Kidney failure is still a leading cause of death in people who have suffered a spinal cord injury. But kidney disease is preventable. While the kidneys are not directly affected by SCI, they can be seriously injured if bladder functions, such as urination, are not properly managed. Urinary tract management is vital to preserve kidney function after SCI.

THE NORMAL URINARY TRACT AND URINATION

The parts of the urinary tract are illustrated above.

    The Kidneys are two fist-sized organs located in the back of the abdominal cavity. The kidneys perform complex functions that are vital to life. They constantly receive blood from throughout the body and filter it to remove toxic wastes from the blood and regulate the water volume and chemical concentrations of the body. In this blood filtering process, the kidneys use fluid and waste products to form urine.

    The Ureters are tubes through which urine leaves the kidneys and travels to the bladder. The ureters enter the bladder through the ureterovesical junction, the valve in the muscle wall between the ureter and the bladder. The function of this one-way valve is to prevent urine from flowing backward to the kidneys from the bladder (reflux). Under normal circumstances, this valve prevents kidney damage by preventing reflux.

    The Bladder is located in the pelvis and composed of intertwining layers of muscles. It serves as a reservoir for urine.

     The Bladder neck is the outlet of the bladder and is formed by layers of bladder muscle. When the bladder contracts, these layers of muscle pull the bladder neck open into a funnel-shape so the urine can flow out easily.

    The Urethra is the tube through which urine leaves the bladder and is discharged outside the body.

     The External sphincter is part of the urethra, located below the bladder neck and surrounded by a circular muscle. The external sphincter muscle can tighten to prevent the passage of urine, or it can relax and open to allow urine to flow out of the bladder.

    Normal urination, or voiding, occurred when the bladder was filled with urine, the nerves in the bladder were stimulated, and a message was sent along the nerves, through the spinal cord, to the brain that told you your bladder was "full." When the message was received by your brain, you felt the sensation of fullness and realized you needed to urinate.

     If you were in a situation where you could not urinate, the brain sent a message down the spinal cord the told the external sphincter muscle to tighten and the bladder to remain relaxed. When this message was received by the external sphincter muscle and the bladder, you could voluntary stop the bladder from contracting and hold back the flow of urine into the urethra. When you reached a bathroom and could urinate, the brain sent a message down the spinal cord telling the external sphincter muscle to relax and open and the bladder to contract.

     Although this may sound like a fairly simple process, in fact, normal urination is a very complex process that requires an intact nerve supply and coordination of the voluntary and involuntary nerves.

URINATION AND THE URINARY TRACT IN SCI

    After spinal cord injury the bladder is referred to as a neurogenic bladder. This means nervous system control of the bladder has been lost as a result of the injury. This loss of nervous system control, in turn, means that, while the bladder fills with urine, the message that the bladder is full cannot reach the brain. This message is blocked at the level of injury, and you are no longer able to feel the urge to urinate.

   The muscle activities of the bladder and external sphincter muscle are also affected by the injury. The bladder may be hypertonic, or spastic. The bladder will tighten and spasm as it fills and if the sphincter muscle will relax, these spasms (or contractions) may expel urine. If the sphincter muscle will not relax, voiding may not occur.

     If urination occurs, it is called reflex voiding, and is produced by a reflex that is still intact after the injury. When the bladder fills, nerve impulses are sent into the spinal cord at S2-3-4 and a responding nerve impulse is sent back to the bladder in a reflex that causes the bladder to contract.

   This reflex may be destroyed and the bladder can be hypotonic, or flaccid, in patients with lower-level injuries (generally T-12 or lower). In this case, the bladder remains relaxed and stretches as it fills, but has no contractions to empty urine.

    Whatever the altered function of the neurogenic bladder, the most important issue is one of control. The bladder has a disability, and you have lost conscious and subconscious control over the storage function of the bladder. The bladder can no longer control the amount of urine it stores and control of the voiding process may be interrupted. Because of this disability, urinary tract complications can occur if the bladder is not managed properly.

