A case report of three people experiencing intractable autonomic dysreﬂexia following instillation of Uro-Tainer® Polyhexanide 0.02%

Spinal Cord Series and Cases, 2024 · DOI: https://doi.org/10.1038/s41394-024-00626-5 · Published: March 5, 2024

Simple Explanation

Bladder washouts are used to deliver treatments directly into the bladder, including solutions for catheter problems. However, there's concern people use these without fully understanding the purpose or having clinical guidance. Three individuals with spinal cord injuries experienced severe autonomic dysreflexia (AD) after using a specific catheter rinse solution. This AD required intervention to resolve the symptoms. The cases highlight the need for careful patient selection and clinical oversight when using catheter rinse solutions in people with SCI who are susceptible to AD.

Study Duration

Not specified

Participants

Three people living with spinal cord injury

Evidence Level

Level 4: Case Report

Key Findings

1
The use of Uro-Tainer® bags of PHMB as ‘catheter rinses’ presents risks for individuals with SCI, potentially leading to severe autonomic dysreflexia.
2
The availability of these solutions without adequate medical oversight may lead to misuse and potential harm, especially in individuals prone to autonomic dysreflexia.
3
Clinical oversight and monitoring are crucial when using these solutions, especially PHMB, in people with SCI, as it can trigger autonomic dysreflexia.

Research Summary

This case series highlights the potential risks associated with using Polyhexanide (PHMB) catheter rinses in individuals with spinal cord injuries (SCI), specifically the development of intractable autonomic dysreflexia (AD). The three cases presented demonstrate that PHMB can trigger severe AD, requiring immediate intervention to manage symptoms. This underscores the need for careful patient selection, clinical oversight, and monitoring during the use of such solutions. The study emphasizes the importance of clear guidelines regarding the indications, frequency, and administration of catheter rinses, particularly in individuals at risk of AD, to prevent potentially catastrophic outcomes.

Practical Implications

Clinical Guidelines

Develop clear guidelines for the use of catheter rinse solutions in individuals with SCI, particularly those at risk of AD.

Patient Education

Provide comprehensive education to patients and caregivers on the appropriate use of catheter rinses, including potential risks and monitoring strategies.

Neurogenic Bladder Assessment

Implement mandatory neurogenic bladder assessments and RN supervision for individuals at risk of AD before commencing catheter rinse solutions.

Study Limitations

1
The adverse reaction of intractable AD was only observed in three people.
2
The volume of solution could have been the causative factor for developing AD, rather than the active ingredient.
3
Underlying bladder pathology affecting bladder capacity, tendency to spasm or urothelial irritation in the absence of evidence of symptomatic UTI could be a factor.

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