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Thread: Foley removed after 1 year: Flap Update/Questions

  1. #1

    Foley removed after 1 year: Flap Update/Questions

    I have removed my Foley catheter after a year indwelling while recovering from Ischial wound. Had my flap surgery 8 months ago (after 10 months on wound vac) and it is finally healed after being sheared open the day I was transferred from hospital to skilled nursing. I discharged in December to home and my wound had sheared the very day I arrived home as I had only a mere 3 days of epithelial layer built up. I spent the next month at home bed-bound and since being up in my chair, I've had about 4 minor shearing episodes which we treated while continuing sitting therapy. All is good now, last shearing has closed and I'm using Meplilex (sp?) 2x2s to protect the area for now. It's working fabulously. I am also taking extra precautions when transferring to avoid shearing (ie.: using a soft terrycloth hand towel on my transfer board which was the answer to much of my shearing issues). I hadn't used a transfer board in 35 years until I got the wound and needed it to prevent tearing off my wound vac draping. For toilet transfers I have been wrapping a soft terrycloth hand towel on the side of the toilet seat where my wound site is to avoid shearing and again, it's been key in helping. We tried all sorts of fabrics and the soft terrycloth was the best. I had my nurse mimic my transfers and he was able to tell me where he felt the drag. This was super helpful, wish I had thought of it sooner.

    I had the foley installed a year ago when I first got the wound so as to avoid maceration as I have a lot of urinary incontinence. I have always straight cathed and am returning to that regimen now. I have had the foley out for two days now and I've been trying to straight cath every couple of hours however I am getting only trace amounts in the catheter and everything else is soaking my incontinence pads. I'm not surprised by this, I expected it. But I'm wondering now, how long it might take to get a little bladder retention back... even just a little. I will be having my urodynamics/cystoscopy done next week, which is why I have removed the foley now. I was advised to have no foley for a good 5+ days prior to my urodynamics (thank you SCI nurses here because my urology team never even suggested it). I have cut back on my water intake a bit during this time which is not the best choice but it's maddening enough with all the leakage I already have. Would love to hear any input, especially from other women. It seems to always be the men here who are super candid and while it's very much appreciated, it would be helpful to hear how other women handle these things. Thanks in advance!

  2. #2
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    Quote Originally Posted by oncetherwasagirl View Post
    I have removed my Foley catheter after a year indwelling while recovering from Ischial wound. Had my flap surgery 8 months ago (after 10 months on wound vac) and it is finally healed after being sheared open the day I was transferred from hospital to skilled nursing. I discharged in December to home and my wound had sheared the very day I arrived home as I had only a mere 3 days of epithelial layer built up. I spent the next month at home bed-bound and since being up in my chair, I've had about 4 minor shearing episodes which we treated while continuing sitting therapy. All is good now, last shearing has closed and I'm using Meplilex (sp?) 2x2s to protect the area for now. It's working fabulously. I am also taking extra precautions when transferring to avoid shearing (ie.: using a soft terrycloth hand towel on my transfer board which was the answer to much of my shearing issues). I hadn't used a transfer board in 35 years until I got the wound and needed it to prevent tearing off my wound vac draping. For toilet transfers I have been wrapping a soft terrycloth hand towel on the side of the toilet seat where my wound site is to avoid shearing and again, it's been key in helping. We tried all sorts of fabrics and the soft terrycloth was the best. I had my nurse mimic my transfers and he was able to tell me where he felt the drag. This was super helpful, wish I had thought of it sooner.

    I had the foley installed a year ago when I first got the wound so as to avoid maceration as I have a lot of urinary incontinence. I have always straight cathed and am returning to that regimen now. I have had the foley out for two days now and I've been trying to straight cath every couple of hours however I am getting only trace amounts in the catheter and everything else is soaking my incontinence pads. I'm not surprised by this, I expected it. But I'm wondering now, how long it might take to get a little bladder retention back... even just a little. I will be having my urodynamics/cystoscopy done next week, which is why I have removed the foley now. I was advised to have no foley for a good 5+ days prior to my urodynamics (thank you SCI nurses here because my urology team never even suggested it). I have cut back on my water intake a bit during this time which is not the best choice but it's maddening enough with all the leakage I already have. Would love to hear any input, especially from other women. It seems to always be the men here who are super candid and while it's very much appreciated, it would be helpful to hear how other women handle these things. Thanks in advance!
    Are you taking an anticholinergic like oxybutynin?

