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

• Published in: Spinal cord series and cases 2023-08, Vol.9 (1), p.39, Article 39
• Main Authors: Miller, T., Roik, L. J., Kalimullina, T., Samejima, S., Shackleton, C., Malik, R. N., Sachdeva, R., Krassioukov, A. V.
• Format: Article
• Language: English
• Subjects: 692/700/478; 692/700/784; Adult; Anatomy; Biomedical and Life Sciences; Biomedicine; Catheters; Catheters, Indwelling - adverse effects; Cross-Sectional Studies; Human Physiology; Humans; Neurochemistry; Neuropsychology; Neurosciences; Quality of Life; Spinal cord injuries; Spinal Cord Injuries - complications; Urinary Bladder, Neurogenic - complications; Urinary Bladder, Neurogenic - therapy
• ISSN: 2058-6124; 2058-6124
• DOI: 10.1038/s41394-023-00596-0

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 ( R 2  = 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.