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The temporal burden of preparing catheters for re-use in adults with spinal cord injury: a cross-sectional study

Spinal Cord Series and Cases volume 9, Article number: 39 (2023) Cite this article

Subjects

Abstract

Study design

Cross-sectional

Objectives

Neurogenic lower urinary tract dysfunction is common among people with spinal cord injury (SCI). Although single-use clean intermittent catheterization is recommended to facilitate routine bladder emptying, catheter re-use is common. Barriers associated with the preparation (i.e., cleaning) of catheters for re-use are unknown. This study examined barriers to catheter re-use in adult individuals with SCI by assessing (1) the time needed to clean a catheter, and (2) the perceived difficulty of the catheter cleaning routine.

Setting

Laboratory

Methods

Twenty individuals with chronic SCI ( ≥ 1 year since injury; Group 1 = 10 with tetraplegia; Group 2 = 10 with paraplegia) completed the study. Using a standardized cleaning procedure (i.e., Milton method), catheter cleaning was timed for each participant. Perceived difficulty was assessed using a 5-point Likert scale. Functional impairment was assessed with the Upper Extremity Motor Score (UEMS).

Results

Significant between-group differences were observed for total cleaning time (Group 1 = 1584.1 ± 179.8 s; Group 2 = 1321.0 ± 93.8 s, p = 0.004) and perceived difficulty [Group 1 = 2.6 (2, 3); Group 2 = 2 (1.7, 2.3), p = 0.028]. Total cleaning time was significantly correlated with UEMS (ρ = −0.709, p ≤ 0.001) and perceived difficulty (ρ = 0.468, p = 0.037). UEMS emerged as an independent predictor of total cleaning time (R2 = 0.745, β = −0.833, p ≤ 0.001).

Conclusions

Preparing catheters for re-use is time-intensive and difficult for people with higher SCI level, severity and more pronounced upper limb motor impairment, which was independently associated with total cleaning time. Performing this routine on a consistent basis would require a substantial time commitment and would have a profoundly negative impact on overall quality of life.

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Fig. 1: Comparisons between participant groups (perceived difficulty).
Fig. 2: Comparisons between groups (perceived satisfaction).

Data availability

Data are available from the corresponding author on reasonable request.

References

  1. Ackery A, Tator C, Krassioukov A. A global perspective on spinal cord injury epidemiology. J Neurotrauma. 2004;21:1355–70.

    Article  PubMed  Google Scholar 

  2. Kovacs CW. A personal perspective on catastrophic case management. Prof Case Manag. 2010;15:341–2.

    Article  PubMed  Google Scholar 

  3. Garshick E, Kelley A, Cohen SA, Garrison A, Tun CG, Gagnon D, et al. A prospective assessment of mortality in chronic spinal cord injury. Spinal Cord. 2005;43:408–16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Groen J, Pannek J, Castro Diaz D, Del Popolo G, Gross T, Hamid R, et al. Summary of European Association of Urology (EAU) guidelines on neuro-urology. Eur Urol. 2016;69:324–33.

    Article  PubMed  Google Scholar 

  5. Krassioukov A, Biering-Sørensen F, Donovan W, Kennelly M, Kirshblum S, Krogh K, et al. International standards to document remaining autonomic function after spinal cord injury. J Spinal Cord Med. 2012;35:201–10.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Krassioukov A, Claydon VE. The clinical problems in cardiovascular control following spinal cord injury: an overview. In: Weaver LC, Polosa C, editors. Progress in Brain Research. vol. 152. Elsevier; 2006. p. 223–9. https://doi.org/10.1016/S0079-6123(05)52014-4.

  7. Samejima S, Shackleton C, Miller T, Moritz CT, Kessler TM, Krogh K, et al. Mapping the iceberg of autonomic recovery: mechanistic underpinnings of neuromodulation following spinal cord injury. Neuroscientist. 2023; 00:10738584221145570. https://doi.org/10.1177/10738584221145570.

