I am aware this is not a medical forum but I am hoping someone has some experience or advice here. His next uro appointment is not until 11/27/23 though I am constantly refreshing the website to try and find one sooner.
Dad (67) has had a foley catheter for about 2 years and has switched to a suprapubic catheter maybe 4-5 months ago because he was a "difficult change". Whenever the nursing home would do it he would have to go to the ER with a bag full of blood. The urologist would do it fine but admitted it was harder than normal. The conventional catheter was uncomfortable for dad as well. Ever since the switch to the suprapubic catheter he has been frequently clogging and needing his catheter changed all the time due to sediment build-up at the opening that is inside of him. (You can see how much sediment that is in the tube as well. It is a lot. It looks like sand after a few days)
This problem seemed to get better for a few weeks when his old urologist introduced daily saline flushes but as of late he has been clogging again. It has clogged 3 times in the last 7 days and needed to be changed each time. Who knows how many hours he goes without them/us realizing he is clogged. I make sure he is flushed every day. He generally knows and tells me when I ask. Right now he has a UTI with a bacteria colony count 10k+ which I just gave my consent to treat with midline antibiotics.
They tried increasing the size of the catheter as well. He is currently on 20fr. I read some people need their suprapubic changed 1-2 times a week BEFORE it clogs to prevent bacteria and infection. This might be him it hurts him and remains sore for days. (Even when it was a 16fr & 18fr) He is at 1x flush per day. I am tempted to suggest 2x or 3x but I heard this may increase risk of further infection due to open air flow.
I'm asking here because he is switching insurance so we can get him a nurse practitioner 5 days a week. She has seen him but does not have much else to offer aside from more eyes on his catheter and wishing we get into the uro. Unfortunately he will need a new urologist who he can't see until Nov 27 so we are kind of in no man's land. (He missed his last apt due to transportation issues not his fault)
Does anyone have any ideas? Pre-emptively change his suprapubic 1-2 times a week even though it hurts him? Flushes more often than 1x per day?
I would be tempted to suggest putting it back in his urethra because the sediment was such a lesser issue then but I know when the tube gets clogged now he can at least void the overflow out of his penis and get some of the urine out. If he clogs when it's in his penis I fear what might happen.
Any suggestions or information would be much appreciated. I have a few members on staff who I feel would be receptive of any of my suggestions.
He was previously in another nursing home and has been in septic SHOCK 3x in the last 2 years so he has a history of really bad UTIs. Again, he is currently being treated by anti-biotics right NOW which I hate because I am well aware about building up immunity.
Lastly, he has constipation issues which I know may contribute, however, due to the amount of visible sediment both in his tube and around the opening that is inside of him that I can see when they pull them out of him, I am confident that is the much bigger issue.
We did go up in size on the catheter at one point eventually because of this issue, as I recall.
Dad had home health visits weekly and it was great having a nurse check how the catheter site looked, how the urine looked, regularly. Then once a month the visiting nurse would change the catheter.
I definitely recommend getting in early to see the urologist’s physician assistant. My dad’s urologist’s PA was great, and was very helpful and enthusiastic about getting into the nitty gritty of resolving all the different issues we had with the superpubic, *much* more so than the urologist. We referred to her as the Catheter Whisperer!
Gosh, it stresses me out just remembering these issues— like coming into my dad’s bedroom in the middle of the night to turn him and finding urine had seeped out at the catheter site because of a clog, having to change everything… 😞Hope you are able to get some helpful guidance on this soon — good luck!
The only issue he/I ever had with it was the fact that very few nurses actually knew how to change it, so that makes me wonder if the nurses at his facility know how to change it or are comfortable changing it.
When my husband first had to have it changed, the nursing agency that we had said that they didn't have any nurses that knew how to change it and that I would have to take my husband to the urologists office so he could change it, which I did.
And then when my husband went under hospice care in our home later that year after he almost died from aspiration pneumonia, the hospice agency only had one nurse(a LPN)that said she was comfortable changing it, so we had to make sure that it was her that came out when it needed to be changed.
In fact, now that I'm reminiscing about this, I'm remembering that the hospice agency asked ME if I wanted the LPN to teach ME how to change it so I could do it myself. Of course I said NO(actually I'm sure it was more like HELL NO!!!), but recommended that she teach the other hospice nurses how to change it instead.
Anyway I'm digressing. The fact that my husband was in our home and I was his caregiver, I did make sure that he was drinking plenty of fluids as I understood the importance of that for not only his catheter but his overall health as well.
I can only guess that your dad is not getting enough fluids daily thus why he keeps having issues with his catheter needing to be flushed, plus perhaps the nurses at his facility don't really know how to change it, or aren't comfortable doing so.
I do hope you get things figured out sooner than later.
I agree with you and am ALSO "confident that this is a much bigger issue" than constipation contributing. These sediments are lining and WILL clog any catheter. And there hasn't been testing I am assuming as to why so many calcium or uric acid or other deposits are there to be dealt with.
Given that this is such a crucial issue, and so dangerous, and you ARE going to be dealing with it until the 27th, I think that you have to deal with it by going to urgent care or the ER by EMT when you cannot clear this catheter. As you say, there is now infection and the constant TRYING to clear it could contribute to that. This risks sepsis, even death, and cannot be ignored.
For now attempt to clear catheter as you have been taught and advised, but when you cannot, and when you palpate a still full bladder go to the ER. So sorry you are dealing with this.
This contributes I know to sediment. He has a 32oz water bottle that I told him he should be drinking 3x a day minus any ensure/coffee he drinks. (I told him just to do it 3x) He does have short term memory issues due to TBI/dementia but he is still clear and acknowledges. Permanent staff knows although there is frequent change due to agency nurses. We have signs up to refill it if he doesn't ask. Obviously I do not know exactly how much he is consuming in a day for sure.
What kind of testing can be done to figure out the calcium or uric acid situation?
Thank you so much for replying!