Guidelines for Intermittent Catheterization in Spinal Cord Injury Patients

Intermittent Catheterization — Purpose, Preconditions, Contraindications, and Key Techniques

1. Purpose of Intermittent Catheterization

Early initiation of intermittent catheterization is a critical component of bladder training and is regarded as the 'gold standard' for facilitating bladder emptying. The intermittent filling and emptying cycle of the bladder promotes the recovery of bladder reflex activity.

Intermittent catheterization encompasses two approaches:

① Sterile intermittent catheterization (SIC): maintains strict aseptic technique throughout the procedure.

② Clean intermittent catheterization (CIC): uses clean, but not necessarily sterile, technique.

Sterile intermittent catheterization is associated with a lower incidence of urinary tract infection and bacteriuria compared with clean technique.

2. Preconditions for Intermittent Catheterization

For early-stage spinal cord injury (SCI) patients presenting with voiding dysfunction, urological organ injuries (e.g., bladder rupture, urethral injury) must be excluded as a priority. Once vital signs are stable and no contraindications to intermittent catheterization are present, intermittent catheterization should be initiated as early as possible.

Prerequisites for intermittent catheterization include:

① The patient has adequate bladder capacity and maintains regular fluid intake, with a target 24-hour urine output of approximately 1,500–2,000 mL.

② Catheterization is performed at regular intervals of every 4–6 hours. The frequency may be adjusted based on the volume of urine obtained at each catheterization. The volume drained at each catheterization should not exceed 500 mL.

③ The patient's general medical condition is stable; no active emergency management, intensive care, or high-volume intravenous infusion is required.

3. Contraindications to Intermittent Catheterization

Contraindications include:

① Concomitant urethral or bladder injury (urethral bleeding, hematuria)

② Concomitant urethral malformation, urethral stricture, urethritis, or urethral abscess

③ Concomitant bladder neck obstruction or severe benign prostatic hyperplasia (BPH)

④ Concomitant vesicoureteral reflux or hydronephrosis

⑤ Severe spasm of the pelvic floor muscles or the external urethral sphincter

⑥ Severe autonomic dysreflexia

⑦ Severe urinary incontinence

4. Key Techniques for Intermittent Catheterization

Key procedural points include:

① Select an appropriately sized catheter.

② Aseptic technique: after disinfecting the urethral meatus, insert the catheter transurethrally using sterile technique.

③ Adequate lubrication: the use of a lubricating agent is recommended to minimize the risk of urethral trauma and other mechanical complications.

④ Gentle manipulation: insert the catheter slowly and carefully to avoid urethral mucosal injury.

⑤ After urine drainage is complete: apply gentle pressure over the suprapubic region while slowly withdrawing the catheter. Before the catheter is fully removed, clamp or fold the distal end of the catheter to prevent urinary backflow. This ensures complete bladder emptying with minimal residual urine.

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