Hello! I just wanted to offer an update on the C4/C5 patient with urological troubles I posted about a few months ago. Thank you for the advice. It was a long and frustrated post so I appreciate KDL and everyone else who took the time to read it. The patient is doing great. No UTIs so far. He has ditched the Foley catheter at night and intermittent caths every four/five hours. He drinks about a gallon of water a day. For the most part, his urine is clear and odorless, no S & S of infection, bloodwork and urinalysis all normal, and no more antibiotics! He feeling better about managing his bladder. Still has the same urologist, but armed with the info from the SCI best practice guidelines, he better prepared to direct his care.
I hope it is OK if I share two things that were helpful for this patient:
Although it is not an evidence based practice, the patient wanted to flush his bladder out after the first morning?s cath to get the small amount of sediment that collects there during the night. He was given acetic acid and sterile water by his urologist. Both caused dysreflexia during instillation and internal irritation making subsequent caths more difficult. So instead I tried out 50ccs of normal saline. No dysreflexia and no irritation. In wound care, saline is the recommended material because it doesn?t cause a shift in intracellular osmotic pressure ? it mimics the salinity of the body?s own fluids. This shift in pressure can weaken and damage the tissues. I imagine that the delicate epithelium of the bladder isn?t all that different from a wound in terms of reacting poorly to water or vinegar being routinely poured on it. Just speculation, but saline works well for him and might for others who choose to flush.
Another problem he encountered was urethral trauma during catheter insertion. One of his nurses perhaps used too much pressure while passing through the sphincter and injured him. He bled quite a bit, went to the ER, and had to use a Foley until the urethra healed. His caths were frequently difficult to insert past the sphincter, so we tried instilling sterile lubricant directly into the urethra and it has helped tremendously. He reports less dysreflexia from cathing and the catheters much easier to insert.
In order to get enough lube into the penis, a special instillation tip is needed. This is what we came up with: urologists can prescribe lidocaine jelly for numbing the urethra ? and this medication comes with the special instillation tip. We didn?t use the jelly, but I found that SurgiLube makes a 4.52 oz screw-top tube of lubricant and the instillation tip that comes with the jelly can be attached to it. So now he preps everything for cathing, wipes off the instillation tip with an alcohol pad and lets it dry, cleans the penis, squirts a bit of lube onto the urethral hole to facilitate entry, inserts the instillation tip almost all the way into the penis, and slowly squeezes the tube until lube spills out the urethra. Then caths normally before the lube is expelled. After the cath, he squirts a little lube out of the tube to remove any contaminates, washes the instillation tip well with antimicrobial soap and water and dries it. He has two instillation tips that he rotates, switching them out when opening a new tube of lube. Using a Q-tip with one end cut off (and soap + water) works well to clean old lubricant out the instillation tip after taking it off the tube. Each tube lasts him a couple of days. For people who like the concept of putting something antimicrobial into the urethra, Surgilube contains chlorhexidine gluconate, rendering it bacteriostatic yet still approved for urological use. Good luck!
Update on patient and some things that helped him with IC.
I hope it is OK if I share two things that were helpful for this patient:
Although it is not an evidence based practice, the patient wanted to flush his bladder out after the first morning?s cath to get the small amount of sediment that collects there during the night. He was given acetic acid and sterile water by his urologist. Both caused dysreflexia during instillation and internal irritation making subsequent caths more difficult. So instead I tried out 50ccs of normal saline. No dysreflexia and no irritation. In wound care, saline is the recommended material because it doesn?t cause a shift in intracellular osmotic pressure ? it mimics the salinity of the body?s own fluids. This shift in pressure can weaken and damage the tissues. I imagine that the delicate epithelium of the bladder isn?t all that different from a wound in terms of reacting poorly to water or vinegar being routinely poured on it. Just speculation, but saline works well for him and might for others who choose to flush.
Another problem he encountered was urethral trauma during catheter insertion. One of his nurses perhaps used too much pressure while passing through the sphincter and injured him. He bled quite a bit, went to the ER, and had to use a Foley until the urethra healed. His caths were frequently difficult to insert past the sphincter, so we tried instilling sterile lubricant directly into the urethra and it has helped tremendously. He reports less dysreflexia from cathing and the catheters much easier to insert.
In order to get enough lube into the penis, a special instillation tip is needed. This is what we came up with: urologists can prescribe lidocaine jelly for numbing the urethra ? and this medication comes with the special instillation tip. We didn?t use the jelly, but I found that SurgiLube makes a 4.52 oz screw-top tube of lubricant and the instillation tip that comes with the jelly can be attached to it. So now he preps everything for cathing, wipes off the instillation tip with an alcohol pad and lets it dry, cleans the penis, squirts a bit of lube onto the urethral hole to facilitate entry, inserts the instillation tip almost all the way into the penis, and slowly squeezes the tube until lube spills out the urethra. Then caths normally before the lube is expelled. After the cath, he squirts a little lube out of the tube to remove any contaminates, washes the instillation tip well with antimicrobial soap and water and dries it. He has two instillation tips that he rotates, switching them out when opening a new tube of lube. Using a Q-tip with one end cut off (and soap + water) works well to clean old lubricant out the instillation tip after taking it off the tube. Each tube lasts him a couple of days. For people who like the concept of putting something antimicrobial into the urethra, Surgilube contains chlorhexidine gluconate, rendering it bacteriostatic yet still approved for urological use. Good luck!
0 commentaires:
Enregistrer un commentaire