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    Leaking Urinary Catheter

    My wife and I are the caregivers for our downs vent dependant daughter who sustained a c1-c2 injury in 1980. We have experienced many problems over the years and have overcome many. At present we are dealing with a high leakage foley catheter. Our doc took her off ditropan and for quite a while we had no problems. She is using an all-silicone foley 18 fr with a ribbed 5cc balloon and we normally use 10cc in the balloon. She is on Phenobarbital, Metoclopramide, Prevacid, Folamin, Nyasatin, Levothyroid, Warfarin, and Acidophilus. We were told by our rural urologist to clamp off the tube varying times and this would solve the problem and irrigation was also discussed. We are have a daily deluge which makes cleaning and bathing in bed tough on everyone. I would be forever grateful for some advice and help on this issue. We live in a very rural setting where getting local help is very difficult. Thanks

    #2
    Why was she taken off the Ditropan? Anticholenergic medications such a Ditropan are the the best treatment for spasms that cause leakage around the catheter.

    A 16 Fr. catheter is also preferred, even for adults. The larger the catheter, the more the bladder spasms. It is a myth that inserting bigger catheters is the solution for this. It is also potentially dangerous to clamp the catheter or do routine irrigations. Both put her at higher risk for UTIs, reflux of colonized urine to the kidneys, and can cause serious autonomic dysreflexia.

    I assume you are changing the catheter every 4-6 weeks? Is it encrusted on the inside when you do so?

    (moving this over to the Care forum)

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

    Comment


      #3
      We are not sure why she was taken off the ditropan - however the same doc just gave us another script for ditropan after my wife perswaded her to do so. I am asuming we should go back to a 16fr on the size which we can do. We usually have changed the catheter once a week and yes it is usually encrusted on the inside. We really appreciate your help in this. Thank you so much

      Comment


        #4
        Once a week is too often. Most can go 4-6 weeks between changes. How much water is she getting daily? Too little will contribute to encrustations. Lots of encrustations can usually be controlled with daily Renacedin instillations. Discuss this option with her urologist.

        (KLD)
        The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

        Comment


          #5
          We give her 500ml of gatoraid in the morning at 120 per hr then 2 cans of Peptamen 1.5 or 500ml at the same rate and finish up in the evening with another 500ml of gatoraid at the same rate. This schedule starts at 9am and goes until 9pm after giving her night meds we usually vent the feeding tube as she has some problems with excess air in her stomach. The gatoraid was her docs idea to keep her sodium level up as when it gets low she has seizures. Could the gatoraid be causing the encrustations?? We are not familiar with Renacedin instillations what exactly is that?The only water she gets is when the feeding tube is flushed after the liquid meds.

          Comment


            #6
            The Gatorade may be contributing to this, but if she has problems with hyponatremia then it may have to continue or use a different source of sodium (such as hypertonic sodium solution without all the other chemicals in Gatorade. It would be worth discussing with her physician.

            Renacedin is a chemical that you would instill through the catheter (using a sterile irrigation syringe) slowly (usually 30 cc.) and then clamp the catheter, letting the chemical sit in place in the catheter for about 20 minutes, then allow to drain by gravity. It can help to dissolve the encrustations and is used daily.

            (KLD)
            The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

            Comment


              #7
              I'm suddenly having leaking around a urethral catheter also. First happened 3 months ago and may have been due to a UTI. Finally got into my neuro-uro's PA January 2nd. She changed me from Ditropan XL 10 mg BID to 10 mg QD of VESIcare. Lots of bladder spasms and lots of leaking if I sit up or, for the 1st time in ages used my standing table, last night like crazy. Just had a UA and nothing at all. Still use a 14 French and tried the 3 weeks between changes again. Weekly works so much better for me.

              Anyway, PCP and I talked and after a month on Vesicare I'm going back to Ditropan XL and 10mg TID. Any problems I go back to 20mg a day. What could be causing this? I'm leaving for a long weekend tomorrow early and flying with a pad is going to suck. Oh, I drink about 1.5 to 2 liters a day normally. Hardly ever hit caffeine and drink a rare glass of wine except when cruising. Oh, have hyosycomine (HyoMax FT) .125 mg chewable to help in emergencies for bladder spasms but they aren't helping much right now.
              Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

              Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

              Comment


                #8
                Originally posted by Sue Pendleton View Post
                I'm suddenly having leaking around a urethral catheter also. First happened 3 months ago and may have been due to a UTI. Finally got into my neuro-uro's PA January 2nd. She changed me from Ditropan XL 10 mg BID to 10 mg QD of VESIcare. Lots of bladder spasms and lots of leaking if I sit up or, for the 1st time in ages used my standing table, last night like crazy. Just had a UA and nothing at all. Still use a 14 French and tried the 3 weeks between changes again. Weekly works so much better for me.