URINARY TRACT COMPLICATIONS

    To prevent possible problems, you must be aware of the urinary tract complications that can occur. These complications, which can cause kidney damage or kidney failure, include:

     Infection, such as bladder infection, kidney infection, or blood poisoning. Serious infections can be avoided by scrupulous urinary care and knowing the early signs of infection. Sometimes your doctor will prescribe medication to prevent symptoms from occurring. You need to observe your urine and know the symptoms of urinary tract infection, which include:

• Urine that is cloudy or has a foul odor
• Sediment in the urine
• Chills and fever, and lack of appetite or energy

     Calculi, or stones, may occur in the bladder or in the kidney. Bladder stones are easily removed. Kidney stones may require major surgery to remove.

     Reflux is the backward flow of urine from the bladder to the kidneys. It can be caused by high pressure in the bladder, by the bladder being too full, or, from the bladder contracting against a sphincter muscle which will not relax. Reflux can also be caused by an infection that damages the valve between the bladder and the ureter. In some people with high SCI injuries, reflux can cause Autonomic dysreflexia which requires immediate care. Reflux, and high pressure in the bladder, can also cause hydronephrosis, the collection of urine in the kidneys.

URINARY TRACT TESTS AND EVALUATION

     The following tests evaluate your urinary system and diagnose complications. Your physiatrist, or the urologist assigned to you, will determine whether any of these tests are appropriate for you.

History/Physical exam will be done by your physician.

Urine Culture and Sensitivity Test/Urine Analysis may be done to check for infection of the bladder. In this test, a urine sample is checked for the amount of bacteria, type of bacteria, and the antibiotics which will be most effective in killing the bacteria.

Blood Tests help determine the level of kidney function.

Intravenous Pyelogram (IVP) is an X-ray of the kidney to determine its structure and function.

Cystogram (CG) is an X-ray of the bladder to show its contours and if reflux is present.

Voiding Cystourethrogram (VCU) is an X-ray of the bladder, taken while voiding, to show the contours of the bladder and the function of the bladder neck, external sphincter muscle, and urethra.

Cystoscopy is a direct examination of the bladder through an instrument called a cystoscope. Done by a urologist, a cystoscopy can detect infection of the bladder and bladder stones. Cystoscopy can also determine how well the bladder is emptying.

Urodynamic Studies are special tests for bladder function which help your urologist determine the best program of urinary tract management for you.

GOALS AND METHODS OF URINARY TRACT MANAGEMENT

The goals of a program of urinary tract management are:

• Preservation of kidney function and health
• Adequate emptying of the bladder
• Prevention of complications listed above
• Staying dry, also called "continence"
• Managing the bladder in the simplest, safest possible way

     There are several methods of urinary tract management that address the loss of control over the storage and voiding functions of the bladder that occur in SCI. An individual program will be worked out for you by your doctor and nurse which will tell you what liquids and how much to drink, how often to catheterize, check the pH of your urine, have check-ups, etc.

The most common types of bladder management are:

• Intermittent catheterization program (ICP)
• Catheter free voiding program with external collection
• Indwelling (urethral or suprapubic) catheter

Each of these methods is discussed in detail in the following sections.

*See Intermittant Catheterization Program (ICP), Catheter Free Voiding with External Collection, Indwelling Catheter, Caring for Drainage Bags, Irrigating the Catheter

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. 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 promote sterile urine, i.e. urine that has no evidence of bacterial growth. For this reason, a no-touch, sterile, or "clean" technique is used.

PROCEDURE FOR INTERMITTENT CATHETERIZATION - CLEAN TECHNIQUE -FEMALE

1. Gather the necessary equipment:

• Towelettes (or a soapy washcloth)
• Wet wash cloth for rinsing, and a Towel
• Cotton balls, antiseptic, and forceps
• Container for collecting the urine
• Water-soluble lubricant
• Catheter (# 14 French; 5 inches long)
• Mirror (unless a helper is catheterizing), Lamp or flashlight

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:

• Make sure lighting is good.
• You will probably need to be propped up so that you are in a semi-sitting position.
• If someone else is doing the procedure, you can lie flat.
• A spreader bar with mirror attached can help.
• Tennis shoes may help prevent you from slipping.

5. Open catheter tray

• Touch only the outside of the wrapper when opening the outer paper.
• Start so that the first flap is opened away from you; the inside of the covering is sterile.
• Save the plastic wrapper to throw the used equipment in.

