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Thread: Catheter care

  1. #1

    Catheter care

    I find myself in need of updating my bladder management routine. I've searched through the forums, and gotten truly good information, but I have a few specific questions rearding cleaning and storing one's catheters.

    I've for a long time followed a technique pretty much like that given by KLD on Nov. 19 '02 [search on "catheter (Rochester Personal Cath)" ]. The results are as good as can be expected, I guess - I come down with a UTI about one every 3-6 months or so, usually e.coli. I'm not entirely satisfied with that record, and have been thinking anyway of revising my technique. what has spurred me on is that after a recent infection with a different bacterium, my PCP, who heretofore has acquiesced to the clean technique, is now insisting that I follow a sterile routine. I'm very much against this, since my past experience (I'm, what, 40 yrs or so post) is that sterile tech. at home doesn't lessen the UTI incidence, and is a great pain to maintain. But this disagreement is a good chance to review the protocols, and before I meet again with my PCP I'd like to anticipate as many questions as I can. So:

    - Of the three types of catheter material (PVC, sicicone, rubber), which can be successfully sterilized by boiling? (I currently use Mentor PVCs, which lose their transparency and rigidity, on boiling even for as little as 3 -5 mins. I'm worried that the integrity of the plastic is compromised, and I certainly don't want traces of PVC in my bladder.

    - I also saw posts advocating sterilizing by microwaving. Does anyone know which material takes this best, and also what would be the appropriate time (several times have been mentioned in .various posts).

    - There's some chance that flora can accumulate between the side-wall eyelets of the catheter and the blind tip. Does anyone know of a catheter that has an open proximal end, instead of the side-wall eyelets?

    - One problem I notice with the usual protocol is that there's often a little residual water left in the catheter, even after long drying. (I reuse the catheter every 3-6 hrs. during the day.) To promote drying, I've begun to squirta few ccs of isopropyl alcohol into the catheter after use, moving it to and fro to catch the water by holding the catheter in a loop, then shaking it out vigorously. This way I see no residual water droplets inside, and I assume any remaining alcohol soon evaporates. But I'm not enirely comfortable reinserting such a treated catheter. Am I doing more harm than good with this technique by risking introducing a minute amount of alcohol into the bladder?

    - I'm also wondering if drying might be promoted by storing the catheter along with a dessicant tab (calcium chloride or whatever) in the ziplock bag wherein I carry it around.

    - For what reason does KLD specifically recommend paper bags over ziplocks for storing clean, dry catheters?

    I have questions about improving the bladder environment itself, but that will send those along in another post. TIA to everyone for any help. - fw

  2. #2
    The reason for using paper bags is to allow good air flow and assure no trapping of moisture inside the bag as you would find with plastic bags or other containers.

    I doubt you will find a catheter open at the tip. Even with a polished opening, this would be likely to gouge tissue from the urethra and bladder and be dangerous for use.

    I never recommend the use of latex catheters of any kind for people with SCI.

    If you want to microwave, do a test with a couple of your catheters. I never recommend any latex products, so try this with either vinyl or silicon. Place catheters in a single layer on paper towels around the edge of the microwave. Place a full 8 oz. of water in the middle of the microwave in an appropriate container (ie, glass). Microwave the catheters for 10 minutes on high. Allow to cool. Place in clean new brown paper bags until time to use them again.

    You could certainly try sterile technique if your PCP insists. Insist on getting a "touchless" type catheter kit (made by Bard, MMG/O'Neil and Mentor) to make this easier for you. It is much easier to use these than traditional sterile catheter kits. Keep track of your actual infections (not just colonization) for 6 months and see if it makes a difference. If not, go back to clean technique.

    Dr. Lapides original work on clean catheterization in the 1960s showed a lower rate of infection in those who did clean vs. sterile. This is because it was easier to do, so the patients did their caths more often. This led to the finding that it was more important to do caths frequently (ie, every 4 instead of every 6 hours, etc.) and to not allow the bladder to get over-distended (ie, keep the bladder less than 450cc. or so maximum) than it was the type of catheterization used.

    (KLD)

  3. #3
    Thanks, KLD. For now I'm going to try rinsing then shaking out the catheter with isopropyl alcohol, to cut down on the air-drying time, but I'll also try the paper bags by and by.

    I doubt you will find a catheter open at the tip. Even with a polished opening, this would be likely to gouge tissue from the urethra and bladder and be dangerous for use.
    Open-tipped catheteters are mentiopned in passing in an interesting 1998 update to Lapides' article
    (http://www.medscape.com/viewarticle/416648_1).
    But I agree with you, if they actually exist they would probably be more of a danger than a help.

    I never recommend the use of latex catheters of any kind for people with SCI.
    This reminded me to check - it seems that red "rubber" catheters that I remember from years back are like as not red latex.. So I won't use them. I'm not going the boiling route anyway, too much trouble!

    Thanks again - fw

  4. #4
    i dry mine by hanging from a hanger in the closet, thus encouraging all water to drain. to do so, take a hanger with a pant rod that swings out, place a chunk of tissue, cardboard, etc in the space that closes between the two rods, leaving open a small slot, drop the caths tip down into the slot so the funnel end keeps it from falling thru, hang up to drain. this promotes thorough air drying around the whole cath. if totally dry i think bladder bacteria can't survive, they need a moist medium, i believe, let each set hang a min of 2 days

  5. #5
    Thanks, crags, it's helpful to hear the various ways that people manage this. I'm trying to get away from these long drying times and having bunches of catheters hanging around. It's so difficult to show that one variation works better than another! Comparing drying times in paper bags of the water-washed caths and those where washing is followed with an alcohol rinse, I see that the rinsed ones dry almost immediately vs a day or more for the unrinsed ones. I'm still not comfortable with the use of alcohol, even though there seems to be no residue. I'm going to see what my PCP thinks about this method. - fw

  6. #6
    Originally posted by me (fw):

    For now I'm going to try rinsing then shaking out the catheter with isopropyl alcohol, to cut down on the air-drying time, but I'll also try the paper bags by and by.
    I've found that the alchohol apparently *does* leave a residue, as KLD warned. Even though it hasn't done any damage in the short time I've tried it, I've abandoned that attempt at quick drying. Back to the drawing board... fw

  7. #7
    "There's some chance that flora can accumulate between the side-wall eyelets of the catheter and the blind tip. Does anyone know of a catheter that has an open proximal end, instead of the side-wall eyelets?"

    i doubt you'll ever find this since the blunt round tip is designed for safety and min of tissue trauma.

    opposing eyes guarantee that should one eye be resting against tissue you'll still get drainage

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