  8. Ho CP, Krassioukov AV. Autonomic dysreflexia and myocardial ischemia. Spinal Cord. 2010;48:714–5.

    Article  CAS  PubMed  Google Scholar 

  9. Anderson KD. Targeting recovery: priorities of the spinal cord-injured population. J Neurotrauma. 2004;21:1371–83.

    Article  PubMed  Google Scholar 

  10. Sun AJ, Comiter CV, Elliott CS. The cost of a catheter: an environmental perspective on single use clean intermittent catheterization. Neurourol Urodyn. 2018;37:2204–8.

    Article  PubMed  Google Scholar 

  11. Taweel WA, Seyam R. Neurogenic bladder in spinal cord injury patients. Res Rep Urol. 2015;7:85–99.

    PubMed  PubMed Central  Google Scholar 

  12. Waller L, Jonsson O, Norlen L, Sullivan L. Clean intermittent catheterization in spinal cord injury patients: long-term follow up of a hydrophilic low friction technique. J Urol. 1995;153:345–8.

    Article  CAS  PubMed  Google Scholar 

  13. Welk B, Isaranuwatchai W, Krassioukov A, Husted Torp L, Elterman D. Cost-effectiveness of hydrophilic-coated intermittent catheters compared with uncoated catheters in Canada: a public payer perspective. J Med Econ. 2018;21:639–48.

    Article  PubMed  Google Scholar 

  14. Kovindha A, Mai WNC, Madersbacher H. Reused silicone catheter for clean intermittent catheterization (CIC): is it safe for spinal cord-injured (SCI) men? Spinal Cord. 2004;42:638–42.

    Article  CAS  PubMed  Google Scholar 

  15. Kennelly M, Thiruchelvam N, Averbeck MA, Konstatinidis C, Chartier-Kastler E, Trøjgaard P, et al. adult neurogenic lower urinary tract dysfunction and intermittent catheterisation in a community setting: risk factors model for urinary tract infections. Adv Urol. 2019.

  16. Håkansson MÅ. Reuse versus single-use catheters for intermittent catheterization: what is safe and preferred? Review of current status. Spinal Cord. 2014;52:511–6.

    Article  PubMed  Google Scholar 

  17. Prieto J, Murphy CL, Moore KN, Fader M. Intermittent catheterisation for long‐term bladder management. Cochrane Database Syst Rev. 2017. https://doi.org/10.1002/14651858.CD006008.pub4.

  18. Kinnear N, Barnett D, O’Callaghan M, Horsell K, Gani J, Hennessey D. The impact of catheter-based bladder drainage method on urinary tract infection risk in spinal cord injury and neurogenic bladder: A systematic review. Neurourol Urodyn. 2020;39:854–62.

    Article  PubMed  Google Scholar 

  19. Christison K, Walter M, Wyndaele J-JJM, Kennelly M, Kessler TM, Noonan VK, et al. Intermittent catheterization: the devil is in the details. J Neurotrauma. 2017;35:985–9.

    Article  Google Scholar 

  20. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol. 2010;31:319–26.

    Article  PubMed  Google Scholar 

  21. Grasdal M, Lai R, Walter M, Krassioukov AV. Short-term reuse of catheters is associated with microbiological and structural burden: a prospective pilot case series. Front Urol. 2022;2:1–8.

    Article  Google Scholar 

  22. Miller T, Lange D, Kizhakkedathu JN, Yu K, Felix D, Samejima S, et al. The microbiological burden of short-term catheter reuse in individuals with spinal cord injury: a prospective study. Biomedicines. 2023. https://doi.org/10.3390/biomedicines11071929.

  23. Newman DK, New PW, Heriseanu R, Petronis S, Håkansson J, Håkansson MÅ, et al. Intermittent catheterization with single- or multiple-reuse catheters: clinical study on safety and impact on quality of life. Int Urol Nephrol. 2020;52:1443–51.

    Article  PubMed  Google Scholar 

  24. Wilks SA, Morris NS, Thompson R, Prieto JA, Macaulay M, Moore KN, et al. An effective evidence-based cleaning method for the safe reuse of intermittent urinary catheters: in vitro testing. Neurourol Urodyn. 2020;39:907–15.

