Catherisation is another option for bladder management . It is advantageous in patients that are DP negative and recumbent , as it will reduce the risk of bed sores and urine scalding . Urine can be measured , and notes taken on the colour and aroma . All bladder management options have a risk of UTI but the process of placing a catheter into a cavity makes catherisation a high risk .
Bloor ( 2013 ) suggests using a closed system when using a urinary catheter system to prevent any catheterassociated UTI . A study by Bubenik and Hosgood ( 2008 ) showed that the longer the catheter was in situ , the greater the risk of a UTI . The study suggests that regularly turning the patient and putting them on antibiotics can help to prevent this .
In this case , the patient was monitored regularly using manual expression and ultrasound scanning . In the first few days post-surgery , the patient was very reluctant to come out of the kennel and did become stressed during the bladder check . In future , I would be keen to place a urinary catheter for the first few days post-surgery to allow the pain relief to take effect . This can also give the patient time to recover before manual expression .
Elizabethan collars should always be used when a patient has a urinary catheter placed . These prevent any interference with the catheter , which can cause bacteria to build up . Bloor ( 2013 ) suggests using daily urinalysis while urinary catheters are in situ , as they are easy to complete and allow early management of UTIs . Although this a more expensive solution , I feel it would be a good suggestion for future practice .
Alongside bladder control , it is important to turn the patient every 4 hours and monitor closely , to prevent urine scalding and decubital ulcers . In this case , a duvet and thick vet beds were used as the patient was leaking urine . The patient was also cleaned and dried every time it was turned . This approach was effective and well tolerated by the patient .
Remove the urinary catheter and cease manual expression once the patient is ambulatory , to allow it to urinate by itself . Close monitoring should follow to make sure the bladder does not become blocked or painful . Treatment should be given if the patient has not passed urine in 12 hours ( McKee , 2000 ).
Rehabilitation
Including a physiotherapy plan can help to improve the speed of the patient ’ s recovery , but should be followed with caution ( Barnes , 2003 ). Cage rest is essential for the first 48 hours after surgery , to make sure the patient has a chance to start healing before being able to walk . Assisted walking should then be started using slings and specialised harnesses to prevent any injuries . There are many types of physiotherapy that can aid in the recovery of IVDE patients , including cryotherapy , hydrotherapy and passive range of motion ( PROM ).
Cryotherapy involves placing an ice pack ( wrapped in a towel ) on the surgical site . It has been shown to provide analgesia and reduce inflammation ( Barnes , 2003 ) but should not be used for more than 10 – 20 minutes as it may cause local anaesthesia ( Davies Veterinary Specialists , 2018 ). Current evidence shows that there may be advantages of using cryotherapy with neurological patients and this will therefore be considered by my practice team .
PROM and massage help to prevent muscle atrophy and stiffness and are a cost-effective way to improve range of motion in patients . However , it is important not to start any PROM or massage for at least 24 hours post-surgery as the muscles need to recover . Some patients may not tolerate PROM or massage , due to their temperament . Any complicated surgeries should be passed on to a fully qualified physiotherapist ( Bloor , 2013 ). In this case , the physiotherapy was effective as the patient tolerated massage and PROM well .
In some studies , the use of transcutaneous electrical nerve simulation ( TENS ) aided patient recovery . This is because it encourages stimulation of the muscles and provides analgesia . We currently only use TENS on patients that are DP negative ( and have been for more than a week ) but , due to these findings , I would like to investigate using TENS earlier on DP-negative patients , to see if this has any effect .
Hydrotherapy is also useful in improving patient recovery , although it can be time-consuming and expensive . It is often used in post-surgery rehabilitation once the patient has gone home , as the wound needs to have healed first , to prevent infection and wound breakdown . I have seen many cases of hydrotherapy being used as a rehabilitation tool and all have worked well . A study by Ellapen et al . ( 2018 ) concluded that in 62 % of patients , hydrotherapy decreased their recovery time and provided analgesia .
In this case , the patient was still ataxic but ambulatory when discharged ( Figure 2 ). Recovery did not progress as hoped , and the owners said they struggled with the physiotherapy , so written instructions were given to help them complete the techniques .
28 Veterinary Nursing Journal