6. Sterile drape

• Pick up the sterile drape by the corners and open it
• The side you've touched should be next to the bed.
• Place the sterile drape under the buttocks

7. Put on the Sterile Gloves

• Touch only the inside of the gloves with your hand
• Touch the outside of the glove only with another sterile glove
• Anything that touches the catheter must be sterile.

8. Open package of antiseptic and pour it over all the cotton balls

9. Open package of lubricant

• Lubricate catheter to about six inches from the end
• Put lubricated catheter back in tray
• Be sure all equipment is set up before cleansing

10. Open labia (see diagram above)

• Use your left hand to open the labia; if you are left-handed, use your right hand.
• Keep labia apart until the catheter is in place.

11. Cleanse the urethral opening (see diagram above)

• With one hand, use forceps to pick up one cotton ball and clean one side of the urethral opening.
• With a second ball, clean the other side of the urethral opening.
• With two new cotton balls, clean over the urethral opening.
• Use each cotton ball for only one stroke from front to back. Never re-use.
• Drop used cotton balls on white paper surrounding the tray.

12. Insert the sterile catheter

• Still holding the labia apart, pick up the catheter with your "sterile" hand, about 4 inches from the tip.
• Gently insert the catheter into the urethral opening until the urine flows, directing it upward and forward. Don't let fingertips of gloves touch labia or any part of the area around the rectum and urethral opening.
• Insert one inch further.

Problems:

   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:

• Any change in the color or odor of the urine
• Cloudiness in the urine
• Bleeding or sediment in the urine

17. Discard all used supplies

18. Wash your hands

19. Drink cranberry or prune juice to promote acidic urine and reduce the risk of urinary tract infections.

PROCEDURE FOR INTERMITTENT CATHETERIZATION - CLEAN TECHNIQURE - MALE

1. Gather the necessary equipment

• Special Intermittent Catheterization Pack
• Basin of water
• Soap
• Three (3) disposable paper wash cloths
• Linen saver (chux)

2. Wash penis and scrotum with soap and water, rinse, and dry.

3. Open catheterization pack

• Touch only the outside of the wrapper when opening the outside package.
• Start so that the first flap is opened away from you; the inside of the covering is sterile.
• Save the plastic wrapper to throw the used equipment in.

4. Put on the Sterile Gloves

• Touch only the inside of the gloves with your hand.
• Touch the outside of the gloves only with another sterile glove.
• Anything that touches the catheter must be sterile.

5. Sterile drape

• Pick up the sterile drape by the corners.
• Open the sterile drape, making sure it does not touch your body or the bed.
• Place the sterile drape over the genital area, with the hole in the center of the drape over the head of the penis.

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.

• Hold penis erect.
• With right hand, use a pair of forceps to pick up the saturated cotton balls.
• Cleanse penis by wiping from front to back over the urethral opening and then around the head of the penis. If uncircumcised, pull back foreskin and clean entire head of penis.
• Discard cotton balls, away from the sterile field.

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

• Pick up the catheter with the second pair of forceps.
• Insert catheter into the urethra by sliding the catheter along the upper edge of the urethra.
• Do not touch the penis with the forceps.

Problems:

   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

• When the catheter is in, drain urine into the sterile tray.
• Allow urine to drain until you are sure the bladder is empty.

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:

• Any change in the color or odor of the urine
• Cloudiness in the urine
• Bleeding or sediment in the urine

16. Dispose of urine and all equipment.

CATHETER-FREE VOIDING WITH EXTERNAL COLLECTION

If your physician recommends a trial of becoming catheter-free:

TRIGGER VOIDING

   You may be taught ways to trigger voiding. Some methods to stimulate urination are tapping yourself in the area over your bladder, stroking your thighs, and pulling pubic hairs. Your doctor may suggest a trial with these methods to find the one which works best for you.
 

EXTERNAL CATHETER/WATERPROOF PANTIES

   Most people with a spinal cord injury don't have normal control of urination even when they empty their bladder well. Men usually wear an external condom collecting device, called an external catheter. As yet, there is no external device for women, so they usually wear waterproof panties with liners.

