Rachel: Welcome everybody to this talk on self-catheterization. It is a passion of mine after years at Shriner's. I do not know about any of you, but when I was in OT school, self-catheterization was something that was not taught. I learned about self-catheterization from a great nurse in my facility. I then wrote a case study report for a Slack publication on a little girl with spina bifida and the topic of self-catheterization. I also presented this topic to a local OT program. This course was developed from that.
Populations
Who need to self-catheterize? Regular self-catheterization is for those who cannot empty their bladder on their own. It allows people to work and participate in their normal activities of daily living, while also preventing kidney infection and other renal disorders.
Neurogenic Bladder
What is a neurogenic bladder? The bladder is a hollow organ located in the pelvis or lower abdomen. The bladder has two important functions. It helps to store your urine until it is full. When the bladder becomes full there is an urge to urinate and the bladder empties completely without any leakage. This is what happens in a normal person, a normal bladder.
When the conditions of the nervous system affect the bladder, it is called the neurogenic bladder. There are two major types of bladder control problems that are associated with a neurogenic bladder. And depending on the nerves involved and the nature of the damage the bladder becomes either overactive which is spastic or hyper-reflexive, or underactive, which could be flaccid or hypotonic.
One cause of a neurogenic bladder is a spinal cord injury or a spinal surgery. Another one is diseases that affect the nervous system, like a central nervous system tumor. Finally, what I am most familiar with is spinal congenital abnormalities, that are present at birth like spina bifida. This is a pictorial to give you an idea of what the bladder looks like and what nerves are supplying the bladder and related structures.
In Figure 1, this shows how the brain and the central nervous system all relate, and how the nerve signals go to the bladder and the sphincter muscles.
Figure 1. Overview of the central nervous system path to the bladder.
How OTs and Nurses Teams Teach
How do OTs and nurses team teach? I had a really wonderful experience at Shriner's with great nursing mentors. One nurse had been there for many years working in the urology clinic with kids with spina bifida. She has now since retired. I also had a wonderful experience being able to work at our inpatient unit with a nurse who had spina bifida herself. I was able to learn so much from them regarding the mechanics of catheterization, technique, and the reasoning.
As an occupational therapist, there is no need for me necessarily to be catheterizing my patients. However, we can facilitate teaching with the families and the patients themselves. The earlier we start teaching the better. It is a lifelong skill to help them be more independent. How does team teaching work? I had the privilege at Shriners for many years to provide care for children, free at cost. We were also able to admit children into our inpatient unit for many different reasons.
Inpatient, Intensive Outpatient vs. Outpatient
We have now gone to billing third parties over the last few years. Some of our inpatient requirements have also changed. For many years, I was able to identify kids, coming into the spina bifida clinic, who needed self-catheterization training. I found that by bringing them into inpatient with 24 hour care, I could assess how involved they were in their self-catheterization. This also allowed me to have a good idea of what their home situation. Was their family supportive of their independence, or were they doing too much? I found admitting many of the kids, I saw in clinic, to be a positive thing.
Now we do more intensive outpatient where families can stay in our "hotel rooms", that are in the hospital but they are not on the inpatient unit. They could also come from home, and we see them, sometimes with nursing, for several hours at a time. It is still intensive where we are seeing them everyday, but it is in an outpatient setting where they are not actually in an inpatient bed.
With outpatient teaching, we might work someone we see locally. For those who are local, we can do a short stint of outpatient where they come regularly, just for that specific goal. However, it is now hard to admit a child just for self-catheterization training. To qualify for inpatient rehab, they have to have three hours a day of therapy, for at least two of three disciplines (OT, PT or speech). For patients with a spinal cord injury, self-catheterization training is part of their plan of care, but they are in for many other reasons. This is some background on why a patient would qualify for inpatient, intensive outpatient, or outpatient. Hopefully that helps you to understand that a little better.
