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should be avoided and replaced by containers of light plastic material to prevent pressure
sores.
DRAINAGE BAG
All that has been said about the care of the urinal also applies to the drainage bag con
nected with the indwelling catheter. The urinal commonly used for this purpose was
the G.U. supra-pubic bag but in recent years more and more plastic bags either disposable
or supplied with a tap which can be opened to drain the urinal are used, which have the
advantage that one can see the condition of the urine especially the degree of sediment
and mucus, and as this bag is marked one can measure the amount of urine drained at
different times. Whether this equipment or other types of containers are used, a closed
drainage system between the catheter and the drainage bag has to be established, both
during the day and the night, by attaching the catheter to the nozzle of the rubber urinal
or plastic container or by means of sterile glass and tube connections with a Winchester
which does not represent a closed drainage system and following sterilization should con
tain some antiseptic fluid. If the male paraplegic with an indwelling catheter is lying in
bed and the catheter is connected with the urinal or Winchester the connecting tube
should never be placed back between the legs to drain behind the patient because of the
danger of producing damage to the urethra, but the catheter should be placed forward
and upwards from the end of the penis.
As pointed out earHer, no satisfactory urinals for female paraplegics have yet been found,
and it is even more important to restore bladder continence in these patients by early
training. It is our experience that this has proved more satisfactory than in the male.
Those females who, because of their particular bladder dysfunction (dys-co-ordinated
spastic automatic bladder), cannot achieve this have to be satisfied with regular changing
of soft absorbant pads unless trials with Vincent's technique are made first (see p. 375)
which, as pointed out, has the risk of developing pressure sores in complete lesions.
Keane of the Spinal Unit in Dublin developed a suction device, called Urovac, which
prevents continuous incontinence in bed-ridden female patients with progressed multiple
sclerosis by electrically controlled suction. This apparatus can be fixed to several patients
in the ward and through a common tube the urine is sucked out into a large container
outside the ward to prevent offensive odour. However, for female paraplegics who are
able to move about in their wheelchairs this device has so far not proved successful.
3. Reconditioning of bladder function by training—self-care
The paralysed patient should be made fully aware and in detail of his bladder dysfunction
by the medical and nursing staff, and this should start as early as possible during the
intermediate stages to ensure his full co-operation and develop his own responsibility
for the control of his bladder dysfunction. As soon as he is catheter-free he must learn to
correlate the fluid intake with emptying the bladder at regular intervals according to
bladder capacity and presence or absence of infection. The amount of fluid intake varies
between 3-6 pints within 24 hr, and in the presence of bacteriuria—i.e. non-active