External Catheters - An external catheter is a device that collects urine after it is outside the body. It helps to keep you dry. There are many kinds on the market; be sure the one you use is best and safest for you. You will also need Elastikon tape and scissors, soapy washcloths, wet washcloths, and a towel. Change the external catheter daily to prevent skin irritation. There are two methods of applying an external catheter:

To apply with tape:

1. Wash entire genital area well with soap and water. Retract foreskin and wash well, rinse and dry well; bacteria tend to collect here.

2. Check the skin of the penis for redness or abrasions. Allow skin to air. Skin prep applied to penis will protect it from moisture.

3. If uncircumcised, pull the foreskin toward the head of the penis. This prevents the tourniquet effect which can cause swelling, sores, and possibly gangrene.

4. Roll the external catheter upward until the entire penis is covered (make sure there is at least two inches between the head of the penis and the end of the condom).

5. Place a pre-cut piece of Elastikon tape around the external catheter directly below the rolled edge at the top of the external.

6. Wrap tape around the penis so that tape ends meet and stick together. Do not overlap tape. This allows for penile erection and proper circulation. Do not stretch tape tightly.

7. Clip ring at the top of the condom to prevent tourniquet effect. Some external catheters stay better if the tape is spiraled (your nurse will demonstrate).

8. Connect the external catheter to the drainage bag.

To apply with adhesive:

1. Follow the first 3 steps of applying with tape. Then apply tincture of benzoin or skin cement to help keep external on. It is a good idea to clip pubic hairs around the base of the penis.
2. To contain the adhesive, make a drape from a paper towel by tearing a small hole in the center and placing it over the penis.
3. Spray the shaft of the penis with adhesive. Let it dry until tacky (about 30 seconds) then continue with steps 4-8 for applying the external catheter with tape.

Hints:

• If you have trouble keeping an external in place, use skin prep to adhesive or (if you use tape before rolling condom on. Skin prep also protects skin.
• If you use a Taxas catheter, save the plastic pieces. You can make your own external catheter using the pieces and a condom.
• Check the external frequently to be sure it is draining freely and is not on too tight. Call your doctor if a sore deeper than top layer of skin occurs on penis, or if you cannot apply external below sore.
• If an irritation or a sore occurs from an external catheter, you may be able to apply the external catheter below the sore, or you may need to leave the external catheter off for a few days until the sore heals.
   

   The following figures demonstrate two types of external catheters, as well as two ways of applying the tape.

Waterproof Panties - If waterproof (incontinent) panties are used:

• Wash the skin well and dry thoroughly before putting in fresh liners. Be sure to wash and change liners frequently.
• If any skin soreness occurs from the urine, air your skin as much as possible.
   

TIMING LIQUID INTAKE

    Some patients learn how to stay comfortably dry by timing their intake of fluids with urinating. For example, drinking less liquid before going out decreases the amount of urinating while you are out. It takes times to experiment with drinking liquids to learn how long it takes for the bladder to fill so that you can stay dry.

INDWELLING CATHETER

   Any catheter which is inserted into the bladder and allowed to remain in the bladder is called an indwelling catheter. A common type of indwelling catheter is a Foley catheter. A Foley catheter has a balloon attachment at one end. After the Foley catheter is inserted, the balloon is filled with sterile water. The filled balloon prevents the catheter from leaving the bladder.

STAYING HEALTHY WITH A FOLEY CATHETER

DO

• Drink at least 4000cc (4 quarts) of liquid a day to keep urinary output over two quarts. Check urine daily for color, odor, etc.
• Keep urine pH at 5.5 or under
• Check leg bag every 1-2 hours; if nothing is in it look for cause.
• Take medication regularly as prescribed
• Wash genital area twice daily, or more often if needed, especially around the catheter
• Men: tape catheter on abdomen at night to prevent fistula
• Use only sterilized equipment for irrigation and drainage
• Use sterile technique for urinary procedures
• Irrigate only with prescribed solution
• Report signs of infection to your doctor
• Have urinary work-up every six months to one year as ordered. This includes IVP and cystogram, which are X-rays of urinary system (also blood tests and urine tests). Entire work-up usually can be done in a few hours as an outpatient.
• If your catheter plugs, change it immediately. Pinch catheter between fingers daily to feel if there is grit inside. If there is, it is time to change the catheter.
• Change catheter as often as recommended by your doctor (usually every 2-4 weeks) unless it plugs
• If you notice eggshell-like particles in catheter tip, or in urine let your doctor know

DO NOT

• Touch with your bare hands anything that will go into the catheter or directly into your bladder, i.e., tips of leg bag, irrigation syringe or solution.
• Allow the night drainage tubing to be higher than your bladder. The urine drains back into bladder and can cause infection.
• Let your bladder get too full from a plugged catheter, too full bag, etc.
   

