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Thread: In-dwelling cath vs. intermittent cathing?

  1. #1
    Senior Member zillazangel's Avatar
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    In-dwelling cath vs. intermittent cathing?

    My fiance and I were discussing the pros and cons of an in-dwelling cath vs. intermittent cathing. He has done intermittent cathing for 16 years (I should say his attendent does the cathing of course), but he gets so many UTIs, at least one a months for the past 8 months I've known him at least. Also it's really inconvenient in alot of ways. What are the pros and cons of in-dwelling vs. intermittent? He really likes the idea of keeping his body integrity maintained by doing intermittent cathing and I can see the logic in that. Or, can anyone point me towards a good source of information I can read more about this? His pysiatrist is big on doing an in-dwelling and he is not giving us good information on which to make a CHOICE, he is treating us like children who need to be told what to do. WE NO LIKE THAT!

    Thanks!

    p.s. (Name) is a C4/5 quad who has no movement nor sensation below the nipple line at all.

    Zillazangel, I am an able bodied significant other of a C4/5 quadriplegic man

  2. #2
    Is he really having a true UTI (fever, chills, etc.) every month, or just a positive culture (ie, colonization)? There is a big difference. If he is actually having a fever, I would question how large his caths are and what his bladder pressures are. When did he last have urodynamics?

    If you have access to round the clock attendant care, at this level intermittent cath is still the ideal, but most do not have reliable help this intensively.

    For those who cannot cath themselves, options may include a sphincterotomy and external condom catheter, or an indwelling catheter. Urinary diversion (ostomy) would not be indicated for these reasons alone (big surgery). Indwelling catheters can be urethral or suprapubic. Urethral catheters can damage the urethra, and can interfere with sexual functioning (esp. in men), so many opt for a SP catheter.

    Research indicates that if intermittent cath is done correctly, it has the least risk of damage to the upper urinary tract (kidneys), lowest risk of serious UTI, lowest risk of stones, and lowest risk of bladder cancer. Indwelling catheters significantly increase the risk for all of these complications, and will also reduce fertility in males. While many do well with indwelling catheters, the risks for these complications still exist and are statistically significant.

    If you are not happy with your physiatrist and how you are treated as health care consumers, shop around. Let the new potential physician know that you are interviewing them about their philosophy of care and approach, and that they will be on a trial period. If they won't agree to an interview before you "hire" them, look elsewhere. In many areas of the country there is an excess of physicians (medical schools are turning out too many in many specialties), so you may very well be in a buyer's market.

    (KLD)

  3. #3
    Senior Member zillazangel's Avatar
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    Thanks for the quick reply! He is having true UTIs, fever, chills, and a positive culture. We have round the clock attendant care too, and your information is VERY helpful and it makes me wonder why the h-e-double hockey sticks this doc wants to put an indwelling in. Looking forward to more replies and I'll search the litearture too. We are definitely going to look for a new doc. I think my fiance is more passive than I about doctors - he just ends up not going to the doctor when he's not happy, which is not good. Me, I just find a new one. Thanks so much for the advice, it was VERY helpful!!

    Zillazangel, I am an able bodied significant other of a C4/5 quadriplegic man

  4. #4
    Senior Member zillazangel's Avatar
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    Also, what do you mean when you say how large his caths are? Amount of urine or how long the cath tubes are? His tubes are 14 inches and I/his attendent gets out between 200-800 ccs depending on how hot it is, how much he's had to drink. We cath every 6 hours like clockwork, have for 16 years.

    Zillazangel, I am an able bodied significant other of a C4/5 quadriplegic man

  5. #5
    The amount of urine is important. 800 cc. is way too high. Most recommend that the maximum be no more than 450 cc. This means that he needs to either adjust his cath frequency or his fluids (or both) in order to avoid having so much. Too large amounts can definitely contribute to UTIs.

    A set schedule for caths may work in the hospital, but most need to adjust it at home. He would probably do better if he were cathed every 4 hours, at least during waking hours.

