changing supra pubic

[Lizbv]

Can someone tell me the correct procedure to change the cath? Thanks

Want to make sure I've been doing this correctly since I have no RN's or LPN's due to cost and not being "homebound" (Medicare guidelines).

Also, do you think with SCI diagnosis, I should try to fight the health insurance (Aetna) to try to get a one visit at least for SP change? Has anyone suceeded at this? Other than home healthcare not being covered (because I' work, etc) its good ins.

TAKE YOUR HANDS OFF MY MOJO

[Clipper]

I ran into the same difficulties with my insurance company because of the "homebound" thing. This was my argument:

1) Though I am not homebound, I do depend on others to helf me bathe and dress. I also cannot transfer independently in the doctor's office, which means that someone must accompany me when I get my catheter changed. Depending on others greatly restricts my ability to get to the doctor to have the catheter changed.

2) If the catheter comes out accidentally, I must go to the ER. This is far more costly than having a home health agency available during such emergencies.

3) The examine table at my doctor presents a danger. It is unstable and difficult to re-dress after a catheter change. This risk creates the potential for additional medical complications.

4) The home health RN does much more than change my catheter. She checks my skin, takes my vitals and assesses any problem areas. This increases my medical well-being in the long run.

Basically, you have to make the case that having an RN come out is more practical and less expensive. Mine visits once every six weeks. I used to have Aetna, and they paid for it. FIGHT!

[SCI-Nurse]

A SP catheter can be changed by anyone who is willing to learn the technique. We teach our patients, family members and unlicensed PCAs to do it all the time. I am much more comfortable with this than having my patients not be able to get it changed if it clogs and they get AD and cannot irrigate, or if it comes out when they are traveling or a long ways from a hospital. Going to the ER will not be possible for many, and once you arrive, few ERs will see this as an emergency...you may sit for hours waiting to be triaged for treatment.

A sterile catheter is needed, and ideally a catheter insertion tray with sterile supplies. Nearly all insurances pay for this. Your insurance may also pay for 1-2 nurse visits to teach you or someone else how to do this, which is ideal.

Here is the procedure:

CHANGING A SUPRAPUBIC CATHETER:

1. Assemble all equipment: catheter, lubricant, sterile gloves, cleaning supplies, syringe with water to inflate the balloon, drainage receptacle (generally all is in the cath kit).

2. Wash your hands and put on non-sterile exam gloves. Pull the old catheter gently so that that balloon is snug against the stoma. Mark where the catheter exits the stoma on the catheter with a felt-tipped pen.

3. Remove the old catheter and lay it on a towel close-by to your new catheter tray.

4. Wash the stoma site and skin around it with soap and water.

5. Apply the sterile gloves. Make sure you do not touch the outside of the gloves with your hands.

6.Use betadine or cleansing swabs to clean the stoma. Start at the stoma and move outwards about 3 inches. Do not cover a already cleaned area with the swab. Repeat with all 3-4 swabs in the kit.

7. Lubricate the catheter from the tip back at least 3 inches. Compare the mark on the old catheter with the new catheter. Place your finger tips at the same place on the new catheter.

6. Slowly insert the catheter into the stoma just to your fingertips (as above in #7).

8. Once the urine flow starts, advance the catheter another 1/2 inches. Hold the catheter in place while you inflate the balloon with water. Care must be taken to ensure the catheter is in the bladder. If pain is felt which inflating the balloon, or you get AD or have sudden spasms, stop; deflate the balloon; and pull back the catheter another 1/2 inches; and attempt to inflate the balloon again.

9. Secure the catheter, and attach the drainage bag. Wash the betadine off the skin after insertion. Keep pubic hairs trimmed to 1/4" within 2" of the catheter.

The danger with a SP catheter is passing it too deep so that it goes all the way through the bladder into the urethra (from above). This can result in you inflating the balloon INSIDE the urethra, which can cause damage, bleeding, lack of urine drainage, AD and sudden spasticity.

(KLD)

[Lizbv]

Thanks so much Clipper and KLD.

Clipper is what you wrote below exactly what your doctor submitted to the insurance? How did you go about it wioth Aetna?

KLD if the sterile cath is in a blue plastic inside the original packing can you only touch the blue with sterile gloves or should you only be concerned about keeping the cath sterile?

Secondly, should you only touch everything inside the tray w sterile gloves? Usually I just have them lay everything out, open things, then put on sterile gloves.

TAKE YOUR HANDS OFF MY MOJO

[SCI-Nurse]

The blue inner sleeve should only be touched with sterile gloves. With your gloves off, open the outter wrapper only. Then apply the gloves, carefully pick up the catheter inside the blue sleeve, open the sleeve and put the catheter inside the sterile tray.

Always put your gloves on before touching anything inside the tray (other than the glove package, which should be on top).

(KLD)

[Clipper]

Originally posted by Lizbv:

Clipper is what you wrote below exactly what your doctor submitted to the insurance? How did you go about it wioth Aetna?

Aetna always paid for such visits - no questions asked. When I changed employers and switched to BCBS, no problems. Then I moved. Same insurance, but the home health agency balked at first. BCBS in Oregon is more strict about the homebound thing. But since I'm still on BCBS Maryland, the visits were allowed. I told the home health agency everything I wrote in my last post, and they worked it out.

Did Aetna assign you a case manager? This seems to have made a difference for me. Once they understand that using a home health agency will save THEM money in the long run, they tend to change policies. I hope this info is helpful.

[Lizbv]

Thanks SCI nurse.

Clipper, I did have a case manager when going after home health. It seems like they only want to speak to my doctor tho. Did you talk to your case manager yourself?

TAKE YOUR HANDS OFF MY MOJO