URINARY TRACT MANAGEMENT IN SPINAL CORD INJURY: URINATION AND THE URINARY TRACT IN SCI: INTERMITTENT CATHETERIZATION PROGRAM (ICP)
If you do start urinating, intermittent catheterization is done to release the remaining urine from the bladder and measure the amount of urine left in the bladder after you urinated. Ideally, there should be no urine left in the bladder when the catheter is removed. However, most people have some residual urine. The amount of residual urine will be measured routinely until the amount is as low as possible. Amounts routinely under 100cc are usually acceptable. Your doctor will tell you what is safe. Residuals are checked periodically as long as you are in the hospital and also after you go home.
At the start of rehabilitation, intermittent catheterization is routinely done on all patients every 4 to 6 hours. As you improve and your bladder empties better, intermittent catheterization for residual urine will change from every 4 to 6 hours, to every 8 to 12 hours. One of the goals of the intermittent catheterization program is to decrease the incidence of urinary tract infections by using a "sterile" technique. Some bacteria is expected but should be kept at a low level. Bacteria in the urine does not necessarily indicate a UTI.
PROCEDURE FOR INTERMITTENT CATHETERIZATION - STERILE TECHNIQUE -FEMALE
1. Gather the necessary equipment:
2. Urinate first if you are doing an intermittent catheterization to measure residual urine
3. Wash your hands
4. Position legs and mirror so you can see the urinary opening. Hints:
5. Open catheter tray
6. Sterile drape
7. Put on the Sterile Gloves
8. Open package of antiseptic and pour it over all the cotton balls
9. Open package of lubricant
10. Open labia (see diagram above)
11. Cleanse the urethral opening (see diagram above)
12. Insert the sterile catheter
If you have difficulty finding the urinary opening, mark the vaginal opening by leaving the last cotton ball, or a tampon, in the vaginal opening.
If you should insert the catheter into the vagina by mistake, use a new catheter kit.
If you should have a spasm while catheterizing, stop and wait until the spasm has passed and then continue.
If you meet continued resistance, stop and call your doctor. Do not force the catheter in.
13. Hold end of catheter in the tray and wait for urine to drain. If the bladder seems empty, but you aren't sure if the catheter tip is all the way in, apply pressure on the abdomen over your bladder with the palm of your hand, or, cough. A small amount of residual urine will be expelled if the catheter is in the right place.
14. Gently withdraw the catheter when the urine stops draining. Do not drain more than 500 cc of urine at one time. If there is more than 500 cc, clamp the catheter for 5-10m minutes before draining another 500 cc or the remainder.
15. Measure the amount of urine and record the amount urinated and the residual amount if you are keeping an accurate record.
16. Examine the urine and contact your nurse or doctor, IF you see:
17. Discard all used supplies
18. Wash your hands
PROCEDURE FOR INTERMITTENT CATHETERIZATION - STERILE TECHNIQUE - MALE
1. Gather the necessary equipment
2. Wash penis and scrotum with soap and water, rinse, and dry.
3. Open catheterization pack
4. Put on the Sterile Gloves
5. Sterile drape
6. Pour cleansing solution over the cotton balls in the tray.
7. Open package of lubricant that is in the tray and squeeze lubricant over entire length of the catheter.
8. Pick up penis with your left hand, using the drape between your hand and the penis.
9. Repeat Step 9 until all cotton balls are used.
10. Discard first pair of forceps, away from the sterile area.
11. Insert the sterile catheter
If the catheter meets resistance, pause for one or two minutes at the point where resistance is felt, and then apply gentle pressure with the catheter. This will usually fatigue the sphincter muscle causing the muscle to relax and allowing the catheter to pass.
If you are unable to pass the catheter, do not force it. Stop the procedure and notify your physician.
12. Drain the urine
13. Gently remove the catheter when the urine stops draining and place it in the tray.
14. Measure the amount of urine and record the amount if you are keeping an accurate record.
15. Examine the urine and contact your nurse or doctor, IF you see:
16. Dispose of urine and all equipment.
Touchless disposable catheters are also available and are often used when you are out in the community. They require less setup and can be used while sitting in the wheelchair.
PROCEDURE FOR INTERMITTENT CATHETERIZATION - STERILE TECHNIQUE - MALE AND FEMALE
It is important to sterilize your supplies 3 times per week with one part of bleach for ten parts of tap water. Let it soak overnight then rinse thoroughly with water again.
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