedure.
 Do not allow residual urine in the bladder.
 Need to follow the time schedule q4h.
 Limit the intake of fluid 1-1.2 litres/ day.
 Observe the colour,amount and sediments.
 Observe for any leaking of urine in between the ICC duration.If leaks are present to be
reported and to maintain bladder dairy.
 The volume of the urine should not exceed more than 300-350 ml each time of ICC.
 Use nozzle and apply jelly into the urethra before inserting the cathetar.( male – if there is
tightness

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Complications:
Urethral trauma

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 Orchitis.
 Bladder spasm

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Urinary cathetarization:
Definition:
Urinary cathetarization is the insertion of cathetar into the
bladder through the urethra using aseptic technique.
Indication:
 Acute urinary retention (BPH,blood clots).
 Chronic obstruction.
 Initiation of continuous bladder irrigation.
 Neurogenic bladder.
 Hygiene care of bedridden patients.

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Contraindications:
 Urethral injury.
Complication:
 UTI.
 Urethral trauma and bleeding.
 Urethritis.
 Fistula.
 Bladder stone and cancer.
 Sphincter erosion.

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Equipments:
 Dressing cups(2)with cotton balls
and gauze pieces.
 Artery clamp.
 Thumb forceps.
 K-Basin (2).
 Surgical towel(2)
 Sterile syringe 5cc &10cc.
 Distilled water.
 2%xylocaine jelly.
Other equipments:
 Sterile gloves.
 Mask.
 Antiseptic solution.
 Foley’s cathetar.
 Micropore.
 Razor set if required.

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Procedure:
 Assemble equipments and bring near the patient bedside.
 Open the cathetarization pack.
 Pour antiseptic solution into the dressing cup.
 Open outer plastic cover of cathetar in such a way that the inner cover
is not contaminated and slide it into the cathetarization pack.
 Cover the cath set without contaminating the inner layer of the wrapper.
 Withdraw the amount of distilled water as indicated on the cathetar,in
the syringe.
 Place the patient in modified lithotomy position and drape Perineum
with clean sheet.

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 Wash hands and wear gloves.
 Clean the Perineum with Betadine.
 Place one sterile towel under Buttocks and the other towel over
the pubic region and place the Sterile K-Basin near Perineum to
drain urine.
 Instruct the patient to take a deep breath and relax.
 Lubricate cathetar and insert into urethra 2-2.5 inches or until
urine flows.
 Instill 10ml of stelile water.

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 Pull the cathetar outward to a certain stability.Connect
the cathetar to urosac and Keep it below the level of
bladder.
 Secure the cathetar on the lower abdomen with
micropore.
 Position the patient comfortably and replace
equipments.

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Suprapubic cathetar:
Definition:
Suprapubic cathetar is a device that is inserted into your bladder to drain urine if you can’t
urinate on your own.
Indication:
 Urinary incontinence.
 Pelvic organ prolapse.
 Spinal injury or trauma.
 Multiple sclerosis.
 Benign prostate hyperplasia.
 Bladder cancer.
 If Tissue around your genitalis is damaged
 Your urethra may be too damaged or sensitive to hold a catheter
 If you have undergone surgery on bladder, urethra,uterus,penis .

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Procedure:
 Assemble the equipment and bring the patient and bring it near the patient
bedside
 Open catherisation pack and pour antiseptic solution into the dressing pack.
 Open outer plastic cover of catheter in such a way that the inner cover is not
contaminated and slide it into the catherisation pack
 Cover the catheter set without contaminating the inner layer of the wrapper.
 Withdraw the amount of distilled water as indicated on the catheter in the
syringe.
 Put the patient in supine position and drape the Perineum with clean sheet
 Wash hands and wear gloves
 Clean bladder area with Betadine
 Locate your bladder by gently feeling around the area.

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 Place one sterile towel over the Perineum and another sterile towel
over the abdomen and place the Sterile k basin near Perineum to drain
urine
 Lubricate catheter with 2%xylocaine jelly.
 Deflate the balloon with one of the syringe and take out the old catheter
slowly
 Take off the two pair of gloves.
 Insert the new catheter as far in as the other one was placed.
 Wait for urine to flow it may take few minutes
 Inflate the balloon using 10 ml of sterile water and attach your drainage
bag.

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Contraindications
 Coagulopathy
 Prior lower abdominal and pelvic surgery
 Pelvic cancer

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Condom drainage
 Condom is important to empty your bladder by tapping every 2 to 3
hours,if you do not empty regularly you increase the risk of
developing infection.
 INDICATIONS:
 Urinary incontinence
 Overactive bladder-that causes sudden urges to urinate that you
cannot control
 Mobility issues
 Dementia

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Advantages:
 Less likely to have cathetar
associated uti.
 Comfortable.
 Non-invasive.
 Available for home use.
Disadvantages:
 Can leak if your using the
wrong size.
 Can cause skin irritation &
allergy (from the latex
condom)
 Can be painful to remove.
 Can cause breakdown in
skin.

34. z
TIMED VOIDING:
Timed voiding and bladder training are about teaching a person to
regain voluntary control over your bladder.Timed voiding starts by
going to the toilet before you get the urge,on the clock,even if u
don’t feel like you need to pass urine.

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