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Urological problem solving - Suprapubic catheter's balloon blocking its lumen?

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    Urological problem solving - Suprapubic catheter's balloon blocking its lumen?

    I have been using the same brand of Bard silicone-coated latex (24fr, 5cc) catheters (suprapubic) for years:

    For the last couple weeks, I have had trouble with my catheter draining. We have tried the solutions that usually work for me, including irrigation with saline and changing the catheter (several times). None of this worked. Irrigating was very difficult, both pushing in the fluid and pulling it out were met with much resistance. Also, the urine was clear, and there was no blockage, mucus, sandy sediment, or anything in the tube that would obviously impede flow. The catheters were not kinked/bent.

    When my bladder gets full, I have extreme spasms and autonomic dysreflexia, with very high blood pressures. The urine does not leak through my urethra until these spasms have already become severe, and my blood pressure is in the 200s/100s. I have even had diastolic pressures approaching 200. My head feels like it is pounding from the pressure. I worry that this could cause permanent damage to my kidneys if there is backflow.

    My level is C-4/5, and I am not able to manage a catheter change myself. When I am alone and a situation like this occurs, I have had to call my wife home from work for help, and once I called 911, and had to go to the emergency room to manage the issue.

    For several days, the only way I was able to get urine through the catheter was to suction it out of the catheter with a syringe, with great force.

    I have seen three urologists over the past couple weeks, have had ultrasounds, urine cultures, and cystoscopy. One of the urologists thought I probably had an infection that was causing the spasms and pinching down on the catheter, blocking flow. I increased my daily Ditropan XL from 10 mg to 30 mg, but this did not help with the spasms. I consulted with another urologist about trying Botox injections to reduce the spasticity, hoping that that might keep the spasms from pinching off the catheter.

    Others have mentioned trying to rotate the catheter, twisting it in place or trying to reposition it somehow, or to add more fluid into balloon to move the catheter tip away from the bladder wall. None of this worked.

    After all of the diagnostics and cultures, everything looks good—no stones, no infection, no problems with the bladder tissue or malformations such as diverticuli, no inflammation, etc. We concluded that the issue must be caused by the spasms pinching off the catheter, and I decided to schedule for Botox injections.

    After two weeks of hell, we did one more catheter change on Monday morning. When we let the volume out of the catheter balloon, about 200 mL of urine flooded through the catheter into my bag. Relief!

    Since we changed to a new catheter, I have had no flow problems since.

    I spoke to a nurse at Craig Hospital yesterday and she suggested that I may have had a bad batch of catheters. She said that other patients have had similar issues. What was happening with them was the catheter balloon was defective and when it was inflated, it squeezed inward and pinched off the lumen of the catheter, blocking all flow through it. This explanation seemed to be consistent with everything that has happened so far, but I am unable to confirm it, because we already disposed of the problematic catheters. The new one has been working fine.

    Also at Craig, they gave me a different (possibly less irritating) style of catheter to try:

    I am curious to get others to weigh in on this whole situation and to find out if anyone else on the forum has had a similar problem.

    Yes you could have had a bad batch of catheters - it has happened with my patients also.

    Next, do not use saline to flush - use sterile water or diluted acetic acid solution. If you have a history of bladder stones, high percentage of sediment in your urine then flushing works well.

    Rule of thumb - if you don't get good urine output - then something is wrong and change the catheter. Report the defective catheters to the medical supply company you have received these from or in turn the company who makes the catheters.

    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.



      I have been dealing with this issue for years. You are the first person I have seen write about this issue on CareCure. I have had a suprapubic catheter since ‘88. I started out using a 22gauge catheter which I would change monthly. I didn't seem to have many issues the first few years. But since I'm a high quad and live alone I moved to a 24gauge because of catheter clogging during the night and now use a 26guage.

      For about the last 22 years I've dealt with catheters that do not flow well. I've tried various brands and various types and they all seem to have the same issue. I have often thought the canal for the balloon must have a weak area(s) where it narrows the flow of urine. I spoke to quality assurance at Bard numerous times in all they would ever say is that I was the only one to ever complain. I've only heard of one of the quad that had, or should I say, noticed this issue.

      Nobody seems to think this important issue, I think most people think I'm a hypochondriac, but when you put that catheter in the morning and have to live with it all day not flowing well it's pretty damn miserable. By the end of the day I will be nauseous like I have the flu and my bladder and kidneys be killing me. I will end up with too much fluid in my intestines and then have problems with diarrhea. Lovely. This has to be damaging to the ureters and kidneys

      My attendance usually think I'm nuts changing catheters one after another, but once I shown them the issue and the difference in the flow rate of a good catheter and a bad catheter even they plainly see the difference.

      A box can be completely good, partially good, or completely bad. I keep track of the lot numbers for every box I get and keep track of which are good and which are not. If a batch is bad the ext box from the same batch will also be completely bad.

      I have tried just about all the brands out there as well as the various types: silicon coated, 100% silicon, lubricous, etc and they all have this issue. I currently use Rousch silicon coated, 100% silicone, and Kendall 100% silicone. A number years ago these seem to be the best, but now the error rate is pretty high with these as well.

      I'm sorry I have nothing to offer in the way of a solution, but this is a great frustration for me as well and can make life quite miserable. If you come up with a better brand catheter with a low rate of that catheters please post.
      Last edited by NWC4; 24 Jun 2012, 8:06 PM.