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Thread: The correct way to change a SP catheter?

  1. #1
    Senior Member Rollin Rick's Avatar
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    The correct way to change a SP catheter?

    Every month I have a nurse come in to change my suprapubic catheter. Whether there is a right way, wrong way or it doesn't matter way, I need to find out if her way is causing my chronic uti's...........

    The very first thing she does is deflate the balloon, pull the catheter out, then she goes about getting things set up for the new one. In the meantime (at least 5 minutes or better) I am laying there with no catheter. Is this a good way for bacteria to enter the stoma? After checking the balloon on the new one she starts putting on the solution that comes with the kit around the catheter site before inserting. I always believed that when you take out the old one you should insert the new one right away? Does it matter? Should you put the solution on before you pull out the old one? Is there a correct way it should be done or it just doesn't matter?
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  2. #2
    Senior Member Tim C.'s Avatar
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    Good way for hole to close up.

    "Every month I have a nurse come in to change my suprapubic catheter. I always believed that when you take out the old one you should insert the new one right away? "

    My nurse paused in replacing the tube, I ended up in the ER with AD.
    Spent two days there because attending physician claimed I suffered a heart issue as determined by EKG (they did EKG because my bp was all over the place, but this was due soley to AD when bladder could not void itself) .
    6 hrs of stress testing and 48 hrs of hosp stay later, i was released.

    Don't hesitate in replacing new sp tube!

  3. #3
    Rick, you're absolutely right that this nurse is taking too long to insert the new cath after removing the old one. A SP stoma can close up in as little as one-two minutes without a catheter in place, so the new catheter needs to be inserted right after the old cath is removed. This nurse should have been instructed in nursing school that she should have all of the prep work taken care of before she begins the procedure.

    There is a specific way to change an indwelling catheter, and I believe you have reason to be concerned that this nurse is increasing your risk for UTIs -- not because of the delay between when the old cath comes out and the new one goes in, but because she's not using a sterile technique. I'd bet dollars to donuts that she's handling the items in the cath change kit and your new catheter without following established practices that keep these items sterile, and that she's not doing what's needed to keep the area around your stoma sterile, either (e.g. using the sterile drape that comes with the cath change kit).

    I would call the agency and register a complaint, and insist that whoever is sent to do your next change receive a refresher course in the proper way to change a SP catheter. You also need to become an expert in how to properly do this procedure so you can monitor whoever is doing it for you and prevent them from doing anything that puts you at risk.
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  4. #4
    Senior Member GoTWHeeLs's Avatar
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    I just spent 2 hours without a catheter after some problems occured. No issues now...
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  5. #5
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    I was taught to do Davids, don't know if its right or not, but he doesn't get any uti's or any other problems.

    I open the cath insertion tray, lay out the waterproof pad on the table, open the lubricant and put it on the pad, open the cath, but leave it in the package not touching it at all, put on the gloves, wash the cath site with one of the iodine swabs, deflate the balloon, pull out the old cath, immediately dip the new cath in the lubricant and insert it. I then get some output before I inflate the balloon. Once there is output, I inflate the balloon, use the other iodine swab to reclean the area, take off my gloves and throw everything away.

    Hope this helps, and if I am doing anything wrong, I would really like to know.

  6. #6
    I see what you're saying and it makes some sense. Seems like the sooner you cover it back up the better. At the same time I don't think five minutes is very long to have it open. If it bothers you maybe you could just have her cover it with one of the sterile towels supplied with a changing kit.

  7. #7
    Senior Member Spadfan's Avatar
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    Quote Originally Posted by MSWIFE1 View Post
    I was taught to do Davids, don't know if its right or not, but he doesn't get any uti's or any other problems.

    I open the cath insertion tray, lay out the waterproof pad on the table, open the lubricant and put it on the pad, open the cath, but leave it in the package not touching it at all, put on the gloves, wash the cath site with one of the iodine swabs, deflate the balloon, pull out the old cath, immediately dip the new cath in the lubricant and insert it. I then get some output before I inflate the balloon. Once there is output, I inflate the balloon, use the other iodine swab to reclean the area, take off my gloves and throw everything away.

    Hope this helps, and if I am doing anything wrong, I would really like to know.

    This is similar to the procedure that we have followed for years (30+). The only differences being that we don’t do a betadine cleaning before removing the tube. On the day the tube is changed my wife shaves the area and then I take my shower and wash around the tube thoroughly with soap and water. I then get back into bed to change the tube.

    Betty gets everything ready to go as described above, but removes the old tube before gloving. Touching the tube after gloving breaks the sterile technique because the old tube is not sterile. After putting on the sterile gloves, she swabs in a circular fashion starting at the edge of the site and spiraling outward for about 2 inches. Our kits have 3 swabs and they are all used in this manner. Next the tube is lubricated and inserted. After getting a return the balloon is inflated.
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  8. #8
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    Spadfan - I have wondered about that, sometimes I will change gloves after taking out the old cath. I also shave him every so often, not once a month at cath changing time, but whenever needed. He always takes a shower first as well.

  9. #9
    You are doing the procedure correctly- although not everyone shaves the area. It certainly doesn't hurt to do so.

    While there are incidences of stomas closing quickly, this occurs much more frequently when the stoma is new - not several years later. Five minutes is really not that long for it to be open. Remember, bacteria travels up the catheter as well as through the stoma. Plus, at home your body is more used to the bugs around it, therefore less likely to get an infection from it.

    All that being said, if you are uncomfortable with the way the nurse is doing the procedure, you need to tell her or the agency. You have the right and responsibility to have it done the way that you want it done. Did anyone either in the hospital or at the physician's office teach you the way that the physician prefers it to be done? Each of us has our own little ways of doing things, and as long as the nurse does not break sterile technique, she is not doing it incorrectly.

    I hope that I am not making this more confusing.

    CKF

    Quote Originally Posted by Spadfan View Post

    This is similar to the procedure that we have followed for years (30+). The only differences being that we don’t do a betadine cleaning before removing the tube. On the day the tube is changed my wife shaves the area and then I take my shower and wash around the tube thoroughly with soap and water. I then get back into bed to change the tube.

    Betty gets everything ready to go as described above, but removes the old tube before gloving. Touching the tube after gloving breaks the sterile technique because the old tube is not sterile. After putting on the sterile gloves, she swabs in a circular fashion starting at the edge of the site and spiraling outward for about 2 inches. Our kits have 3 swabs and they are all used in this manner. Next the tube is lubricated and inserted. After getting a return the balloon is inflated.

  10. #10
    Quote Originally Posted by MSWIFE1 View Post
    I was taught to do Davids, don't know if its right or not, but he doesn't get any uti's or any other problems.

    I open the cath insertion tray, lay out the waterproof pad on the table, open the lubricant and put it on the pad, open the cath, but leave it in the package not touching it at all, put on the gloves, wash the cath site with one of the iodine swabs, deflate the balloon, pull out the old cath, immediately dip the new cath in the lubricant and insert it. I then get some output before I inflate the balloon. Once there is output, I inflate the balloon, use the other iodine swab to reclean the area, take off my gloves and throw everything away.

    Hope this helps, and if I am doing anything wrong, I would really like to know.
    You use the gloves in the insertion kit to pull out the old catheter? Sorry but I would have to think that those gloves would no longer be sterile. I was taught to take the old cath out with regular boxed gloves.

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