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Urethera foleys, UTIs and instillations

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    #16
    Originally posted by hlh View Post


    Thanks for this. I saw one of the plastic ones and wondered...

    Did you guys do instillations sometimes with the SPC? How did you do it? DId you use a clamp?
    Yes, of course, GJ did supra pubic catheter instillations for years using super-oxidized water (SOW) products like Microcyn wound and skin spray. I instilled about 30cc fluid, Microcyn spray diluted a little, with saline. I used a Bard catheter plug (https://store.mvmsinc.com/bard-cathe...cap-p1093.aspx), cleaned with an alcohol wipe to plug the end of the catheter. The instillation was retained for about 10 minutes, then drained by reconnecting to the drainage tubing.

    The instillations were usually done in bed at night. If the urine began to look cloudy, an instillation was added in the morning before dressing.

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      #17
      Originally posted by gjnl View Post

      Yes, of course, GJ did supra pubic catheter instillations for years using super-oxidized water (SOW) products like Microcyn wound and skin spray. I instilled about 30cc fluid, Microcyn spray diluted a little, with saline. I used a Bard catheter plug (https://store.mvmsinc.com/bard-cathe...cap-p1093.aspx), cleaned with an alcohol wipe to plug the end of the catheter. The instillation was retained for about 10 minutes, then drained by reconnecting to the drainage tubing.

      The instillations were usually done in bed at night. If the urine began to look cloudy, an instillation was added in the morning before dressing.

      Thanks for sharing your extensive experience.

      When you reconnected after instillation, did you reconnect to the same drainage bag (leg bag?) that he was using during the day? Or did you have a clean one available that you switched to instead? If you reconnected to the previously used drainage bag, how did you keep it "clean" while waiting for those 10 minutes? Did you just recap it with a clean cap, then wipe it with an alcohol wipe before reconnecting? If so, how long would you keep re-using the same leg bag that is re-opened daily? Did you ever use a clamp instead of the plug, like KLD suggests?

      Right now, I help my Dad do his instillations during the day, right before his bed bath. He also has been using a plug while retaining the instillation. And so far we have always been reconnecting to a new or clean drainage tubing/bag.

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        #18
        Originally posted by hlh View Post


        Thanks for sharing your extensive experience.

        When you reconnected after instillation, did you reconnect to the same drainage bag (leg bag?) that he was using during the day? Or did you have a clean one available that you switched to instead? If you reconnected to the previously used drainage bag, how did you keep it "clean" while waiting for those 10 minutes? Did you just recap it with a clean cap, then wipe it with an alcohol wipe before reconnecting? If so, how long would you keep re-using the same leg bag that is re-opened daily? Did you ever use a clamp instead of the plug, like KLD suggests?

        Right now, I help my Dad do his instillations during the day, right before his bed bath. He also has been using a plug while retaining the instillation. And so far we have always been reconnecting to a new or clean drainage tubing/bag.
        Since GJ's instillations were at night, he was in bed and draining into a clean plastic, night drain bottle (Urocare) after he retained the instillation. I cleaned the leg bag the during the instillation and hung it to dry overnight. I always used alcohol wipes to clean plugs or tubing connectors before they went into the catheter. The night drain bottle sat in a plastic shoe box to catch accidental spills or leaks, and the tubing connector was wiped down, capped, and then wiped down again before connecting to the catheter.

        We only used the Bard catheter plug, never tried a clamp. That said, one time in a pinch (I forgot to pack the plug) while traveling, I used one of the ACCO binder clips (https://www.officedepot.com/a/produc...e-Black-12Box/). I wouldn't recommend that for long term use, but in a pinch you improvise.

        GJ used the same Urocare disposable vinyl leg bag daily for a month. The bag was cleaned with bleach solution or 91% isopropyl alcohol and hung to dry overnight.

        Comment


          #19
          Originally posted by gjnl View Post

          Since GJ's instillations were at night, he was in bed and draining into a clean plastic, night drain bottle (Urocare) after he retained the instillation. I cleaned the leg bag the during the instillation and hung it to dry overnight. I always used alcohol wipes to clean plugs or tubing connectors before they went into the catheter. The night drain bottle sat in a plastic shoe box to catch accidental spills or leaks, and the tubing connector was wiped down, capped, and then wiped down again before connecting to the catheter.

