Dad being discharged with a catheter - experiences?

[CMOTDibbler]

My lovely, frail, elderly dad is being discharged from hospital tomorrow with a catheter following an admission in acute urinary retention due to a massive prostate - he'll be awaiting a TURP. But this could be some time apparently

Any experiences of issues he might find? I'm not local enough to them to just pop in, so ideas of things to watch for would be good so I ask the right questions

Hi. My mum had one for just under a year. He has to make sure that it is replaced. Some are long term catheters so will be designed to be changed after three months (I may be wrong about this so you do need to ask), some need changing after a week. There's a risk of him getting a UTI after it's been changed so look out for any change in behaviour/temperature. He needs to be careful not to pull it as it will be incredibly sore if he does. My mothers used to fall out but we suspect that this was due to a problem with the muscle holding it in (they are not supposed to do this).

I can't think of anything else.

Yes do keep a check that he is not in pain or running a temperature.

I have had catheters on and off over quite a while after operations on my bladder. Sometimes the doctor/nurse pushes the catheter tube in too much so the end sticks up into the bladder and the end pokes into the bladder wall which is really uncomfortable. It just needs pulling back a bit so its not sticking up so far. He will need to go back to get a nurse to do this if it happens. It really should not feel uncomfortable.

Thanks both, I'll buy a thermometer for him. He's been in quite a lot of pain recently, so that might be harder to detect

Tell him to carry on drinking plenty as per usual - tempting perhaps to cut back on fluids in order to avoid emptying the bag so often, but he needs to keep his kidneys in good shape, especially if he has had long standing prostate problems.
Infection and blockage are the most common problems. Blockages often easily sorted with some water and a large syringe to flush, but best done by district nurse in first instance (who may be happy to leave one with him if he knows what to do).
Good luck!

Infections in older people can show up in very odd ways, such as quick onset dementia. It can be very hard to keep on the ball, especially if you're not near. Just be aware that he could have an infection if he starts to act out of character.

I'll nag him about the drinking - he's previously had kidney stones and an abcess, though they have done kidney function tests this week to check.

Should he be discharged with a district nurse contact/appointment?

dibbler - I'm sure he should be discharged with some follow up care .

I'm terribly sorry to say this but I think with men that it's not unusual for the catheter to get blocked .
I have a feeling that in an emergency before help arrives ,sitting in a bath can help .
Though unlikely that a frail elderly person could do that .

Sorry ,but thought you'd prefer to know .

I will be refusing to leave tomorrow without some definate followup organised then.

Thanks for the heads up on how frequently the catheter might block - they have a little community hospital accessible by mobility scooter, so I guess he could prob go there to have it replaced, so I'll investigate that.

He can't get in the bath. In fact his mobility has taken a major downturn over the last 10 days, and they are sending him home with a wheelchair apparently

I am a community nurse , in my area all patients discharged with a catheter are seen at home by the district nurse team.
He should be sent home with some catheter bags and supplies if he needs a replacement.
A district nurse referral should be done to arrange follow up for your father.If it blocks a nurse will visit at home to sort it out.

Thanks Ggirl - would you see people routinely when they first come home? He's had loads of problems with information never making it from the hospitals to his gp in the past, so its good to know what should happen!

We normally see a pt the day after discharge to check they are coping with catheter etc. The ward staff need to stipulate what they need the district nursing team to do on the referral they fax us,with dates etc.
It'snot uncommon for referral to not be sent on time so it's worth checking before your father leaves the ward that a referral to the District Nurses has been done.

My Dad had a catheter for two years as he needed to be on extremely high dose diuretics to lower his blood pressure. He was visited regularly by the District Nurses (who, incidently, are fab, thanks for all you do, ggirl) and just got on with life. In fact, as he was permanently in a wheelchair, the catheter made life much easier because he didn't need to worry about accessible toilets as much.

Hand washing ! Important

What ggirl said. My elderly neighbour was sent home wi
th one last year and I helped him with it, am also a nurse but not community.

He will usually have a smaller bag strapped to his leg, and a larger bag to attach at night while in bed. He will need to be able to get this on and off or carers in to do it. If it stays in, he will need the supplier phone number so he can get more bags delivered when he needs them. The bags also need to be changed fairly frequently and it needs a bit of dexterity. Hope he gets on with it ok.

aww poppypebble what a lovely thing to say..thank you .I love my patients and my job!!!

Thanks again. He's been changing bags today, so he seems ok with that.

My mum got lost in the hospital for an hour visting him today though...

As an ex district nurse I would also add just make sure they send your dad home with sufficient supplies of leg and night bags and at least one spare catheter. I have lost count of the number of times I have gone to someone with a catheter problem only to find no supplies in the house.

District nurses don't usually have instant access to these, normally they are re-ordered on a prescription. Something else to check.

I'd add to make sure they send some of the very large syringes and some sterile water in case it needs to be flushed. I was sent home with a catheter but nothing to flush it with so ended up in A&E.

Brilliant CPtart - I will make sure that happens.

Hi,
Make sure the hospital state clearly in the discharge information that your Dad is suitable for community recatheterisation. I send probably two patients a month into hospital for recatheterisation who could well be suitable for it to be done at home but it is not stated (during the night time nobody to check with).

If his catheter stops draining encourage him to check for simple mechanical problems - leg bag higher than bladder (water will not drain uphill), kinks in the tubing - two most likely areas being where the catheter exits his underwear and at the point where the tubing of the leg bag enters the leg bag. Another cause of 'blocking' or bypassing (where the urine will go round the catheter and come out of the penis) for new catheter patients is a full leg bag .

If it stops draining contact your DN team straight away, they will not be able to be there immediately - many patients try and hang on, hoping it will get better, not wanting to trouble anybody. Don't let him! Also, if it does not drain, he may not feel discomfort or need to pass urine as his bladder will probably have a ridiculously large capacity due to the retention he had previously. So do not use discomfort or not as a guide to whether he needs attention- or let anybody do so during a telephone call.This will probably improve over time.

If it was my Dad I would not let anybody near it with a syringe to flush a blockage or a catheter tip irrigation solution to clear a blockage, if it is blocked it needs changing.

And make sure he attaches the night bag to the bottom of the day bag (and opens the tap at the bottom of the day bag) - a lot of people take the leg bag off and swap them over at night.

That's probably enough for now, any specific questions, just ask.

oh I love MN ,what a great helpful post .

That was not clear - swapping leg and night bag is not an alternative method some people use - I meant it is a (very) wrong thing that lots of people do. (I find them out during the night when I see their leg bag rinsed out and on the side to dry

Well, it wasn't the best discharge ever, and really the time to decide that maybe the patient having three hypos needs advice from the diabetic team is before you've told them they can go home . And patients with very impaired blood flow/severe neuropathy in their feet shouldn't be in compression stockings - I really hope it hasn't done any harm as his feet as so borderline.

But dad is home with lots of spare bags, and strict instructions from me to get on to his gp tomorrow for a prescription for new bags and a spare catheter (they wouldn't give him one).
I will find the DN team number and harass him to use that early if necessary - apparently they don't visit routinely but will make contact.

Bless him though, hes really struggling to walk now. But he agreed on having the fabulous rollator I saw when I was buying him new shoes, so that is progress.

Mum pleased to see him, but still thinks they'll do something to his hip

Glad to hear he's home despite the hit and miss discharge.

Just another tip, if he rings the GP to order more bags and catheters they will usually need to know the type/size of the catheter as they are not all the same. If the ward didn't give you this information, it should be on the DN referral and it may be better to let them do it first time for you.

Good luck, hope he gets on ok.

Thank goodness he's got you Dibbler .