TAPING A CATHETER (FEMALE)

WHY IS IT DONE?

• To prevent the catheter from being pulled out of the bladder.

WHAT YOU NEED?

• Paper tape

WHAT TO DO

• Cut six-inch strip of one inch paper tape
• Place tape down on catheter about 2-3 inches from the end
• Secure both ends of the tape to the inner thigh. Alternate thighs to prevent skin irritation

TAPING A CATHETER (MALE)

WHY IS IT DONE?
To prevent:

• Peno-scrotal fistula
• Catheter from being pulled out of bladder

WHAT YOU NEED?

• Paper tape

WHAT TO DO

• Cut six-inch strip of one inch paper tape
• Place the tape down on the catheter about 2-3 inches from the end
• Secure both ends of the tape to the abdomen below the navel.

OTHER INFORMATION
    Taping the catheter while in a wheelchair can help prevent it from being pulled out
     It must be taped up at night, or when you are lying down for a long time.

STAYING HEALTHY WITHOUT A FOLEY CATHETER

DO

• Drink amount of liquid necessary to keep urine clear or light in color
• Check urine daily for color, odor, and eggshell-like particles (call your doctor if these are seen in your urine).
• Keep urine pH 5.5 or under
• Take medication regularly as prescribed
• Wash genital area twice daily or more often if needed. If you wear an external catheter, wash when changing the catheter and leave it off at least 15 minutes.
• Empty bladder regularly, usually every 3-4 hours
• Do intermittent catheterization as often as needed so that more than 300cc of urine do not accumulate. Catheterize for residual urine as often as ordered.
• Use proper technique for urinary procedures. If you ever need to irrigate following catheterization, use only sterile equipment.
• Have urinary work-up every six months to one year as ordered. This includes IVP (Intravenous pyelogram) and cystogram, which are X-rays of the urinary system, as well as blood and urine tests, all of which can be done in a few hours as an outpatient.
• If residual urine is ordered regularly, report any marked increase in amount to your doctor (i.e. 60cc or more)

DO NOT

• Let your bladder get too full of urine (not over 300cc). If your bladder is very small, the amount is less.
• Leave external catheters on so long that skin gets irritated
• Apply external catheters too tightly or sores will occur
• Use permanent rubber externals as skin breakdown can occur
• Apply external catheter over a sore
• Stretch tape or overlap tape when applying the external catheter or it will act as a tourniquet and cause pressure sores
• Decrease fluid intake -You may become dehydrated, prone to stones, UTI's (urinary tract infections), etc.

CARING FOR DRAINAGE BAGS

Caring for Drainage Bags - Leg and Bedside

CONNECTING A CATHETER TO A DRAINAGE BAG

• Wash hands before and after the procedure.
• Wipe end of the catheter with alcohol swab, cleansing thoroughly.
• Wipe the connector on the drainage tube with alcohol swab, cleansing thoroughly.
• Connect catheter to the tubing.
• If you have a Foley catheter, clamp tubing either by pinching with your fingers or using a clothespin prior to disconnecting (see diagram below). Unclamp when new tubing is recommended. This will prevent urine from leaking out of catheter.

POSITIONING A URINARY DRAINAGE BAG

Always keep the drainage bag below the level of your bladder.

Leg Bags

• Always apply leg bags to the calf.
• Alternate legs each day.
• Always apply leg bag with flutter valve at the top. This prevents the urine from backing up into the catheter from the leg bag. Test the flutter valve during cleaning. Tip the bag upside down. If water flows out of the flutter valve, discard the bag

Leg Bag

• Make sure the leg bag-connecting tubing is short enough to prevent kinking, and long enough to prevent pull on catheter.