  3. #3
    With the foley, the bladder is collapsed and it may take a while to increase the capacity or it may never; You need to take an anticholinergic or Mirgbetron to prevent the bladder spasms and increase the capacity. If that doesn't solve it, you may need Botox to the bladder.
    CWO
    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.

  4. #4
    No, I am not on any meds (yet). I was finally able to cath 100cc on day two so that's a little progress at least. Hoping my Uro will finally start working with me in a better capacity and advise me of these things before hand. Apparently it's common knowledge and yet I have had to resort to the internet to find these simple things out yet she's the one with the costly co-pay. I did try Ditropan (oxybutynin) years ago under a diff Urologist and had no luck with it. Maybe it will be different now or another will work. Botox is already on my list of discussion with her. I hope I'm not doomed with incontinence for the rest of my life. Thank you both for responding, CWO and gjnl.

  5. #5
    Oxybutynin has been shown to be the most effective for SCI bladder. However, research has shown that anticholinergics MAY contribute to dementia. Low doses recommended but of course some need max dose. Therefore, we are using more often Trospium or Sanctura that are anticholinergics but does not cross the blood- brain barrier as much and Mirgabetron is not an anticholinergic but is not typically used first. Or anyone with a neurological disease of any type such as Parkinson's Disease, Stroke, etc.. we use also after clering with neurology. So, you doctor may recommend this.
    CWO
    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.

  6. #6
    Senior Member Donno's Avatar
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    You might try re-installing the foley, but keep it blocked and drain every 2 or 3 hours until you get your retention back again. I get mild disreflexia when my bladder gets too full, so it is easy to tell when to drain. It took me about a month to get up to retaining 200 to 300 ml after 8 or 9 months using a foley for wound vac and then flap surgery.
    Don - Grad Student Emeritus
    T3 ASIA A 25 years post injury

  7. #7
    Quote Originally Posted by Donno View Post
    You might try re-installing the foley, but keep it blocked and drain every 2 or 3 hours until you get your retention back again. I get mild disreflexia when my bladder gets too full, so it is easy to tell when to drain. It took me about a month to get up to retaining 200 to 300 ml after 8 or 9 months using a foley for wound vac and then flap surgery.
    While I do miss the convenience of the foley, I do not miss the crazy amount of UTIs it was causing me. There is of course, no way to confirm that the catheter is the only cause of them but in my case it was most likely. I am still managing to get at least one good 150 cc cath in each day but still super wet all day and night. One month it took you? Ugh, I hope I can get some good results soon because this has been way too strenuous physically and emotionally to deal with all the apparel changes. Not to mention the damper it puts on my social life. Thanks for the input, it helps to know someone understands.

  8. #8
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    Quote Originally Posted by oncetherwasagirl View Post
    While I do miss the convenience of the foley, I do not miss the crazy amount of UTIs it was causing me. There is of course, no way to confirm that the catheter is the only cause of them but in my case it was most likely. I am still managing to get at least one good 150 cc cath in each day but still super wet all day and night. One month it took you? Ugh, I hope I can get some good results soon because this has been way too strenuous physically and emotionally to deal with all the apparel changes. Not to mention the damper it puts on my social life. Thanks for the input, it helps to know someone understands.
    Leaking can be a little easier for men to deal with because there are incontinent pouches that can absorb leaked urine. For women, maybe the disposable incontinent underwear may be helpful to absorb leaks and at least keep outer clothing, cushion and cushion cover dry in between caths. Something like these: https://www.weareverincontinence.com...nence-panties/

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