Heart Rate Variability During Urinary Bladder Catheterization in Individuals with Spinal Cord Injury: Anxiety vs. Sensory Activation During Catheterization

Background: Urinary catheterization is a routine procedure for individuals with spinal cord injury (SCI), but it can provoke autonomic responses that may lead to autonomic dysreflexia (AD). Understanding how different catheterization methods impact autonomic responses is crucial for effective patient management. This study aims to evaluate the impact of anxiety versus sensory discomfort on autonomic responses during catheterization.
Objective: To assess cardiovascular autonomic responses and anxiety levels during three types of urinary catheterization (self-performed, blinded nurse-performed, unblinded nurse-performed) in individuals with chronic SCI, and to determine the relative contributions of anxiety and sensory discomfort to these responses.
Methods: Seven adults with chronic motor-complete SCI (AIS A/B) and lesions above T6 participated in three catheterization scenarios: self-catheterization, blinded nurse-performed, and unblinded nurse-performed. Cardiovascular responses were monitored using finger plethysmography (blood pressure) and ECG (heart rate). Anxiety was measured with the State-Trait Anxiety Inventory Short Form (STAIS-5) and Generalized Anxiety Visual Analog Scale (GA-VAS). Heart rate variability (HRV) was analyzed to gauge autonomic balance, with low-frequency (LF) and high-frequency (HF) components representing sympathetic and parasympathetic activity, respectively.
Results: Heart Rate Variability (HRV): Increased sympathetic nervous system activity was noted during nurse-performed catheterizations (blinded: LF = 0.5 ms; unblinded: LF = 0.5 ms) compared to self-catheterization (LF = 0 ms). Systolic Blood Pressure: No significant changes in systolic blood pressure or evidence of AD were observed across catheterization methods. Anxiety Scores: STAIS-5 scores were stable across methods (e.g., Self-catheterization pre: 1, post: 1; RN-unblinded pre: 1, post: 1; RN-blinded pre: 2, post: 1). GA-VAS scores similarly showed minimal variation (e.g., Self-catheterization pre: 1, post: 1; RN-unblinded pre: 1, post: 1; RN-blinded pre: 2, post: 1).
Conclusions: Nurse-performed catheterizations lead to increased sympathetic activity, as evidenced by higher LF HRV, without inducing AD. The stable anxiety levels across different methods suggest that sensory discomfort may be a more significant driver of sympathetic responses than anxiety. These findings underscore the need for tailored care strategies to address sensory discomfort during catheterization, potentially enhancing patient outcomes and managing autonomic responses more effectively for individuals with SCI.
Implications: This study highlights the importance of addressing sensory discomfort in addition to anxiety when managing catheterization in individuals with SCI. By focusing on reducing sensory discomfort, healthcare providers can improve patient comfort and potentially reduce sympathetic responses during catheterization, contributing to better overall care and management for individuals with SCI.
Lay Abstract: For individuals with spinal cord injuries (SCI), urinary catheterization can impact heart rate and blood pressure. This study explored how different methods of catheterization—self-performed, blinded nurse-performed, and unblinded nurse-performed—affect heart rate variability and anxiety. Results showed that nurse-performed catheterizations increased sympathetic nervous system activity compared to self-catheterization, although anxiety levels remained stable. This suggests that sensory discomfort plays a more significant role in these responses than anxiety. The findings could guide improved care practices for individuals with SCI by focusing on minimizing sensory discomfort to enhance patient comfort and care during catheterization.