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Thread: No More Home Nurse Visits for SP Cath Changes

  1. #1
    Senior Member wheeliegirl's Avatar
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    No More Home Nurse Visits for SP Cath Changes

    Kaiser nurse is telling me that because I am not "home bound" I can no longer use their services for SP cath changes. I contacted my urogists office and they say I should go to the "nurse clinic". I call the "nurse clinic" and they say they don't/can't/won't do SP cath changes and that I need to contact my urologist.

    Anyone else with Kaiser or Medicare or ??? who is not "home bound" have an SP catheter and how do you get your catheter changed? By the way, I live alone, have no one to do this for me, and there is no way I can do this myself. I'm a T2 para, and still wouldn't be able to access the stoma even with mirrors etc.

    I'm so frustrated!!!!! Home Heath is less expensive than a specialist visit every month, which is why the urologist set me up with home health care in the first place!!!

    What do you guy do?

  2. #2
    Is this nurse clinic part of your urology service, or is it a general nurse clinic available for all Kaiser patients? Many nurses have not been properly trained in the differences in changing a SP catheter vs. a urethral catheter. Where I worked we had this problem, and put all the RNs on the inpatient units, home care, and clinics through training so they can do this when needed, as previously it required a urologist, and this was not always available when it needed to be changed.

    I would ask your urologist if there is a nurse in the urology clinic who could do this for you, or train the nurses in the nurse clinic to do so. You may need to speak to the nursing supervisor and nurse educator or clinical nurse specialist for that clinic to see if such education can be provided. i doubt you are the only Kaiser patient at your location who needs this.

    Kaiser defines what they consider care that is "maintenance" that can be provided in the home setting without you also being homebound. You are unlikely to get them to make an exception, although if you show up in their emergency room often enough for a change, they might reconsider!

    Many of my clients who have paraplegic injuries change their own SP catheter, but obesity can be a problem with access. Is there no one else (family, attendant, friend, etc.) who could learn how to help you with this?

    (KLD)

  3. #3
    Senior Member wheeliegirl's Avatar
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    1) I live alone. No relatives or friends close enough to me to ask them change it for me

    2) It is a general nurse clinic where you would go for dressing changes. They said they change urethral catheters but not SP and referred me back to my urologist office or "general surgery"

    3) Urology nurse told me to go to nurse clinic but I'm still waiting for a reply from them after telling them the clinic said "no". Last email was Friday around 2 pm. I'm sure I'm not the only patient of theirs who has an SP so hopefully she is trying to clarify this. I will give today and if I don't hear anything I will take your suggestion and ask to speak to the nurse manager at the clinic. I have to go to the pharmacy that is in the same building this week so maybe I can stop in and talk to someone at that time

    4) I'm not allowed to speak to anyone directly. Everything is done through their appointment desk or messaging system on their web site or app. Even though I ask for a call back they communicate via message

    5) I don't understand the third paragraph. Please clarify.

    6) I would rather do this at a nurse clinic than an ER or doc visit as they are both far away from me. I have 2 nurse clinics within 3 miles of my house. Going for doc visits always mean I have to take half a day off work. Costly for me all the way around.

    Thanks

  4. #4
    Paragraph #3 simply means that an HMO can define for its policy holders what will or will not be provided through home care. If they see that you are using an expensive ER visit for something that could really can or should be provided in a clinic or homecare visit, they may reconsider both their nurse clinic policy and your specific home visit needs.

    Do you have a Kaiser primary care provider with a case manager? They should be able to help you work this out with the Kaiser system. You can also request "out-of-network" care be approved, if you are able to demonstrate that Kaiser cannot provide the care that you required for this. Not easy, but it has been done.

    (KLD)

  5. #5
    Senior Member pfcs49's Avatar
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    I've been doing monthly SP catheter changes myself for 10 years.
    I'm T12, 200 lbs, 5'11". I can't really see my stoma without a mirror; it's recessed in a fatty fold in my gut when sitting.
    So what?! It's like getting laid!
    After my shower, I set everything up, starting with sliming the site well with the betadine from the kit. I have the insertion depth marked on the edge of a drawer in the bathroom. I slit the sterile bag the catheter is in around that point and make a black ring around the cath with a Sharpie where it should be when fully inserted. I also hang the new leg bag on my brake arm and connect the new cath to it, also fitting the inflation syringe from the kit.
    When I'm satisfied all is in order, I fit last month's emptied syringe to the old cath and deflate it, then pull it out while holding the new cath I've removed from it's sterile bag. I dip the end in the supplied lubricant. The new cath finds the stoma every time/no problem! (like sex) Inserted to the ring/mark, I'll inflate the balloon, pulling it in and out slightly to confirm the balloon is inside the bladder wall and all is well.
    After a few times, it becomes second nature. And no more PITA adjusting my schedule for the visiting nurse.
    Independence rocks!
    69yo male T12 complete since 1995
    NW NJ

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