Q: Are there standards for when to start bladder training for patients with spinal cord injury in the critical care unit versus not clamping a urinary catheter because of the possibility of catheter-associated urinary tract infection? When the catheter is unclamped, what is the threshold for urine returned that would be of concern?

A: Mikel Gray, PhD, FNP, PNP, CUNP, CCCN, replies:

Thanks for asking these timely and clinically relevant questions. Although nurses have historically advocated removal of indwelling catheters whenever feasible, the current focus on prevention of catheter-associated urinary tract infections has accelerated clinical decision making related to identifying the earliest possible time for removal. The Consortium for Spinal Cord Medicine has developed 2 clinical practice guidelines that address management of neurogenic bladder dysfunction following spinal cord injury.1,2  The Consortium is a multidisciplinary group whose members include the American...

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