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Urethera foleys, UTIs and instillations

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  • Urethera foleys, UTIs and instillations

    Would appreciate some input from folks who use uretheral foleys and who can give some pointers.

    My 77 year old Dad (incomplete para) is having more difficulties with aging, and is getting tired of all the daily SCI crap. Since being on home isolation since March, his physical therapy has stopped, and with more inactivity he's developed a couple of small pressure sores on his butt from ?inactivity/shearing. To stay off his butt, he changed his normal bladder management from CIC during the day and placing a foley himself each night, to using a uretheral foley all the time. This gives him a break from cathing and time off his butt.

    But unfortunately, it looks like he is having his 3rd UTI in a row since using the foley full time. This is not good.

    After a run of UTIs back in 2014, he started Gentamicin instillations with great success. Then last summer he had his first couple UTIs since 2015, and it was a Gentamicin resistant bug. He stopped the Gentamicin after treating his last UTI with fosfomycin, and amazingly he did ok without it and no UTIs for 6 months. He started using Microcyn instillations with CIC once every other day. Maybe that helped?

    But now UTIs are back. The same resistant bug from last year (ESBL E.Coli) came back first. Then about 10 days after treating the E coli, something else started growing (Citrobacter Koseri). Fortunately, everything has been treatable with oral antibiotics so far (fosfomycin, nitrofurantoin).

    It is a little tricky to figure out whether you have a true UTI vs colonization, and when to treat when you have a foley, I think. You lose all of your typical symptoms of cystitis that are relieved by the foley (urge/frequency, uretheral pain etc..). And if you are like my Dad, by the time you are 77 you have enough other medical problems that can make you feel crappy/sick/worse pain etc... that you sometimes don't know is it a UTI or something else causing my fever today? And Since my Dad has an immunodeficiency, it is really risky to wait until he spikes a high fever to start treating for UTI.

    So a couple questions for uretheral foley users.

    1) Any UTI prevention tips that are more specific for using a uretheral foley vs. CIC?

    2) If you instill with your foley, how exactly do you do it?

    So far, he separates the bag from the foley, instills the microcyn with a 60cc syringe, places a plug, lets it dwell for at least 30 minutes or so, then reattaches the foley to a clean drainage bag. Do you always reattach to a clean bag after instilling? How often do you instill? The process winds up taking a lot more time than instilling with CIC!

    3) And if you are using a uretheral foley all the time, are you considering a Superpubic? Why or why not?

    4) Did any of you get a superpubic specifically because you were having more UTIs with a uretheral foley? My Dad's docs claim a SPC would help decrease the infection rate. He's not ready to jump to that yet, but honestly, he loves not having to cath anymore, and long term foley might improve his quality of life. So maybe SPC is better for him?

    Any thoughts appreciated. My dad is just so tired.... of cathing, of instilling, of UTIs ... of everything SCI.

  • #2
    Originally posted by hlh View Post

    1) Any UTI prevention tips that are more specific for using a uretheral foley vs. CIC?
    Unfortunately, having a foreign body inside the bladder 24/7 (either urethral or SP) will significantly increase the risks for colonization, and UTI in most people.

    Originally posted by hlh View Post
    2) If you instill with your foley, how exactly do you do it?

    So far, he separates the bag from the foley, instills the microcyn with a 60cc syringe, places a plug, lets it dwell for at least 30 minutes or so, then reattaches the foley to a clean drainage bag. Do you always reattach to a clean bag after instilling? How often do you instill? The process winds up taking a lot more time than instilling with CIC!
    This is fine technique, although many cannot tolerate plugging the catheter for 30 minutes, and only do 10-20 minutes.

    Originally posted by hlh View Post
    3) And if you are using a uretheral foley all the time, are you considering a Superpubic? Why or why not?
    For men, the SP has two main advantages: 1) no interference with genital sexual activity and 2) less risk of trauma to the lower urinary tract (ie, bladder neck, prostate, and urethra). Changing a SP catheter requires a different technique than a urethral catheter, but once learned it is no more difficult.

    Originally posted by hlh View Post
    4) Did any of you get a superpubic specifically because you were having more UTIs with a uretheral foley? My Dad's docs claim a SPC would help decrease the infection rate. He's not ready to jump to that yet, but honestly, he loves not having to cath anymore, and long term foley might improve his quality of life. So maybe SPC is better for him?
    This probably has little effect on the number or severity of UTIs with long term use.

    Originally posted by hlh View Post
    Any thoughts appreciated. My dad is just so tired.... of cathing, of instilling, of UTIs ... of everything SCI.
    Has he been checked for possible prostatitis? When a UTI comes back with the same bug and strain time after time, I always want to be sure there are no problems such as stones, prostatitis, or bladder diverticuli that are allowing bacteria to hide out from the antibiotics while becoming more resistant, and reseeding bacteria into the urine once the course of antibiotics is over.

