Review of Intermittent Catheterization and Current Best Practices

Diane K. Newman, MSN, ANP-BC, CRNP, FAAN, BCIA-PMDB; Margaret M. Willson, MSN, RN CWOCN


Urol Nurs. 2011;31(1) 

In This Article

Indications for Intermittent Catheterization

Intermittent catheterization is the preferred method of catheterization in patients who have bladder dysfunction, specifically neurogenic bladder. Lower urinary tract symptoms of neurogenic bladder include either UI or incomplete bladder emptying and urinary retention caused by outlet obstruction, poor detrusor contraction, or compliance.

A common cause of a neurogenic bladder is spinal cord injury, which occurs in more than 200,000 patients (10,000 cases per year) in the United States. (Linsenmeyer et al., 2006). The use of intermittent catheterization in this population has eliminated many complications associated with an indwelling urinary catheter (Weld & Dmochowski, 2000). Advantages of intermittent catheterization over an indwelling urinary catheter are listed in Table 2. In patients with a spinal cord injury, intermittent catheterization preserves renal function, reduces UI, improves bladder emptying, and reduces the incidence of UTI, leading to a better prognosis and improved quality of life (Cottenden et al., 2009).

Multiple neurological disorders in children are associated with neurogenic bladder. Myelomeningocele, one of the most common causes, is usually seen in children with spina bifida. Children with spina bifida have an opening in the spinal cord through which meninges, cerebrospinal fluid, and neural elements protrude. Although the opening in the spine is closed surgically shortly after birth, some degree of paralysis and bowel and bladder dysfunction remain. According to the Centers for Disease Control and Prevention (CDC) and the National Centers for Health Statistics, spina bifida affected 19.56 out of 100,000 live births in the United States. in 2004. This number was between 25 and 30 per 100,000 live births in the early to mid-1990s. These children are now in the school system, which presents even more challenges for bladder management (Katrancha, 2008). According to new CDC guidelines (Gould et al., 2009), clinicians should consider intermittent catheterization in children with myelomeningocele and neurogenic bladder to reduce the risk of urinary tract deterioration.