          We only used the Bard catheter plug, never tried a clamp. That said, one time in a pinch (I forgot to pack the plug) while traveling, I used one of the ACCO binder clips (https://www.officedepot.com/a/produc...e-Black-12Box/). I wouldn't recommend that for long term use, but in a pinch you improvise.

          GJ used the same Urocare disposable vinyl leg bag daily for a month. The bag was cleaned with bleach solution or 91% isopropyl alcohol and hung to dry overnight.

          Thanks so much for sharing these details.

          I have been having a hard time keeping up with all of my Dad's care these days. He has a lot of medical things going on these days, separate from his UTIs/skin issues. The time everything takes is always longer than I think and I feel like we are just going from one procedure/spray/pill/exercise/bladder thing/bowel/special diet thing to the next. Just managing the one instillation a day, and keeping up with cleaning the leg bag and overnight bag every day sometimes takes up too much time.... And his bags start to smell, even though I wash them so thoroughly and bleach them and dry them well. I try to keep 2 bags at least in rotation and change them when they start to smell.

          His urine is just so dirty these days, and I feel that he is always on the verge of exploding into another UTI. We talk about being "colonized" or having a UTI as if they are discrete, obviously different states. But I don't think it is like that at all. I feel like they are in equilibrium with each other and it just takes a little push to shift you from one state to the other.

          He needs to be doing a couple instillations a day to try to see if we could get his urine a bit cleaner, but I don't know how we could manage it right now.

          Comment


            #20
            After roughly 22 years of doing a modified intermittent cath routine with excellent success, we finally switched to a urethral Foley about a year ago (mostly for convenience). So I'm still learning. This thread is helpful, thanks.

            Like HLH, we are currently trying to determine the difference between "standard colonization" and a UTI that needs to be treated.

            Here's my current normal:
            • daily input/output is between 3 L and a gallon, or even 4 L
            • fluid intake is probably 90-95% water, 5-10% juice, and rarely anything else
            • I also take cranberry softgels twice daily, as well as D Mannose powder in juice twice daily
            • my urine is generally clear (i.e. not cloudy or dark/concentrated) and not stinky
            • my urologist advised us to irrigate several times a week, or more if productive (if sediment flow results)
            • leg bag does occasionally have some floaters (sediment) and some mucus-like stuff
            • we went from 16 French to 18 French to 20 French to accommodate the above and prevent blockages
            • we only use a 1000 mL leg bag; we don't switch to a larger capacity bed bag
            • my temperature does not usually indicate fever, however
            • occasionally I will get a little "shiver" like chill, which makes me wonder about UTI, but
            • rarely do I get malaise or feel crappy
            • I also do a dose of Cantharis 30X once daily; it's a homeopathic remedy for bladder irritation
            • Foley and leg bag are changed every two weeks

            We also wipe down the catheter and the leg bag twice daily with baby wipes (separate wipes for each). I wasn't sure about wiping them down – whether it is needed or even a good idea – but I have seen some experienced quads and their caregivers be somewhat cavalier with handling their indwelling catheter and bag, not appearing to be real concerned with cleanliness.

            My PCP recently gave us a standing order for a urine analysis, which we can drop off anytime at our local hospital lab. He also gave me Bactrim just in case I start to feel awful before we get the results back from a urine analysis, and learn which bug(s) to treat specifically.

            My urologist says that most people irrigate in "suboptimal" fashion. He is a very knowledgeable and entertaining guy, and I'm trying to get him to do a video on optimal irrigation technique (he wants to, but the hospital group he works for is not doing any extra projects at this time, considering COVID-19 etc.). But the way he described it is to try to push in and pull back on a 60 mL syringe several times (at least) because the bladder is a lot like a snow globe, and the "in and out" forced flow stirs up the contents, to help them flow out. And it is the "snow" that primarily harbors the bacteria.

            For me, he recommended irrigating with just normal saline, or sterile water. He said if a person's bladder has the capacity, sometimes it's best to pump in quite a bit of normal saline, to expand the bladder, and to keep it from collapsing when drawing back on the syringe. But that depends on the person's bladder capacity. He said if we are able to push in normal saline easily, but cannot draw anything out, then the bladder wall is collapsing (most likely) and ideally you should put in more normal saline.

            That's the gist of what I remember him saying, or what I think he said.

            Like KLD said, I believe it's okay to put the same bag right back on after irrigating, since nothing can flow up/out the connection port.