    (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.

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    • #3
      Thanks so much for your input KLD.

      My Dad's urologist is experienced with neurogenic bladder, but has been pretty slow to repeat testing for the things you suggest. If my Dad looks like he has his 3rd UTI in a row (vs. just colonization.... sometimes so hard to tell...) and it is the same E.Coli ESBL that he has had previously, then we will push his urologist to repeat testing. So far, his UTIs recently have been two different bugs.

      So I wonder.... maybe no one is using a uretheral foley these days?

      Wondering again if anyone does instillations twice a day.... like the protocol recommended for possibly "treating" a UTI with microcyn (or the equivalent)? And if so, after each instillation, do you plug and then reattach a brand new/clean drainage bag? Or do you reattach the same/previouly used bag? It is a lot of work to keep up the cleaning of so many bags - especially when they are full of bacteria. But obviously a clean bag is better....

      Does anyone have a caregiver do the instillations? So far my Dad has been doing the instillations with my assistance. He attaches the foley to the bag so hard that I can't separate them. He is scared they will separate while he is walking, so he connects them hard. But he now has some pressure sores on his butt so he should be off it as much as possible, so maybe I need to start doing it all for him.

      BTW - my Dad also does some walking with crutches/AFOs - if anyone else who uses a foley and walks has some suggestions for my Dad, would appreciate it. Walking with leg bags/foleys has its own joys/issues.

      Do most foley users (SPC or uretheral) just have bags full of bacteria all the time, with odor/cloudiness, from colonization? It is really unpleasant, I've gotta say. After putting in a new foley, or after treating a UTI with antibiotics, how quickly does your colonization reappear?

      Sorry for all the questions.... Appreciate any help.

      Comment


      • #4
        Colonization is a bacteria growing in the bladder; it does not apply to bugs in the drainage bag. If you have good quality bedside and leg bags, they should have a anti-backflow valve at the top of the bag to prevent urine in the bag (which is pretty much always full of bacteria) from flowing up the drainage tube into the catheter and bladder. The FDA requires such valves on urinary drainage bags of all types.

        As far as how quickly urine becomes colonized when a new catheter is inserted into a bladder with no bacteria, most research on this is done with ABs who are using an indwelling catheter for short periods (3-7 days). It indicates colonization for nearly 100% of these patients within 3 days.

        Now that your dad is using an indwelling catheter, it is best, if possible to maintain a closed system. As previously discussed here, this means leaving the leg bag on all the time, and at bedtime connecting a cleaned bedside bag to the outlet valve of the leg bag. That bag should be cleaned daily with 10% bleach solution. It is best not to remove and clean the leg bag.

        Yes, odor can be a problem, although often this means that the person is not drinking sufficient fluids. For most people this means at least 3 liters of water daily when using an indwelling catheter.

        Obviously, if you are using instillations, with the set-up above, you need to disconnect the leg bag from the catheter. As long as you are maintaining a sterile technique for the instillation, and wearing exam gloves, is it fine for a caregiver to do the instillations for him. This is what is done for most people with tetraplegic injuries who cannot do it themselves.

        (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
          Originally posted by hlh View Post

          BTW - my Dad also does some walking with crutches/AFOs - if anyone else who uses a foley and walks has some suggestions for my Dad, would appreciate it. Walking with leg bags/foleys has its own joys/issues.

          Do most foley users (SPC or uretheral) just have bags full of bacteria all the time, with odor/cloudiness, from colonization? It is really unpleasant, I've gotta say. After putting in a new foley, or after treating a UTI with antibiotics, how quickly does your colonization reappear?

          Sorry for all the questions.... Appreciate any help.
          The foley catheter was tearing up my Johnson. I think they call it erosion. The pubic cath is not perfect but it works well for me. Now my Johnson is free also. I don't understand the stinky dirty bag issue. My bags last about 2 weeks. One 2000ml bed bag for sleeping uninterrupted. A smaller 1000ml (or 500ml) with shorts during the day to wear under clothing. When switching from one bag to the other I rinse the removed bag COMPLETELY with warm or hot water out of the tap. Run water thru the tubing till the bag is half full. Then shake it all around and drain thru the drain valve. Takes about 30 seconds. Leave it to air dry till the next use. Maybe I am just lucky but my bags never stink. Of course this violates the closed system rule.

          Don't know what walking issues he has but if the bag is secured up higher on the thigh or even hung from the waist it won't get kicked around as much.


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          • #6
            Another thought is trying the Rusch Belly Bag:
            https://www.allegromedical.com/cathe...c-p193132.html

            (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

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