Focus: Wound Care & Catheterization
Spinal cord injuries (SCI) dramatically alter a person’s mobility, sensation, and independence. Behind every client living with SCI is a team of healthcare professionals helping them navigate a new normal—and at the heart of that team is often a Registered Nurse (RN).
RNs play a crucial role in clinical care, education, prevention, and advocacy—helping clients manage complex physical needs while preserving dignity and quality of life. Two key areas of nursing involvement in SCI care are wound management and catheterization.
Understanding Spinal Cord Injury
SCI can result in partial or total loss of motor function, sensation, and autonomic control below the site of injury. This can affect:
- Bladder and bowel function
- Skin integrity and circulation
- Muscle tone and spasticity
- Mobility and pressure management
Clients with high-level injuries (e.g., cervical SCI) often require more comprehensive care, including mechanical lifts, full catheterization support, and advanced wound prevention.
Wound Care: Prevention, Monitoring & Healing
Pressure injuries (bedsores) are a major concern for SCI clients, particularly over bony prominences such as the sacrum, heels, and ischial tuberosities. Impaired sensation means early signs of skin breakdown can go unnoticed by the client.
The RN’s role includes:
- Skin assessments
- Staging pressure ulcers and documenting changes
- Dressing changes using appropriate wound care products
- Collaborating with wound care specialists for complex or non-healing wounds
- Educating clients and caregivers on repositioning, offloading, and skin inspection routines
Proactive pressure injury prevention is just as critical as treatment, and RNs are central in training PSWs, family caregivers, and clients in daily skin care practices.
Catheterization: Managing Neurogenic Bladder
SCI can disrupt normal bladder function, leading to neurogenic bladder, which requires careful, consistent management to avoid infection, incontinence, and kidney damage.
Types of catheterization commonly used in SCI care:
1. Intermittent Catheterization (IC):
- Involves inserting and removing a catheter several times per day
- Preferred for long-term bladder management if the client or caregiver is able
- RNs may teach the client or caregiver to self-catheterize, or provide IC during home visits
2. Indwelling Catheters (Foley or Suprapubic):
- Remain in place and drain continuously into a collection bag
- RNs are responsible for regular catheter care, monitoring for signs of infection, and changing the catheter as prescribed
3. Condom Catheters (for males):
- External device used in some cases of incontinence
- RNs ensure proper fit, hygiene, and skin integrity to avoid complications
Additional RN responsibilities include:
- Monitoring for urinary tract infections (UTIs)
- Teaching clean catheter technique
- Managing bladder irrigation or flushing, if needed
- Advocating for urology consults or changes in catheterization approach if problems arise
Beyond Procedures: The RN as Educator & Advocate
RNs not only provide hands-on care, they also:
- Educate clients and families about long-term SCI management
- Promote autonomy by training clients in self-care techniques
- Advocate for assistive equipment (e.g., specialty mattresses, cushions, lifts)
- Support mental health, referring to counseling when needed
Final Thought
Caring for clients with spinal cord injury requires knowledge, compassion, and consistency. Registered Nurses bring all three to the table—ensuring that essential clinical tasks like wound care and catheterization are performed safely while empowering clients to live as independently and comfortably as possible.
Their role is more than medical—it’s deeply human.