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

2. 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

3. Urinary System
Kidneys
Ureters
Bladder
Sphincter
Urethra

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

5. 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)

6. 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.

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

8. 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.

9. 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.

10. Indwelling Catheters
Urethral foley
Suprapubic catheter

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

12. 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

13. 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).

14. 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

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

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

17. The End