F- CLINICAL ASPECTS OF SPINAL CORD INJURIES
383
increased the cost, it greatly facilitates self-catheterization and is undoubtedly more safe
and less time-consuming.
CATHETER BLOCKAGE
Patients with indwelling catheter must also be made aware of the symptoms resulting
from bladder distension (see p. 336) following blockage of their catheter due to kinking,
mucus, stones or due to failure to empty the bag or Winchester. Immediate steps must
be taken to relieve the blockage, which is of particular importance in cases with reflux
into the upper urinary tract or in high cord lesions.
5. Measures of controlling infection
(a) Mechanical procedures
BLADDER WASHOUTS
In cases with indwelling urethral or suprapubic catheters, irrigation of the bladder should
be carried out at least once a day, especially in the morning. Bladder washouts should be
done with a syringe rather than with a funnel as the pressure used by the syringe facilitates
the cleaning of the bottom of the bladder, in particular in crenated bladders with diverti-
culosis. However, care must be taken not to distend the bladder in order to avoid
autonomic hyperreflexia. In this connection, it may be noted that Riddoch (1917)
mentioned in his classical paper, that one of his patients complained about 'head fullness'
during bladder washout, which was the instigation to my own research on the effects of
bladder distension on the cardio-vascular system. It is also useful to turn the patient
during the washout from the supine into semi-lateral position, which will facilitate the
removal of mucus and sediment. The fluid used for bladder washouts should be tepid
(85~9O0 F). The solutions recommended for irrigating bladder with alkaline urine are
0-5 per cent acetic acid, 4 per cent boric acid, Zephiron i : 1000 or flavozole i : 2000.
When the urine is acid, normal saline or potassium permanganate i : 2000 is recom
mended. If pyocyanea infection of the urine is prevalent, washouts with phenoxetol sol.
2-4 per cent, followed by saline, used for 2-3 days, proved effective. In cases with phos-
phatic deposits, we have used Suby's solutions G and M (Suby, Suby & Albright, 1942)
which like Renacidin sol. 10 per cent (as recommended by Mulvaney
el
a/., 1960 and
Bors & Comarr, 1971) has proved useful in dissolving gravel and bladder stones of small
size. However, caution is suggested with the use of renacidin for bladder irrigation in
the presence of reflux, as acute damage to the kidney may occur. The efficiency of these
irrigations is increased by frequent changes in the solutions employed with a view to
producing changes in the pH of the urine.
Tidal drainage has also been used for bladder irrigation in later stages of paraplegia,
but it is of use only if it is understood by all concerned including the patient. We have
used it in suitable cases only during the day under proper control and found it in such
cases very useful in cleansing the bladder from sediment, mucus and even small stones.
Other authors who also still use tidal drainage in selected cases, are Talbot (1963) and