Leg Bag With Extension at Top

Bedside Drainage Bags

Always keep draining bag below the level of your bladder.

• Keep tubing coiled on the bed. Do not let tubing hang below drainage bag.
• Connect drainage bag to the bed. Do not allow bag to lay on the floor

Closed Urinary Drainage

EMPTYING DRAINAGE BAGS

• Empty drainage bags frequently.
• Do not allow bag to become more than half full.
• When emptying, note urine color, consistency, and odor.

CLEANING DRAINAGE BAGS
     Once you have removed your leg bag or bedside drainage bag, it must be cleaned thoroughly to prevent infection and reduce odor.

Supplies Needed

• Hot running water.
• Clorox solution - 2 tablespoon to 1 quart of water ( or 4 ounces of Clorox to 1 gallon of water).
• Catheter tip syringe.

IRRIGATING THE CATHETER

WHY IS IT DONE?

     To find out if the catheter is draining well. Sometimes it is done to prevent urinary stones from forming, in which case solutions, such as acetic acid, Solution G, or Renacidin are used if prescribed

WHAT YOU NEED?

• Sterile glass asepto syringe with rubber bulb (two ounces)
• Cotton balls and alcohol or alcohol wipe
• Paper towels
• Clamp for catheter (with Renacidin only)
• Sterile container to hold irrigation solution
• Irrigation solution
• Clean cap or alcohol wipe packet to cover end of drainage tube or leg bag if you will be connecting to the same system.

WHAT TO DO

• Bring equipment to the bedside in a pan
• Wash hands well with soap and water or towelettes
• Place paper towels under the catheter and tubing connection
• Moisten cotton balls with alcohol and place on the paper towel
• Remove container for irrigating solution from the pan - touch only the outside of the glass.
• Pour about two ounces of solution into the container
• Remove syringe and bulb (squirt water out of the bulb)
• Assemble syringe and rubber bulb as shown in the following diagram. If you dip the bulb in the irrigation solution, it will fit easily into the syringe. After assembling the syringe, it can rest in the jar.

  

   

• Place the pan to collect urine under the open end of the catheter connection
• Wipe around the catheter and drainage tube connection with cotton ball wet with alcohol
• Separate the catheter from the drainage tubing. Cover the end of the tubing and put to one side. Prop the catheter in the collection basin. Do not let open end of catheter touch basin
• Draw up one-ounce of the irrigation solution. Hold the asepto syringe with the tip down, so that no air is put into the bladder. Do not put more than two ounces into bladder at one time
• Put the tip of the asepto syringe into the end of the catheter. Then irrigate by squeezing bulb with slow, gentle constant pressure. Do not forcefully irrigate the catheter. If the solution won't go in easily, change the catheter. Never use suction to drain solution from the bladder. It can cause damage to the lining of the bladder.
• Pinching the end of the catheter, remove the syringe while continuing to squeeze the bulb. If you are irrigating with Renacidin, at this point:
  • If you obtain Renacidin from a pharmacy or supply house, check to see if it has been sterilized after mixing.
  • Instill a second ounce of Renacidin and clamp the catheter before allowing it to drain.
  • Leave the catheter clamped for 10 minutes and then drain. Don't forget to unclamp your catheter. Set a timer if you're forgetful

• Let urine drain, by gravity, into the basin

• Repeat with the remaining solution.

• Cleanses connector with alcohol wipe or cotton ball and reconnect to the drainage tubing.

• Wash irrigation equipment

• WASH HANDS

Hints

• You can change from one drainage system to the next quite easily if you irrigate:
  • Just before bedtime: Disconnect the leg bag from the catheter, irrigate, and reconnect to clean the night drainage system
  • Just before you get up: Disconnect the night drainage system and reconnect to a clean leg bag. Save time by boiling your syringe and the container for the solution the night before. Leave the lid on the pot until ready to do the irrigation.

• If you irrigate in the evening and in the morning, boil two sets in the same pot at once.

• It is more economical to make your own solution.

Precautions

• Do not use acetic irrigation solutions, i.e., Renacidin, Solu-G or acetic acid if blood is noted in urine.