    (KLD)

  6. #6
    Senior Member zillazangel's Avatar
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    Originally posted by SCI-Nurse:

    The amount of urine is important. 800 cc. is way too high. Most recommend that the maximum be no more than 450 cc. This means that he needs to either adjust his cath frequency or his fluids (or both) in order to avoid having so much. Too large amounts can definitely contribute to UTIs.

    A set schedule for caths may work in the hospital, but most need to adjust it at home. He would probably do better if he were cathed every 4 hours, at least during waking hours.

    (KLD)
    I hope I'm not pestering you .... when you say he'd do better cathed every 4 hours, does that mean he'd get fewer UTIs possibly? He *rarely* gets 800 ccs, that happens maybe once a month at most, on a very hot day or if he has had alcohol or something with caffeine (both very rare events). If we cathed him every 4 hours during waking hours, wouldn't his body come to expect to be cathed every 4 hours at night too? He has done 6 am, 11 am, 6 pm, 11 pm for literally 16 years like clockwork ... but clearly something is not perfect here given all the UTIs he is getting (and always has).

    His last urodynamics test was probably 4 years ago and showed nothing out of the ordinary according to him, but I didn't know him then, so I didn't see the test results.

    He takes pyrridium for bladder spasms (about 2x a week probably) and B & O supposities for bladder spasms too (about 2x a month maybe). I just don't think his bladder problems are well controlled. What is the next step - see a urologist or a physical medicine doc?

    Thank you SO much!!

    Zillazangel, I am an able bodied significant other of a C4/5 quadriplegic man

  7. #7
    Suspended Andy's Avatar
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    I am not too sure how relevent this is, but 7 hours between some caths according to the schedule you posted? That is a long time, and may have some affect on UTI's. Reason I say this is one of the Dr.'s I have seen showed a graph of bacteria colonization in urine, after 4 hours the bacteria colonization skyrockets. Maybe one of the reasons the UTI's are so frequent is because of the amount of flora hanging around his bladder for an extended period of time.

  8. #8
    in terms desireability from a urologist's point of view, indwelling (sp or foley)is usually the last option for bladder mgmt

  9. #9
    Good points. There are two reasons why cathing more frequently would help to reduce the risks of UTIs:

    1) Overfilling of the bladder decreases circulation to the bladder walls, and increases the risk of reflux of colonized urine to the kidneys, causing symptomatic UTIs. Higher volumes can also cause higher pressures in some.

    2) Bacteria that commonly cause UTIs can double in number in 45 min.-1 hour. This is a geometric progression and quickly increases the number of bacteria per cc. of urine. Cathing more often keeps the bacterial concentration lower.

    Regulating fluids (and avoiding caffeine and alcohol) can allow most people to cath every 6 hours during the night even if doing every 4 hours during the day. We recommend taking 1/2 of your total daily fluids between awakening and noon, then the rest by 6PM. Sips only as needed to take meds after this. This will allow (for most people) a cath at midnight and 6AM (or similar times depending on your bedtime). I would at least try this for 1-2 months to see if it can make a difference.

    Urodynamics needs to be done every year if you are having frequent UTIs, with a focus on his maximum pressure (should not be over 40). Even without problems, no more than 2 years should pass without urodynamics. If it is over a year, he needs it done again.

    He also needs to be sure that his urologist is very familiar with state-of-the-art care for people with SCI. Many urologists know little about neurologic urology.

    (KLD)

  10. #10
    Senior Member zillazangel's Avatar
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    Wow, I'm *really* glad I asked this. We will not be doing the in-dwelling, but now we certainly will be taking more pro-active steps about his cathing and testing to manage his UTIs. Thank you all SO much, this has been tremendously helpful. I am medically trained, but this is about as far from my area of expertise (psychiatry) as you can get, so this is just great (if only I could put his bladder on Prozac, hmmmmm!). Thank you again!

    Zillazangel, I am an able bodied significant other of a C4/5 quadriplegic man

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