                Anyway, PCP and I talked and after a month on Vesicare I'm going back to Ditropan XL and 10mg TID. Any problems I go back to 20mg a day. What could be causing this? I'm leaving for a long weekend tomorrow early and flying with a pad is going to suck. Oh, I drink about 1.5 to 2 liters a day normally. Hardly ever hit caffeine and drink a rare glass of wine except when cruising. Oh, have hyosycomine (HyoMax FT) .125 mg chewable to help in emergencies for bladder spasms but they aren't helping much right now.
                Hi Sue,
                What is hyosycomine (HyoMax FT)? I never heard of it before. Please explain.

                Thanks,
                Bob
                Suprapubic Catheter 2/05

                Comment


                  #9
                  Originally posted by RAFS View Post
                  Hi Sue,
                  What is hyosycomine (HyoMax FT)? I never heard of it before. Please explain.

                  Thanks,
                  Bob
                  Suprapubic Catheter 2/05
                  http://www.drugs.com/pdr/nulev.html

                  My current is NuLev which is a generic of HyoMax FT. Levsin SL (under tongue) is being discontinued along with many of the generics both in quick dissolve/chew and sustained formats. I guess because the docs prefer Detrol and such. Anyway, it is a fast acting anti-cramping (spasming) med that is most often used for intestinal spasms for IBS, peptic ulcers and bladder spasms! No more than 3 a day are the normal doses and a few hours a part. They help those first 2 days of antibiotics when you have a UTI or have IBS pain. I was prescribed it for both. I have great insurance so the last tag said $0.00 but it is fairly inexpensive. Side effects are the same but much shorter duration as most the bladder spaze drugs like ditropan, detrol, vesicare.

                  Might discuss this one with your urologist or GI doc if it sounds like it might help the occasional "damnnnnnnnnnn, what was that" spasms in the pee holder.
                  Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

                  Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

                  Comment


                    #10
                    bump--help
                    Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

                    Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

                    Comment


                      #11
                      Originally posted by WLH View Post
                      She is using an all-silicone foley 18 fr with a ribbed 5cc balloon and we normally use 10cc in the balloon.
                      Hi WLH,

                      You and your wife should be commended for all the work and love you put into your daughter's care. It must be difficult for the two of you and I just hope you're able to find a solution to yet another "little SCI gift". That of Foley leakage. I can only imagine the number of problems you've been forced to find answers for over the past 29 years. I'm glad you finally found CareCure and SCI Nurse KLD. She is the best.

                      I don't know anything about Foley catheters but remember reading that some people inject 5ccs of saline into 10cc balloons in order to help reduce bladder spasms. Not the other way around of 10ccs into a 5cc balloon. The smaller the balloon size the less irritation there is to the bladder wall, hopefully resulting in less spasms. Unless you're having problems with the Foley coming out (or you have another reason) then I'd suggest filling the 5cc balloon with 5ccs of saline. My guess is your daughter's problems are more involved than simply the balloon size but every little thing you do to lessen the irritation to her bladder should help.

                      Best wishes,

                      Bob.
                      "Be kind, for everyone you meet is fighting a great battle." - Philo of Alexandria

                      Comment


                        #12
                        [Quote]...She is using an all-silicone foley...

                        Maybe try a silicone coated one. The 100%ers always make me leak, no problems with the coated. My theory is the stiffness of the all silicone irritates the bladder.

                        Comment


                          #13
                          We really appreciate the help and great advice. To continue on we have just moved back home from a 28 day stay at the local hospital for pnemonia. We are having trouble with the feedings with the gatoraid and the 1.5 Peptamen. She gets extremely distented after the feedings so they were cut totally off for about a week depending on IV. A .9% sodium chloride solution, Irrigation, USP is being used rather than the gatoraid and our Dr. is considering pulmocare because of the vent. We are giving her very small amounts (30cc) of the Peptamen 3 times daily until we get to try the Pulmocare. Do you have any other suggestions and is this sodium chloride solution the same as you recommended?? Thanks again for your help.

                          Comment


                            #14
                            Hello Bob
                            Thanks so much for your help and advice. I am slow getting back to you as we have had another onset of medical fun with a 28 day stay in the local hospital for pnemonia and we are now having problems with her feedings. Considering changing from Peptamen 1.5 to Pulmocare. Thanks again

                            Comment


                              #15
                              Thanks Rusty we have some of the coated ones and will try them. Thanks

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