    Article  CAS  PubMed  Google Scholar 

  25. Gopalakrishnan K, Nielsen NF, Ramirez AL, Sørensen J, Walter M, Krassioukov AV. Time needed to perform intermittent catheterization in adults with spinal cord injury: a pilot randomized controlled cross-over trial. Cont Rep. 2022;2. https://doi.org/10.1016/j.contre.2022.100010.

  26. Woodbury MG, Hayes KC, Askes HK. Intermittent catheterization practices following spinal cord injury: a national survey. Can J Urol. 2008;15:4065–71.

    PubMed  Google Scholar 

  27. Magdeline L. The law of urination. Australasian Science. 2014;35:42.

    Google Scholar 

  28. Lim S-W, Lee H-E, Davis M, Park K. Perceived barriers and difficulties of intermittent catheterization: in Korean patients with spinal dysraphism and their parents. Neurourol Urodyn. 2016;35:395–9.

    Article  PubMed  Google Scholar 

  29. Goldstine J, Leece R, Samas S, Zonderland R. In their own words: adults' lived experiences with intermittent catheterization. J Wound Ostomy Cont Nurs. 2019;46:513–8.

    Article  Google Scholar 

  30. Zimmermann G, Bolter L-M, Sluka R, Höller Y, Bathke AC, Thomschewski A, et al. Sample sizes and statistical methods in interventional studies on individuals with spinal cord injury: a systematic review. J Evid-Based Med. 2019;12:200–8.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would like to thank the study participants.

Funding

FundingTM is supported by a Michael Smith Health Research BC postdoctoral fellowship and the Rick Hansen Foundation (RHF). TK is supported by a Canada Graduate Scholarship (Master’s) through the Canadian Institutes for Health Research (CIHR) and a WorkSafeBC research trainee award. SS is supported by a Paralyzed Veterans of America (PVA) postdoctoral fellowship, the RHF and the Wings for Life Spinal Cord Research Foundation (WFLSCRF). CS is supported by a PVA postdoctoral fellowship, a CIHR postdoctoral fellowship and the RHF. RM is supported by a PVA postdoctoral fellowship and the RHF. RS is supported by the WFLSCRF and the US Department of Defense. AVK is the Endowed Chair in the Division of Physical Medicine and Rehabilitation within the Faculty of Medicine at the University of British Columbia. This study was supported by a grant from Coloplast A/S, Humlebæk, Denmark (grant number: COLO-AK-NLUTD-SCI: F18-03036, AVK – Principle investigator). The funder had no role in the collection or interpretation of data nor the decision to publish with this journal.

Author information

Authors and Affiliations

  1. International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    T. Miller, L. J. Roik, T. Kalimullina, S. Samejima, C. Shackleton, R. N. Malik, R. Sachdeva & A. V. Krassioukov

  2. Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada

    T. Miller, S. Samejima, C. Shackleton, R. N. Malik, R. Sachdeva & A. V. Krassioukov

  3. Spinal Cord Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada

    A. V. Krassioukov

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Contributions

Each author contributed in the following capacities. Study conception and design: TM, and AVK. Material preparation and data collection: TM, LR, SS, and CS. Data analysis: TM, TK, and RM. Data interpretation: TM, TK, RM, and AVK. Manuscript draft: TM. Manuscript content revision: TM, LR, TK, SS, CS, RM, RS, and AVK. Final manuscript approval: TM, LR, TK, SS, CS, RM, RS, and AVK. Funding acquisition, resource provision and supervision: AVK.

Corresponding author

Correspondence to A. V. Krassioukov.

Ethics declarations

Competing interests

AVK serves on advisory boards for Coloplast A/S, Wellspect Healthcare, and ConvaTec Inc. All other authors have no conflicts of interest to declare.

Ethical approval

Study approval was granted by the University of British Columbia Research Ethics Board (H17-03228) and Vancouver Coastal Health (V17-03228), and was conducted in accordance with the Declaration of Helsinki for human experiments. Written informed consent was obtained from all participants.

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Miller, T., Roik, L.J., Kalimullina, T. et al. The temporal burden of preparing catheters for re-use in adults with spinal cord injury: a cross-sectional study. Spinal Cord Ser Cases 9, 39 (2023). https://doi.org/10.1038/s41394-023-00596-0

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