Which of the following interventions describes an appropriate bladder program for a client in rehabilitation for spinal cord injury?
A. Insert an indwelling urinary catheter to straight drainage.
B. Schedule intermittent catheterization every 2 to 4 hours.
C. Perform a straight catheterization every 8 hours while awake.
D. Perform Crede’s maneuver to the lower abdomen before the client voids.
Correct Answer: B. Schedule intermittent catheterization every 2 to 4 hours.
Intermittent catheterization should begin every 2 to 4 hours early in the treatment. When residual volume is less than 400 ml, the schedule may advance to every 4 to 6 hours. Begin bladder retraining per protocol when appropriate (fluids between certain hours, digital stimulation of trigger area, contraction of abdominal muscles, Credé’s maneuver).
Option A: Begin intermittent catheterization program when appropriate. Intermittent catheterization may be implemented to reduce complications usually associated with long-term use of indwelling catheters. A suprapubic catheter may also be inserted for long-term management.
Option C: Indwelling catheters may predispose the client to infection and are removed as soon as possible. Keep the bladder deflated by means of indwelling catheter initially. Indwelling catheter is used during acute phase for prevention of urinary retention and for monitoring output.
Option D: Crede’s maneuver is not used on people with spinal cord injury. Timing and type of bladder program depend on type of injury (upper or lower neuron involvement). Note: Credé’s maneuver should be used with caution because it may precipitate autonomic dysreflexia.
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