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PSG-03 Occupational Therapist

SELF-CATHETERIZATION AIDS FOR DISABLED FEMALES Charles J. Laenger PE, Constance Thompson RN, Jim Lee Kaiser Rehabilitation Center Tulsa, Oklahoma

ABSTRACT

Loss of hand or arm function prevents certain female clients from performing intermittent urinary catheterization. Devices that will help hold and position the catheter relative to the "target" or uretheral orifice are needed.

This same or a companion device must assist in spreading and holding the labia to expose the orifice and make it available for insertion of the catheter. A free-standing or leg-supported mirror is used by the client to view the orifice.

This facility has designed such assist devices which have been tried by two disabled clients. This has improved ability to position and handle the catheters; however, neither client has developed enough skill or confidence to use them on a functional basis.

BACKGROUND

Inability to perform intermittent self-catheterization deprives many disabled women of privacy and independence. They must rely upon help of others or yield to installation of indwelling catheters which are inconvenient and are sources of infection. Some of these clients may be able to perform self catheterization if a device that will hold and guide the catheter is provided. Even though no device that accommodates all clients and situations has been developed, some progress has been made. Hopefully, other developers will benefit from the efforts described herein.

OBJECTIVE

The objective was to design and fabricate aids that would enable female clients with limited hand function to perform intermittent self-catheterization.

APPROACH

This facility designed several assist devices which help spread and hold the labia and direct the catheter toward the uretheral orifice (see Figure 1). The labia holder and catheter guide was made from thin, transparent, heat formable plastic material. A jig was made of heavier plastic sheet material which is easily modified. The plastic sheet is heated with an electric heat gun and then molded around the jig.

Figure 1. Labia holder and catheter guide and holder.

Since anatomy of external genitalia varies in females, the patient is examined by a nurse with extensive experience. The nurse and engineer collaborate on design configuration for the catheterization aid. The vertical dimension from the buttocks, when the patient is supine, to the uretheral orifice is critical (see Figure 2). The shape of the body of the transparent aid is important because it must hold the labia majus apart to expose the "target" to the view of the client. The examining nurse also provides specifications regarding shape and size of the labia spreader-holder part of the fixture. Another purpose of the fixture is to retain position of the catheter any time the user releases her grip.

The catheter is threaded into a small hole in the fixture. This friction fit helps the user control penetration rate and keeps the catheter in position even if it slips from the hand. Alternately, a larger window can be used if the client has good hand function and good vision. The base of the assist device is stabilized by slipping it under the buttocks of the user. A "blank" or unfinished fixture is provided to the nursing staff who mark it so that a catheter insertion or guide hole can be machined into the fixture.

One candidate was a twenty-five year old woman who was one year post traumatic injury. She had multiple bone fractures and amputation of her non-dominant left arm below the elbow. She was somewhat overweight and her trunk range of motion was restricted by a body cast. She drove a powered wheelchair with her dominant right hand. She wished to achieve a measure of independence by developing the ability to perform intermittent self- catheterization. Because she had limited range and short arms, she was unable to successfully perform self- catheterization.

Figure 2. Female Genitalia

Similarly, another client had both hands, but was weak and had poor dexterity. The assist device was helpful but the head-injured client never developed the capability to perform self-catheterization on an entirely independent basis. Cognition was a factor.

Figure 3. Fixtures must be custom fabricated to accommodate anatomy and capability of user.

Self-Catheterization Aids

DISCUSSION

Self-catheterization by disabled females, such as those suffering from neuromuscular disorders or traumatic injury, is an important but very difficult goal. First, it is difficult to acquire clients who are willing to participate in a development program. Second, adequate assist devices or technical expertise for designing them, are not ordinarily available. Third, it is difficult to acquire reimbursement for this effort. The interest and participation of other rehabilitation facilities and staff members toward the solution of this task is encouraged.

CONCLUSION

Many disabled females would be much more independent and employable if they could perform intermittent urinary catheterization. Partially successful results have been achieved at this facility through modest development efforts. Other innovators and developers are encouraged to address this difficult and very significant problem.

REFERENCES

1. Asayama, K.; Kiharazak K, Shidoh, T; Shigaki, M.; Ikeda T.; "The Functional Limitations of Tetraplegic Hands For Intermittent Clean Self-Catheterization, Paraplegic" 33(1) 30-33 Jan 1995

2. Billau, BW; Howland, DR; "Self-Catheterization for the Woman With Quadriplegia", The American Journal of Occupational Therapy" 45(4): 366-369, April 1991

3. Hunt, GM; Whitaker, RH, "A New Device for Self-Catheterization in Wheelchair-Bound Women", British Journal of Urology 66(2):162-3, Aug 1990

ACKNOWLEDGEMENTS

The nursing and technical support staff of this facility have worked on development of catheterization assist devices on an "off-the-record", non-reimbursed basis. Cerca 1986, a labia spreader-holder was fabricated and successfully used by an inpatient with limited use of one hand and arm. Cerca 1987, a knee-held mirror, was developed. Cerca 1991, a catheter guide was made for an inpatient with limited hand function. Results of these efforts were not published because limited success was achieved. Nevertheless, this staff recognized the need for catheterization aids and has developed partially successful devices. Frustration abounds because resources are not available for a concentrated attack on this problem.

Charles J. Laenger, P.E., Manager Rehabilitation Engineering Kaiser Rehabilitation Center 1125 South Trenton Tulsa, Oklahoma 74120 918-579-7347Self-Chatheterization Aids for Disable Females