Abstract: Intermittent Catheterization the Right Way! (Volume vs. Time-Directed)

Joseph E. Binard, MD, FRCS(C), Lester Persky, MD, Jorge L. Lockhart, MD, and Brenda Kelley, RN, MSN, CRRN. "Intermittent Catheterization the Right Way! (Volume vs. Time-Directed)." Journal of Spinal Cord Medicine 19 (1996) 3: 194-96.

Objectives:
* To evaluate the viability of a volume-directed catheterization program employing the PCI 5000 BladderManager^®, for individuals with diseased spinal cords.

Methods:
* Twenty-one patients with neurogenic bladder dysfunction participated in the study, all of whom had large capacity, low pressure bladders. Prior to the introduction of the PCI 5000, 246 time-directed catheterizations were performed to demonstrate the great variance between catheterized volume and the desired optimal bladder urinary volume.
* Subsequently, the PCI 5000 instrument was used to determine bladder volume. When the bladder reached a predetermined level of distension, the device sounded an alert to advise staff or patient of the need to empty the bladder. Catheterization was then performed, and the volume of catheterized urine was compared to the expected volume, and to the ideal desired volume at which it had been determined that catheterization should occur for each patient.
* Results were compared to timed intermittent catheterization results in a similar series of studies.

Results:
* "In 246 consecutive time-directed catheterizations, only 43 or 17.4 percent were within 20 percent of the intended desired volume. . . . One-hundred and sixty-four were carried out unnecessarily early." The remaining thirty-nine were performed too late, after the bladder had become over-distended.
* "Measurements recorded on the PCI 5000 Ultrasonic device correspond almost exactly to the measured obtained amount [of urine obtained by catheterization]."

Conclusions:
* "These findings show that time-directed intermittent catheterization leads to a high percentage of unnecessarily early as well as some late catheterizations."
* "The use of the PCI 5000 not only prevents bladder overdistension, but it avoids unnecessary catheterization which translates to decreased chances of trauma and infection as well as less expense to the patient or health care institution. Volume-directed catheterization should become a standard of care when intermittent catheterization is contemplated."

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