Urinary Catheter Care
A urinary catheter is a small, thin tube typically inserted into the bladder through the urethra or supra-pubic area to drain your bladder and collect urine. A balloon filled with water at the end of the catheter holds the catheter in place once it is in place.
Types of urinary catheter insertion
There are three main types of urinary catheter insertion – urethral, suprapubic and external. Urethral catheterisation is the most common type of catheter insertion. A small, soft tube is inserted through the urethra into the bladder. This type of urinary catheter is usually inserted by a healthcare professional who maintains an aseptic technique during insertion and cleans the urethral meatus with chlorhexidine. Lignocaine jelly is used to reduce discomfort and promote ease of insertion. Suprapubic catheterisation is less common than urethral insertion but may be recommended if you have certain medical conditions that make urinary urethral insertion difficult or impossible. In this procedure, a small, soft tube is inserted through a small incision in the lower abdomen above the pubic bone into the bladder. Suprapubic catheters are also inserted by a healthcare professional who can be the Registered Nurse or your GP. External catheters look like a condom sheath that is worn on the penis with the tube outside your body and attached to a drainage bag. They are easy to use and can be inserted by yourself or the Disability Support Worker. External catheters are held in place with a strap or adhesive and can need to be changed daily. The urinary catheter tube is attached to the drainage bags, which come in different sizes, depending on how much urine they can hold. There are also different types of catheter valves that can be used to control the flow of urine from the leg bag to the drainage bag. The leg bag is smaller, can be worn under your clothing, attached to your thigh with a strap and emptied when it is full. The night bag is a larger bag and is worn on your bedside at night. It has a valve that allows urine to drain into it, preventing you from waking up to empty it during the night.
Why do you need a urinary catheter?
If you have an obstruction in the urinary tract or sustained a neurogenic bladder after a spinal cord injury or medical conditions, you need a catheter to help empty your bladder completely. Urine retention in your bladder can provide a good environment for bacteria to breed, causing infection. Urinal catheters left in place for days, weeks or even months are called indwelling catheters or Foley catheters. The other type, intermittent catheterisation, is only used to drain the bladder at regular intervals and remove the catheter when drainage is complete.
How to Minimise the Risk of Infection
If you have a urinary catheter, it is important that catheter care is appropriately managed to prevent catheter-associated urinary tract infections (CAUTI), one of the most common complications associated with urinary catheters. The tube provides a direct path for bacteria to enter your bladder, which can lead to a urinary tract infection. Signs of infection include pain when urinating, cloudy urine, and strong-smelling urine.
How Truworth Care can assist you
Ensure that your care plan is fully documented, and overseen by a Health Practitioner or your GP.Support Disability Support workers and others involved in providing support to you to:
- follow infection control procedures to minimise the risk of infection.
- replace and dispose catheter bags as per care plan.
- maintain charts and records.
- monitor the catheter position and ensure it is kept below the level of the bladder with no kinking of the catheter tubing. This can block the flow of urine and cause infection.
- monitor skin condition around the catheter pressure injury and trauma.
- recognise, respond and report blockages, signs of deteriorating health and infection to the Registered Nurse. Autonomic Dysreflexia is a medical emergency which everyone should be looking out for.
Keep the area around where the catheter is clean and dry by washing it with a soapy washcloth.Encourage you and your support network to wash and dry your hands before and after handling your catheter or anything that comes into contact with it, such as tubing or drainage bags. Encourage and assist you in drinking plenty of fluids. This will help flush out bacteria that can cause infection. Empty the bag regularly. If urine stays in the bag, it can breed bacteria. Assist you in wearing loose-fitting and comfortable clothes over the catheter to prevent irritation and chafing. Check for leakages. Leakage is one of the most common problems associated with urinary catheters. While a small amount of leakage is normal, excessive leakage can signify that the catheter is not properly positioned or blocked. The RN can adjust the position of your catheter to help control leakage.
What is Autonomic Dysreflexia?
Autonomic Dysreflexia (AD) is a medical emergency that occurs when the autonomic nervous system (ANS) is damaged. It most often affects the lower part of the ANS, which controls your bladder and bowel. The ANS regulates your body’s involuntary functions, such as blood pressure, heart rate, body temperature, sweating, digestion, sexual function and dilation of your eyes’ pupils through signals sent back and forth from the brain and body through the spinal cord nerves.
There are two main systems within your autonomic nervous system. The sympathetic and parasympathetic nervous systems.
The sympathetic nervous system is responsible for your body’s “fight-or-flight” response preparing it for action when there is stress or threat. Pupils are dilated, the heart rate increases, the heart pumps with more force and blood vessels narrow, causing blood pressure to rise.
The parasympathetic nervous system is responsible for your body’s”rest-and-digest” response. It causes digestion to improve, the heart to pump more slowly with less force and blood vessels to get wider, causing blood pressure to lower.
In a healthy individual, these two systems work in harmony to maintain a balance between the body’s need for energy and its need for rest. However, in someone with autonomic dysreflexia, this balance is disrupted.
You body’s first reaction to pain or discomfort is to go into sympathetic, fight-or-flight mode. However, your brain usually reacts quickly and sends a parasympathetic “rest and digest” response to counteract the sympathetic response. This usually creates the balance needed to prevent your body from overreacting to any pain or discomfort and staying in that “fight or flight” mode.
After a spinal cord injury, your body’s first reaction to pain or discomfort below your injury level is still to go into the sympathetic, “fight or flight” mode. Your brain then tries to send the parasympathetic, “rest and digest” response to counteract the sympathetic response, but your SCI blocks the signals from reaching the spinal cord below your injury level. The “rest and digest” response only goes to those areas above your injury level, allowing the “fight or flight” mode to continue out of control below your injury level. This means that your blood pressure is high including sweating, headaches, and nausea. In severe cases, autonomic dysreflexia can lead to seizures or even stroke.
What can trigger autonomic dysreflexia (AD)?
There are many potential triggers for autonomic dysreflexia(AD), anything that might typically cause pain or discomfort below your level of injury can trigger AD.
Common triggers include:
- Urinary tract infections.
- Constipation, flatus or inflamed haemorrhoids.
- Skin irritation – a pressure ulcer, pinched skin, cut.
- ingrown toenail.
- something too hot or cold touching the skin.
- Bladder distention. This is the number 1 cause of AD. When the bladder is full it needs to be emptied. People who use indwelling (Foley) catheters, condom catheters sometimes called sheaths or suprapubic catheters usually have a kink or blockage of urine flow, causing AD.
- Prolonged sitting or standing.
- Broken bone.
- Sexual activity
- menstruation in women
If you had a spinal cord injury and are susceptible to AD. It is paramount that you and your support network are aware of potential triggers and take steps to avoid them. For example, if you are prone to UTIs, you may need to take prophylactic antibiotics or empty your bladder regularly. If skin irritation is a trigger, be diligent about keeping your skin clean and moisturised.
Autonomic Dysreflexia Management
Proper management of autonomic dysreflexia is essential for people with spinal cord injuries.
Several things can be done to help manage this condition:
It is vital to know the damage level, which will help determine the best course of treatment.
Regular checkups with your doctor is essential. This will help catch any problems early and prevent them from worsening.
Avoiding trigger factors is vital. These include things like constipation, full bladders, and tight clothing. If autonomic dysreflexia is appropriately managed, people with spinal cord injuries can live relatively normal lives.