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Thread: 3 questions

  1. #1
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    3 questions

    Indwelling catheters? I noticed a comment by the SCI Nurse indicating that you no longer use latex indwelling catheters. What other kind are available? I have just begun using a Foley catheter, but thought latex was the only available kind because of the need to inflate the balloon at the end.

    Storage of intermittent catheters? With luck, I may be able to go back to using intermittent catheterization. For the past five years I have been using Bard coude tip catheters, storing them in 100% white vinegar, rinsing with distilled water before and after use, and coating them with K. Y. jelly prior to insertion. If I am able to return to use of intermittent catheterization, information from your web site suggests I should attempt to use straight catheters (I will start by trying out the Rochester Personal Cath). What method of storing between use you recommend? Because Medicare is limiting me to 4 catheters per month, and I am committed to a swimming/strength/stretching program which requires catheterization at the gym as well as at home, I have been attempting to use a single catheter for a two-week period of time.

    Risk for a compromised kidney? Over the past five years while on my program of intermittent catheterization, we fairly frequently (3+ times per week) would drain a bladder volume of 700-1000 cc. Most frequently this would occur immediately following a swim of 40-60 minutes. We always drain the bladder immediately prior to swimming, and I attempt to adjust fluid intake to avoid large volume. Obviously I frequently failed to accomplish that purpose. At other times during the day, we do catheterization when I get some signal that it might be time, or when we realize it's been more than 4 hours since the last drain. Even then, there are times when bladder volume exceeds 700 cc. Our goal is to attempt to hold bladder volume to no more than 400 cc. We probably manage to do that for 3 or 4 of the approximately 5 times per day we catheterize. What are the chances that I have already compromised my kidney, or what are the chances that I will compromise my kidney with this behavior? What symptoms should I watch for?

    Jim

  2. #2
    Other types of indwelling catheters

    Cleaning straight catheters for reuse

    For your long term health, you would be better off doing intermittent cath than using an indwelling catheter. Many people note this problem with increased urine production during swimming. I would just recommend limiting your fluids prior to swimming, and then cathing as soon as possible at the gym when you are done. You should try to keep your bladder volumes below 500 cc. if at all possible. How much fluid do you drink in a day, and how do you schedule it?

    (KLD)

  3. #3
    Senior Member Kaprikorn1's Avatar
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    Jim...I cannot believe that medicare only gives out 4 caths per month!!! That's absurd!

    Anyway...if you do use Bard rubber ones you can maybe dig into your own pocket and pick up 20 or 30. Believe me, it's a WHOLE lot easier to have a "batch" of 20-30 so you're not having to wash a cath EVERY time you use it. I keep a batch of 30 or so and only have to wash caths once a week or so.

    Kap

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  4. #4
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    Originally posted by Kaprikorn1:

    Jim...I cannot believe that medicare only gives out 4 caths per month!!! That's absurd!

    Anyway...if you do use Bard rubber ones you can maybe dig into your own pocket and pick up 20 or 30. Believe me, it's a WHOLE lot easier to have a "batch" of 20-30 so you're not having to wash a cath EVERY time you use it. I keep a batch of 30 or so and only have to wash caths once a week or so.

    Kap

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    Thanks for the comment. I couldn't believe Medicare would limit me to four per month either, especially with prescription and letters of medical necessity from my urologist, and with a three-year history of success using a program of 12 per month. We didn't even consider, nor did anyone suggest to us previously, the idea of using a batch of 20 or 30. What technique do you use to ensure the catheters are kept clean and don't serve as the source of another bladder infection? I don't have enough manual dexterity to do self cath, therefore my wife or someone else always does it for me. Following catheterization, we rinse in water and store in white vinegar until the next use. The batch idea is interesting, and I certainly don't mind digging into my own pocket (except for the 4 I've been doing that for two years anyway), however storing a batch of 20 or 30 without increasing chances of infection sounds like a pretty tall order. I think I'm finished with Bard coude tip, but will be trying out a softer, gentler type such as the Rochester personal cath. Thanks for your help.

    Jim

  5. #5
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    Originally posted by SCI-Nurse:

    http://carecure.org/forum/showpost.php?p=39692

    http://carecure.org/forum/showpost.php?p=36792

    For your long term health, you would be better off doing intermittent cath than using an indwelling catheter. Many people note this problem with increased urine production during swimming. I would just recommend limiting your fluids prior to swimming, and then cathing as soon as possible at the gym when you are done. You should try to keep your bladder volumes below 500 cc. if at all possible. How much fluid do you drink in a day, and how do you schedule it?

    (KLD)
    Thanks for your comments and references! I have been attempting to keep my bladder volume below 500 cc by adjusting fluid intake. However, obviously I have been erring more often on the high side, rather than the low side. I attempt to ensure that I produce at least 2000 cc of urine daily, and adjust water intake based on my anticipated daily schedule. Since my wife or my caregiver (therapist) are usually the ones to perform catheterization, I attempt to drink on a schedule that will ensure I am in a location where catheterization is possible at about the time it should be needed. It works quite well in the morning, because that's pretty predictable. However I take the paratransit bus to the gym, and that usually works well also. On those unpredictable days when there are an unusual number of pickup or drop off stops on the way, I may not get to the gym in time to catheterize before urine volume exceeds 500. Based on that urine volume, I decide how much to drink prior to swimming. Again, I guess correctly most of the time, but it's not infrequent for me to make a mistake on the side of too much intake. Then after my workout, I again adjust intake based on anticipated time of arrival at home. That estimate probably has a higher rate of success than any of my other attempts. I think the swimming "resets" my system in a way that makes it more predictable. Of course, there are times when the paratransit bus ride home takes longer than anticipated and bladder volume gets excessive. Quantity of food intake also adds a degree of uncertainty. When I eat an especially large meal I attempt to proportionately increase my water intake. My major goal is to ensure a urine output of 2000 cc per day, with the idea that I would rather err on the side of more rather than less in this driest desert in North America. Again, thanks for your immensely helpful comments.

    Jim

  6. #6
    Originally posted by SCI-Nurse:


    For your long term health, you would be better off doing intermittent cath than using an indwelling catheter.

    (KLD)
    Does this include SP foleys as well or just an indwelling cath. placed in the winky directly??



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  7. #7
    Senior Member Kaprikorn1's Avatar
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    Jim...here is a topic that covers a lot of cathing advice: LINK

    My whole cathing, washing and storage routine is in a post here as well as several others.

    Kap

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  8. #8
    The other catheter type is silicone.
    Coude or straight catheters are fine. Coude tips are for folks who have difficulty passing the catheter through the sphincter.
    For cleaning storing- wash with soap water, rinse thoroughly, dry and store dry.
    In terms of a compromised kidney- you need to have a routine (generally yearly)ultrasound of your urinary system to check.

    JM

  9. #9
    There are the same risks for UTI, bladder cancer, stones, and kidney deterioration with a SP as with a urethral indwelling catheter.

    An ultrasound cannot tell you about how the kidney is functioning, only if it is damaged already. You need at least a 24 hour urine collection done for creatinine clearance done on the same day as a blood creatinine level to tell how your kidneys are actually functioning.

    (KLD)

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