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Thread: Dangerously high AD blood pressure resulting from wound & suprapubic catheter

  1. #1

    Dangerously high AD blood pressure resulting from wound & suprapubic catheter

    I?m dealing with something new for myself...🥴🙁. I have a very irritated suprapubic catheter stoma and 2 pressure wounds on my body (back of heel/stage 2 & left rib/stage 3). The wounds are on the mend though. Anyways, I?m experiencing terrible autonomic dysreflexia (ad) from these resulting in a dangerously high blood pressure (bp). I use my emergency nitroglycerin paste when my bp?s top # hits 170. Then, it normally continues rising to 220ish before the paste starts working to lower it taking around 20 minutes. This all normally happens in the mornings while doing my routine of stoma and wound care, etc. I try to have a pain med (tramadol or norco) in my system before hand, but it?s not enough to control the ad hitting. I?d so appreciate any suggestions to help prevent the high bp until I can get over this hurtle.

    melinda

  2. #2
    Quote Originally Posted by kmelinda View Post
    I?m dealing with something new for myself...若. I have a very irritated suprapubic catheter stoma and 2 pressure wounds on my body (back of heel/stage 2 & left rib/stage 3). The wounds are on the mend though. Anyways, I?m experiencing terrible autonomic dysreflexia (ad) from these resulting in a dangerously high blood pressure (bp). I use my emergency nitroglycerin paste when my bp?s top # hits 170. Then, it normally continues rising to 220ish before the paste starts working to lower it taking around 20 minutes. This all normally happens in the mornings while doing my routine of stoma and wound care, etc. I try to have a pain med (tramadol or norco) in my system before hand, but it?s not enough to control the ad hitting. I?d so appreciate any suggestions to help prevent the high bp until I can get over this hurtle.

    melinda
    what is causing the irritation of the supra pubic stoma? What are you trying to do to heal the irritation?

  3. #3
    Now, I’m thinking the irritation is hypergranulation. I’ve never had it, but here’s a picture. Is that usually bad painful?

    We’ve been using otc zinc antibiotic cream.

    Melinda

    https://share.icloud.com/photos/0PFp...tElMz1oAaRP_fA
    Last edited by kmelinda; 03-13-2019 at 01:26 PM.

  4. #4
    Quote Originally Posted by kmelinda View Post
    Now, I?m thinking the irritation is hypergranulation. I?ve never had it, but here?s a picture. Is that usually bad painful?

    We?ve been using otc zinc antibiotic cream.

    Sorry, the picture doesn't seem to work. But, below, I have posted a picture of the mild hypergranulation I sometimes have.

    Hypergranulation is inflammatory in nature and probably responds best to a topical antimicrobial like silver sulfadiazine as found in Silverdene.

    Most advice on Care Cure Community has been for nitrate sticks which "burn" the tissue away. I've read that "burning" or curettage (cutting the tissue away), manual removal, may work, but possibly only a short time because manual removal only results in more damage and inflammation that leads to more hypergranulation.

    I read a study about using table salt to shrink or dehydrate hypergranulation. I have tried table salt on my small hypergranulation and it works in just a couple days. I use plain, not iodized salt and grind it very fine with a mortar and pestle. Yes, I've had reoccurrences, but when I catch the reoccurrence when they are as small as in the picture, table salt keeps things under control.

    Curing the hypergranulation may go a long way in helping with autonomia. That tissue is basically an open wound which is a noxious stimulus that contributes to autonomia. Do you do anything to secure your catheter? Securing the catheter to keep it from moving in and out of the stoma (called "pistoning") can help to keep hypergranulation from occurring.



    Attached Images Attached Images  

  5. #5
    First, I need to thank you for being so helpful.

    I redone the picture. So, please try it now if you don’t mind.

    I mostly use a leg strap to secure it, but I have used the stat-loc leg sticker like device. I’m got to just stay with the sticker to secure it better then. This has got to be what’s going on.

    Any suggestions from personal experience on controlling my bp while I’m dealing with this issue?

    Melinda

  6. #6
    Quote Originally Posted by kmelinda View Post
    First, I need to thank you for being so helpful.

    I redone the picture. So, please try it now if you don’t mind.

    I mostly use a leg strap to secure it, but I have used the stat-loc leg sticker like device. I’m got to just stay with the sticker to secure it better then. This has got to be what’s going on.

    Any suggestions from personal experience on controlling my bp while I’m dealing with this issue?

    Melinda
    I know you mentioned that you take the pain medicine ahead of time, but if you're certain there's a 20 minute window for the AD medicine to work, have you tried taking the pain and AD medicine ahead of your routine?
    No one ever became unsuccessful by helping others out

  7. #7
    Thank you... I’ve considered using the nitroglycerin paste before starting my routine in order to try to prevent the high bp, but I’ve been directed otherwise as of now by my physician. I’m actually waiting on my physician’s clinic to discuss my issues & then call me with a new plan regarding my problem.

    Melinda

  8. #8
    Quote Originally Posted by kmelinda View Post
    First, I need to thank you for being so helpful.

    I redone the picture. So, please try it now if you don’t mind.

    I mostly use a leg strap to secure it, but I have used the stat-loc leg sticker like device. I’m got to just stay with the sticker to secure it better then. This has got to be what’s going on.

    Any suggestions from personal experience on controlling my bp while I’m dealing with this issue?

    Melinda
    You are probably lying down when you do the stoma and wound care. It would help if you could sit up when your blood pressure starts to go up. Blood pressures goes up when you are lying down and goes down when you sit up.

    I've not experienced autonomia when I have hypergranulation. Perhaps the combination of stoma and wound care at the same time is making the blood pressure issue worse. Maybe for now you could put some time between stoma and wound care. Possibly starting the nitro paste at 140-150 systolic, not letting the blood pressure get quite so high before medicating.

  9. #9
    You could try Uroject 2 % in the stoma but it doesn't look like stoma would be an issue. However, AD can be caused by any stimulus. You should take the pain medication 45 minutes to 1 hour to be sure it has been dissolved and into system. Nitropaste is ok but wash off. I can't see hypergranulation and that is common. do they have difficulty putting catheter in?
    Why are you changing Sptube daily?
    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.

  10. #10
    Quote Originally Posted by SCI-Nurse View Post
    You could try Uroject 2 % in the stoma but it doesn't look like stoma would be an issue. However, AD can be caused by any stimulus. You should take the pain medication 45 minutes to 1 hour to be sure it has been dissolved and into system. Nitropaste is ok but wash off. I can't see hypergranulation and that is common. do they have difficulty putting catheter in?
    Why are you changing Sptube daily?
    CWO
    I don't read that "kmelinda" is changing the catheter every day. I read that she is doing "stoma care," which to me means that she is washing/cleaning the area around the catheter and possibly cleaning the supra pubic catheter too. When the stoma is irritated or has hypergranulation, any movement of the skin and/or catheter is enough stimulus to set things off. Couple that with the pain stimulus of wound care and she's in trouble with autonomia. Just my interpretation.

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