Barriers to Implementing Intermittent Catheterisation in Spinal Cord Injury Patients in Northwest Regional Spinal Injuries Centre, Southport, U.K.

Abstract

Intermittent catheterisation is the preferred method of managing the neurogenic bladder in patients with spinal cord injury. However, spinal cord physicians experienced problems when trying to implement an intermittent catheterisation regime in some spinal cord injury patients in the northwest of England. We present illustrative cases to describe practical difficulties encountered by patients while trying to adopt an intermittent catheterisation regime. Barriers to intermittent catheterisation are (1) caregivers or nurses are not available to carry out five or six catheterisations a day; (2) lack of time to perform intermittent catheterisations; (3) unavailability of suitable toilet facilities in public places, including restaurants and offices; (4) redundant prepuce in a male patient, which prevents ready access to urethral meatus; (5) urethral false passage; (6) urethral sphincter spasm requiring the use of flexible-tip catheters and α-drenoceptor–blocking drugs; (7) reluctance to perform intermittent catheterisation in patients >60 years by some health professionals; and (8) difficulty in accessing the urethral meatus for catheterisation while the patient is sitting up, especially in female patients. These cases demonstrate the urgent need for provision of trained caregivers who can perform intermittent catheterisation, and improvement in public facilities that are suitable for performing catheterisation in spinal cord injury patients. Further, vigilance should be exercised during each catheterisation in order to prevent complications, such as urethral trauma and consequent false passages. Health professionals should make additional efforts to implement intermittent catheterisation in female spinal cord injury patients and in those >60 years.

Compliance with clean intermittent catheterization in spinal cord injury patients: a long-term follow-up study

“…24 Correct choice of catheter, which is most appropriate for the patient is necessary. Proper education of patients and urgent need for provision of trained care givers to perform CIC is essential.…”

Intermittent catheterization difficulty questionnaire (ICDQ): A new tool for the evaluation of patient difficulties with clean intermittent self‐catheterization

“…Despite this accepted fact, some authors have reported that CISC bladder management could be associated with urological complications, such as bladder stones, urinary infections, and striated urethral sphincter spasm …”

Bladder management in individuals with chronic neurogenic lower urinary tract dysfunction

“…[2][3][4] IC by a caregiver is only rarely accepted by individuals with NLUTD because of the loss of independence. 5 Bladder evacuation by IC may be the most prevalent evacuation method at discharge from rehabilitation; 2,6,7 however, some individuals seem to change their evacuation method over time. 6,7 The reported rate of individuals who abandon IC ranges from 20 to 52%, and most of them seem to revert to an indwelling catheter.…”