            Bill
            Wheelchair users -- even high-level quads... WANNA BOWL?

            I'm a C1-2 with a legit 255 high bowling game.

            Comment


              #21
              Hi Bill,

              Thanks so much for sharing your experience!

              So it is interesting to hear you are irrigating (rather than instilling...) with saline. Why are you doing that? I recall KLD or one of the other nurses saying at some point that irrigating was less common these days. Were you getting UTIs? Or were you just having stinky urine/sediment? Or blocked foleys?

              When my Dad was doing intermittent cath, his urine was clear and not smelly. When he switched to foley this year to take a break / help his skin heal, it didn't take long for things to get stinky/cloudy. And if it wasn't for all the things were are doing now, I'm pretty sure he would quickly explode to a full-blown UTI.

              He drinks well. Usually over 4 liters a day and sometimes up to 5 liters. Only zero calorie sports drinks with salts (he has low sodium so avoids drinking plain water as part of his treatment plan).

              For UTI prevention supplements, he takes:

              Cranberry (Costco) 2x per day
              Methenamine 1g 2x per day
              Vitamin C 1g 2-3x per day
              Probiotic
              D-Mannose 4x per day

              And he instills Microcyn 40-50cc once per day, and leaves it in for about 30 minutes. We've been trying to taper these things down, but his urine just starts to look worse. He changes the foley every 1-2 weeks, and basically changes the bag on it every day after instillation. The bags get smelly quickly too.

              Comment


                #22
                Thank you HLH for starting this thread and welcoming me.

                To answer your question, when I had the 16 French Foley, we were having issues with sediment blockage. We used to intermittent cath with 14 French straight caths, and I have considered going back to that, which is why I wanted to use a 16, so it would not stretch my urethra too much (that was my thought process, whether the concern was warranted or not).

                Long story shorter, for about six months, we did not have issues with sediment. Then blockages were occurring roughly every 7-10 days. My urologist said if you take 100 random guys off the streets, that their bodies could accommodate much larger catheters (I think he said up to a 30 French – if there is such a thing). That was his way of saying that the 20 French should not cause issues for me. He also said the thickness of the catheter walls remains about the same when the size is increased, so that means the 20 French should be a significantly larger drainpipe than the 16 French.

                The irrigation started as an attempt to unblock the catheter.

                I have yet to talk with my urologist about instillation(s) possibilities, but that sounds like a step up for more significant issues than what I have experienced.

                As far as prevention supplements, I have not heard of Methenamine, but I do the others (in addition to some additional supplements for general health).

                Hopefully y'all get your dad's situation to a better state.
                Wheelchair users -- even high-level quads... WANNA BOWL?

                I'm a C1-2 with a legit 255 high bowling game.

                Comment


                  #23
                  Originally posted by BillMiller823 View Post
                  Thank you HLH for starting this thread and welcoming me.

                  To answer your question, when I had the 16 French Foley, we were having issues with sediment blockage. We used to intermittent cath with 14 French straight caths, and I have considered going back to that, which is why I wanted to use a 16, so it would not stretch my urethra too much (that was my thought process, whether the concern was warranted or not).

                  Long story shorter, for about six months, we did not have issues with sediment. Then blockages were occurring roughly every 7-10 days. My urologist said if you take 100 random guys off the streets, that their bodies could accommodate much larger catheters (I think he said up to a 30 French – if there is such a thing). That was his way of saying that the 20 French should not cause issues for me. He also said the thickness of the catheter walls remains about the same when the size is increased, so that means the 20 French should be a significantly larger drainpipe than the 16 French.

                  The irrigation started as an attempt to unblock the catheter.

                  I have yet to talk with my urologist about instillation(s) possibilities, but that sounds like a step up for more significant issues than what I have experienced.

                  As far as prevention supplements, I have not heard of Methenamine, but I do the others (in addition to some additional supplements for general health).

                  Hopefully y'all get your dad's situation to a better state.

                  Hey Bill,

                  Thanks again for the info.

                  Curious - when you were having a lot of sediment... was your urine really smelly?

                  And when it would block the catheter, was it pretty obvious? Complete blockage with discomfort from urine backing up? Or maybe AD?

                  Methenamine is actually the one medicine that both my Dad's urologist and Infectious disease doctor recommended he take for UTI prevention. Honestly, we can't be sure if it really helps.

                  Glad you have a system that is working for you.

                  Comment

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