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Thread: Help with supra pubic cath changes plz

  1. #1

    Help with supra pubic cath changes plz

    I'm hoping someone can help me out with this one.

    My b/f is C5-6 and has had a urethral indwelling cath for the past 12yrs and 9 or so weeks ago his uro did a supra pubic because he said that his urethra needed a rest, we went back to the uro 2 weeks ago to have it changed for the first time and for me to also learn how to change them.

    Old cath came out fine new one went in fine and I learnt the finer points of how to change them myself, Uro said that he would prefer me to change them rather than get a nurse to come every few weeks because b/f suffers from shocking bladder stones and sediment and needs them changed on a fairly reg basis.

    Any yesterday at 10pm it became blocked, tried a bladder washout which wouldn;t go in so b/f asked if I was confident enough to try and change it which I was.

    Got everything ready took the old one out no problems at all, then went to put the new one in and it hit the bladder wall, tried again about 6 times and nothing just kept hitting in, tried various angles etc and still nothing, got a size 16 cath instead of a 20 hoping that would do the trick and still nothing, by this stage there was a slight bit of bloody discharge and I didn't feel comfortable to try any further and b/f was starting to bypass.

    Needless to say I had to put in a urethral cath and within a very short period of time the supra pubic had closed(which we knew would happen)

    B/f seems to think that it may have been because he was having bad spasms at the time but I really don't know why I couldn't get it in beleive me it was from a lack of trying.

    So he will go back in a month or so and have the supra pubic performed again and I'm wondering if anyone can give me any tips on what may have happened and how can I hopefully prevent it from happening again.

    Uro said that some of his patients with supra pubics clamp of thier caths before changing them so the bladder is full and in align with the tract, but as soon as I clamp off b/f's cath he bypasses which is not the answer for us I don't think.

    Any suggestions would be great

    Thanks Marg

  2. #2
    Senior Member taj2002's Avatar
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    Marg-

    I have been changing my husband’s SP for about 31/2 years now. His uro showed me also, and I have never let anyone else change it. I usually don’t have much trouble, but occassionally it takes some pressure to get it in. I have started stabilizing the area around the hole with one hand while inserting the cath with the other. I also do this while I am removing the old cath. I just sort of put light pressure on the area and gently push the cath in. I don’t like the idea of clamping off the SP before changing. A few times my husband’s cath has clogged, and I have had to change the SP. With his bladder full, when the cath is removed, the urine just gushes out the hole everywhere. It runs between his legs, on the sheets and makes a real mess. I think this makes it harder to get the new cath in. Sorry you had problems. The first few times I was very nervous, but now I think that I could change it in my sleep. It gets easier with practice. Good luck when your bf gets the new SP. I agree with your dr that you need to be comfortable with changing it. You never know when it can clog up plus I have had a variety of RNs and LPNs at my house and none of them have ever had experience with changing a SP.

    Trish

  3. #3
    Hi Trish thanks so much for the quick reply,

    To be honest I am really upset that it didn't work, I have always done the cath changes and the uro told me that changing the supra pubic would be a piece of cake for me so I was really dissapointed for both my b/f and myself not to mention all that my b/f went through to have it done(we had some major drama's) and now for this to happen is just so frustrating for sure.

    Have you had to put pressure on the area in the past so as to keep the tract all straight or is there another reason you do that?
    I know what you mean about the clamping issue my bf is exactly the same after trying to get it in the urine just came streaming out both the supra pubic site and his urethral site so clamping is not an option for us either.

    Do you also use a heap of cath gel?
    Also do you go in on an angle to insert it or just straight down (if he is laying on the bed etc) I tried different angle and still nothing but I'm interested to know if you do it on an angle or not

    Thanks so much for your help
    Marg

  4. #4
    Senior Member taj2002's Avatar
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    Hi Marg,

    I mostly started the “stabilizing the area” thing when we switched to all silicone caths. For some reason these are much harder to remove. The latex ones (silicone coated latex) seemed no problem, but the all silicone were just harder to remove. I would have to put my thumb and index finger about an inch on either side of the stoma and apply a little downward pressure as I was pulling the cath out. I then found that it went in a little easier if I sort of stabilized the area. I use very little gel. I have even changed it without the gel. Did your uro show you to mark the old cath at skin level before you pull it out so that you have a reference as to how far to insert the new cath? When I insert the new one, I usually hold my fingers about a half an inch above this mark. With the silicone caths, they are pretty stiff so you just have a couple of inches to manipulate into the stoma. Additionally it seems easier to me if I am standing to the right side of my husband’s bed. He alternates his leg bag from left leg to right leg each day, but at night, the night bag mostly hangs off the right side of the bed. I sleep to his right and I like to be able to see the bag at night to make sure that it is draining. I am assuming that the tract must be somewhat more off to the right because of this. Anyway, my experience is that the new cath goes in better if I go in from the right side. I try to go in mostly straight down, but I am standing to the right which I’m sure influences the angle. Additionally, I try to get the new one in just as soon as I remove the old one. I have everything ready and prepped. I pull the old one out then immediately peel the new one out of the package and go. I’m sure everyone has their own technique, but this seems to work for me….keeping my fingers crossed for us both.

    Trish

  5. #5
    Hi again Trish,
    Yes B/F wears his sports bag on his left leg so I tried going in on the angle that I knew it would have been sitting at but nothing.

    The uro showed me at what point to go in to but I only mananged to get it through the abdominal wall and no further, I could feel it pushing into the outer wall of the bladder.

    I am waiting for his uro to call me back any minute so that I can give him the bad news that it didn;t work(hopefully he's had a wine before he calls)I know he's going to be dissapointed as he has been trying to talk b/f into getting the supra pubic for 4 or more years and finally got it done and now this.

    Thanks for all the little tips I have written them down for next time, which will probably be a couple of months away now(we go on vacation in a few weeks) so won't be getting it done before we go

    Thanks again
    Marg

  6. #6
    This is why we have only the urologist change SP tubes for the first 3 months. It is very easy for the track to close up, even if the catheter is out for only a minute or two. After this, the track is usually healed and scarred enough that a properly trained PCA or family member can change a SP tube. Call the urologist ASAP.

    (KLD)

  7. #7
    Hi and thanks for the reply sci nurse, the supra pubic had been in just shy of 12 weeks when I went to change it, when the uro did the change a few weeks back he said that he was really impressed with how the tract had formed and didn't forsee me having any problems with the next change.
    The catheter would have only been out for approx 15-20 seconds tops so I can;t imagine that it would have closed in that amount of time, but please correct me if I am wrong because I am new to this.

    I called his uro first thing this morning so there are no problems with that, he has a great uro who is also a teaching dr so I am completely confident in his ablilites, just not mine as of yet.

    Thanks for the input it all helps

    Marg

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