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Thread: Suprapubic Catheter Questions

  1. #1
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    Suprapubic Catheter Questions

    I know there has been a great deal of discussion about it in the past and recently as well.

    I had mine placed on January 29th this year. The urologist isn't familiar with SCI persons. I'm learning this more and more as I see him for follow-ups. (it was an emergency procedure)

    He wants my supra to stay put until mid October, then will scope the urethra confirming the damage from cathing has healed. Afterwards I'm hoping to resume intermediate cathing again.
    I personally think having the supra this long isn't necessary.

    I should probably start clamping off the tubing through the day? This supra is going to shrink my bladder capacity, most likely leading to numerous accidents, when I start to self-cath again. What's someone else's thoughts? Nurses?

    I'll be contacting a SCI urologist and getting the details of how long I actually need to keep this supra in. Being a T-10 level, I absolutely hate all the tubing on me.
    I'm 40 minutes driving distance from Shirley Ryan Ability Lab and Northwestern Hospital in Chicago, where I plan on getting a urologist and hoping to see my primary SCI Dr, whom I haven't in 5 years now.

    Thanks
    Eddie

  2. #2
    Indwelling catheter clamping is a bad idea. It may do nothing to maintain capacity, and puts you at risk for reflux, high bladder pressures, and for those with injuries T7 and above, puts the person at significant risk for AD. A better way to try to help maintain capacity is to take anticholenergic medications such as Ditropan or Detrol. Are you on those meds already?

    In my experience, the usual method for managing urethral damage (such as false passages or strictures) due to trauma from intermittent cath is for the urologist to place an indwelling urethral catheter and leave this in place for 30-60 days. This lets the urethra heal while maintaining the lumen. Leaving the catheter out of the urethra may allow strictures (if any) to get tighter. I would encourage you to see your Shirley Ryan Ability Lab urologist ASAP for a second opinion on this plan.

    Meanwhile, you should also consider what you are going to do to prevent such traumatic damage to your urethra again; review your catheterization techniques and the catheter you are using with the SCI nurse at Shirley Ryan Ability Lab. If you are determined to return to intermittent catheterization, you may also want to consider a Mitrofanoff procedure, so that your catheterizations are not done through the urethra at all.

    (KLD)
    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.

  3. #3
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    Quote Originally Posted by SCI-Nurse View Post
    Indwelling catheter clamping is a bad idea. It may do nothing to maintain capacity, and puts you at risk for reflux, high bladder pressures, and for those with injuries T7 and above, puts the person at significant risk for AD. A better way to try to help maintain capacity is to take anticholenergic medications such as Ditropan or Detrol. Are you on those meds already?

    In my experience, the usual method for managing urethral damage (such as false passages or strictures) due to trauma from intermittent cath is for the urologist to place an indwelling urethral catheter and leave this in place for 30-60 days. This lets the urethra heal while maintaining the lumen. Leaving the catheter out of the urethra may allow strictures (if any) to get tighter. I would encourage you to see your Shirley Ryan Ability Lab urologist ASAP for a second opinion on this plan.

    Meanwhile, you should also consider what you are going to do to prevent such traumatic damage to your urethra again; review your catheterization techniques and the catheter you are using with the SCI nurse at Shirley Ryan Ability Lab. If you are determined to return to intermittent catheterization, you may also want to consider a Mitrofanoff procedure, so that your catheterizations are not done through the urethra at all.

    (KLD)
    Thank you for the advice, suggestions KLD. I have never been on any medication for my bladder, except antibiotics when necessary. I'm not a pill popper, less is more in my theory.

    Initially I slightly punctured the urethra when self-cathing one year ago. I was extremely upset it happened, as I had no resistance when doing so. Lucky for me, my symptoins didn't even present Lucky for me, my symptoms did not present themselves for several weeks after it happened.

    The same urologist put a indwelling cath and it was in place for 36 days, then I resumed normal routine of self-cathing every 4 hours in a 24 hour period. We never scoped the urethra either, which I honestly never considered. Obviously my urethra wasn't completely healed and I nicked it again in January this year.

    That mitronauff won't be happening. I don't want anymore surgical procedures performed.

    I'll have Shirley Ryan scope me, and start using a less stiff catheter, more flexible will be required and coude tipped as well.

  4. #4
    I'm not a doctor or a nurse, but about 5 years ago I had urethral trauma and had SP placed for 3 months while I healed. At my injury level, (c6 complete) it was more difficult to drain the collection bag than to do an IC. On the advice of my urologist's PA, I clamped the drain tube and had no problems going back to IC. I do get AD so I am very aware of when it's time to drain. I had no problem with volumes when I went back, and no problems since.

    Just my personal experience.

  5. #5
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    Quote Originally Posted by ABLEC6 View Post
    I'm not a doctor or a nurse, but about 5 years ago I had urethral trauma and had SP placed for 3 months while I healed. At my injury level, (c6 complete) it was more difficult to drain the collection bag than to do an IC. On the advice of my urologist's PA, I clamped the drain tube and had no problems going back to IC. I do get AD so I am very aware of when it's time to drain. I had no problem with volumes when I went back, and no problems since.

    Just my personal experience.

    I'll have had my SP in place for 3 months also, in 10 more days.... waiting until October is way overkill I say. I saw first hand the damage from the scope still images... I have them all in my possession. The first puncture a year ago looked bad enough, but when I recently had very little blood tinged urine this past January, I didn't think it was a major deal. His concern is the urethra showed trauma to it's very last bend, towards the bladder. Why I'll use a softer cath and coude tipped from now on. I have some samples on the way, [after I see the urologist at Northwestern and say I want to be scoped], if I'm confident in what I see for my urethra images, I'll start self cathing with the SP in place, to be 100% sure, then pull this damn tube and for good!
    I'm a very active person at T-10 level. Have a pool I swim in, and usually go water-skiing, handcycling numerous miles, basketball, softball, etc over the Summer..... several times. Can't do it with all this tubing now attached, and definitely won't with an SP in place.
    Thanks

  6. #6
    Quote Originally Posted by nick View Post
    I'm a very active person at T-10 level. Have a pool I swim in, and usually go water-skiing, handcycling numerous miles, basketball, softball, etc over the Summer..... several times. Can't do it with all this tubing now attached, and definitely won't with an SP in place.
    Thanks
    Actually, the SP is not a reason to not engage in these activities. Many people with both indwelling urethral and SP catheters do all of the above on a regular basis.

    (KLD)
    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.

  7. #7
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    Getting into lake water with a direct path to my bladder, no thanks. Capped off SP or not, the site for placement is opened.
    Several transfers a day into my car aggravates the bladder/tubing too much. I have it secured twice also, one on the belly and another is a elastic velcro device for securing on my thigh.

  8. #8
    You are correct. Swimming should be limited to pools, not creeks, rivers, or lakes. It is not advisable to cap or clamp the SP or urethral catheter for this.

    (KLD)
    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.

  9. #9
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    Quote Originally Posted by SCI-Nurse View Post
    You are correct. Swimming should be limited to pools, not creeks, rivers, or lakes. It is not advisable to cap or clamp the SP or urethral catheter for this.

    (KLD)
    Even when limited to just my pool, it should only be me and the immediate family members I live and share it with, correct?

    Thank you KLD

  10. #10
    I assume you manage your pool with chemicals to keep it from being a breeding ground for bacteria and molds, right? Freshwater or saltwater pool? A well established SP stoma should seal well enough around your catheter that it should not allow water in through the stoma.

    (KLD)
    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.

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