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    Trouble changing catheter

    I've been having trouble changing suprapubic catheter, hoping somebody can offer some advice. I've been using a suprapubic catheter for about five years, started using the duette about six months after it was installed. Twice recently (a couple months apart), haven't been able to get the Duette to go through the stoma. When that didn't work, tried a regular catheter which wouldn't go through either. Went to the emergency room, they initially try a regular catheter for about 30 minutes with no luck. Both times, they eventually tried a catheter with a coude tip which went through the stoma almost immediately. I'm assuming because of the stiffness of the tip. The coude catheter is causing mild dysreflexia, which is the reason I started using the Duette in the first place. The only explanation they can give me is that the stoma tries to close up immediately after removing the catheter, but the new one is always attempted to be installed in less than a minute. Is there anything I can do beforehand to keep the stoma open?

    #2
    Two things can help.
    1. knowing the direction of your stoma. No they aren't just straight in. I have to insert the catheter at an angle that points toward my belly button.
    2. a stylet is a thin wire that slips inside the catheter and makes the catheter stiffer and easier to insert. You will need instruction from a nurse for use.

    See more about these in the following.

    See this thread, my post #7 and others
    https://www.carecure.net/forum/showt...tylet+catheter


    See this thread, my post #5
    /forum/showthread.php?257540-New-Placement-of-Suprapubic-Tube&highlight=stylet+catheter


    Last edited by gjnl; 2 Aug 2017, 8:20 PM.

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      #3
      Originally posted by gjnl View Post
      Two things can help.
      1. knowing the direction of your stoma. No they aren't just straight in. I have to insert the catheter at an angle that points toward my belly button.
      2. a stylet is a thin wire that slips inside the catheter and makes the catheter stiffer and easier to insert. You will need instruction from a nurse for use.

      See more about these in the following.

      See this thread, my post #7 and others
      https://www.carecure.net/forum/showt...tylet+catheter


      See this thread, my post #5
      /forum/showthread.php?257540-New-Placement-of-Suprapubic-Tube&highlight=stylet+catheter


      Is it usually the same direction? The person who changes it tells me they always try it in every possible direction/angle. I'm going to try to get in to the urologist office, I'll ask them about using a stylet.

      Comment


        #4
        Be very careful changing a catheter over a stylet. You can easily perforate your bladder. Most nurses don't know how to change a SP, nor use a stylet...in fact I have never worked anyplace where a nurse was allowed to place a catheter with a stylet in place; that was reserved for a physician only.

        You may also need to talk to your urologist about the need to do a stoma revision. Yours may have scarred down or developed a false passage (yes, that can occur in stoma tracts just as it can in the urethra if catheterization is done traumatically).

        (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
          I went to see a urologist today, she got the Duette to work, took a little bit of effort. I asked her about a stylet, she said no, that was for experts only. I'm going back next month to have it changed again, a revision isn't something I can do after all the trouble I had dealing with dysreflexia when they first did the procedure to create the stoma back in 2012.

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            #6
            I'm back to not being able to insert the duette through the stoma. I asked my urologist about a stylet, he told me no. I've tried placing the duette catheter in the freezer, this hasn't helped. I tried inserting the catheter in any possible angle, it refuses to pass through the stoma. I've tried twirling the catheter that is already in the stoma. I've tried twirling the catheter while trying to insert it, but it refuses to pass through. When I try the coude catheter, it passes straight through with no problem, but leaves me with dysreflexia. Anything else I can try?

            Comment


              #7
              Other than doing it the way you are and being proactive in your set up, I can not think of anything that might help technique wise. Are you on any bladder meds that might help with some spasticity that might interfere with your re-insertion.ckf
              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


                #8
                dumb question u got plenty of lube on it?

                Comment


                  #9
                  Not a dumb question at all! ckf
                  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


                    #10
                    Originally posted by vjls View Post
                    dumb question u got plenty of lube on it?
                    Yes, plenty of lubricant

                    Comment


                      #11
                      Just an update if anybody else has this problem. I went to the urologist, he recommended a device called a Jewett Sound, I think it's something surgeons use. After removing the catheter, the Jewett goes into the stoma and dilates it. I couldn't buy just one Jewett, had to buy a set with different sizes. Luckily this morning it worked. I tried inserting the duette catheter, it refused to pass through the stoma. I got the Jewett of the same size (18 French) and pushed it through the stoma, holding it there for a few minutes. After which, the duette still would not pass through the stoma. I used the next size of the Jewett (20 French), held it in place in the stoma for a few minutes, after which the duette still would not pass through. I tried the next size Jewett (22 French), held it in place in the stoma and rotated it, after which the duette passed through the stoma very easily. The Jewetts are made of stainless steel, I bought them used on eBay. I couldn't find new ones for sale anywhere.

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