Wendy Naish, BSc (Hons), MA, RN.
Clinical Nurse Specialist - Urology, Epsom and St Helier NHS Trust, Epsom.Intermittent self-catheterisation (ISC) is defined by Shah and Leach (1998) as 'passing a catheter into the bladder to remove urine when the patient cannot pass urine normally'. The procedure may be repeated every few hours if necessary and is viewed as an alternative technique to an indwelling catheter as a means of managing urinary problems. ISC is an established intervention (Addison, 2001) and is recognised as a safe and effective procedure (Moore, 1995).
A retrospective audit was undertaken of patients who had been taught ISC between September 2000 and December 2002. Working alphabetically using surnames, alternate patients were randomly selected. Of a total of 126 patients, 63 patients were therefore selected to take part in the review. Medical notes were retrieved to accrue data on the reason for ISC, the date the patients started their treatment and any changes made at their follow-up appointments. A questionnaire was given to patients who attended the urology clinic for review between October 2002 and December 2002 (or sent to them by post if they did not have an appointment during this time) to gauge their opinions and experience of ISC and the service they had received.
The age range of the 63 patients was 20-98 years (mean 59 years). Of these 81% (51) were male and 19% (12) were female. The main reason for undertaking ISC were identified and categorised into six groups (Box 1). Figure 1 shows the number of patients in each group.
Knowing the frequency of ISC is important to ensure that patients are catheterising as often as necessary, but not too often, in order to maintain a healthy bladder. There are a number of different formulas found in the literature to determine what the frequency of ISC should be. For example Hunt et al (1996) suggest that volume on catheterisation should not exceed 300-400ml and that it is also important to consider the underlying aetiology, but in general catheterisation should be done frequently enough to avoid the bladder becoming over-distended and to prevent incontinence. We use a simple formula, which is a rough guide for patients to use until they are familiar with ISC. This is shown in Table 1.
Intermittent self-catheterisation (ISC) has gained in popularity since the 1970s and with its advantages for self-care should be offered to all patients as an alternative to managing their bladder-emptying problems. Offering ISC to patients with voiding dysfunction or bladder-emptying problems can enhance the quality of their life and give them the opportunity to resume normal voiding without the hindrance of an indwelling urinary catheter. The above results show that patients who chose ISC were happy to use this method of management for their urinary problems. The results of spontaneous voiding after failed TWOC is also supported by this review, with patients continuing to void spontaneously without the need for surgical intervention. (Patients are followed up for six months before being discharged and have not been re-referred by their GP.)
The author would like to thank Mandy Bell, former Urology Sister, for her help with this initiative.
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