Anyone out there with experience of urinary catheters? Nurses? carers?

[mears]

My 91 year old dad has had an indwelling catheter since Jan this year after being admitted to hospital. Recently he has been passing blood into the bag and has had the catheter changed a few times. He is now being referred to urology for opinion (nightmare since he needs to be hoisted from bed to chair etc).

I have noticed that the nurses recatheterise him with the same size catheter. Would it not be better to change the size? Could this just be trauma? Wouldn't regular washouts help?

I am a midwife so do not have up to date adult experience. I just think that perhaps the catheter itself is an issue. A specimen of urine has been sent today and I am pushing fluids to flush his system.

Any thoughts?

what size is the catheter?

IIRC the "usual" size is 16Ch

It's possible that the catheter is causing some trauma, but they need to rule out a chronic infection, bladder polyp, blood coming from higher up the urinary tract.

It is a 16CH. Initally when he came home from hospital it was a 14.

The thought of trundling him up for a urology appointment is turning me gray! Just thought there might be attempts at other solution first.

A colleague of mine's husband had MS and she found that his catheter worked best when flushed every 3 days because he had the same problem. Is that a bad thing to do?

if he has haematuria (for whatever reason) the blood may be clotting around the tip of the catheter so having a flush might help if it keeps blocking. However it is a potential source of infection being introduced I would have thought (no matter how clean the technique) so the less handling the better.

Press hard for a domicillary visit. Geriatricians DO do them so a urologist should be able to in view of his advanced years & frail state. (IMHO but this is the NHS )

yes, but the hospital in question has a very good "one stop" urology clinic, it's won prizes! None of the relevant investigations can be done at home. Although it's a struggle, it would be a worthwhile trip, I think.

if you can't physically get him in a car, then ask for a two-man ambulance.

Has he had his catheter changed because it is blocked, or for some other reason?

Did the blood start before or after the catheter was changed?

Is his urine clear (other than the blood) or sedimenty?

Flushing is not a bad thing in itself, and can help with keeping the catheter clear, but obviously this is more symptom control than problem solving. The key would be to resolve the need for it.

In general, it isn't a great idea to change long-term catheters unless necessary, because it does give rise to trauma and infection. So the options are either to change to a long-term catheter brand, if the issue is simply a routine one (i.e. catheter change recommended every 4 weeks), or try to resolve the issue causing the need for a change.

I presume that with the referral, the District Nurses feel there may be a urological problem rather than a practical one.

The catheter is meant to be changed every 12 weeks.

It had to be changed initially because of trauma - the catheter tubing was trapped in the bed cotside apparently.

I think there is an issue with trauma because of the fact he is hoisted in and out of bed onto a chair. It is a struggle to get trousers up etc. as he is dressed in bed due to lack of mobility. I am sure it gets tugged. Poor man has had about a litre of fluid down his neck since I arrived this afternoon!!

We would be able to hoist him into a wheelchair but what about the other end Tissy? Is the one stop urology clinic set up for someone who needs a hoist to move? Would we just let them know in advance and they would have one there available? Waht would they do there?

Forgot to say Mum's car takes a wheelchair. I would hate to be at the mercy of ambulance transfer

Hoisting shouldn't be an issue. Flushouts could help, but obviously a site of traumatic injury will need to clot off, it just needs to clot off without blocking the catheter.

If it will be long-term, they may suggest a supra-pubic catheter.

I think hoisting may be an issue because I don't always think he is correctly positioned. I think the catheter gets pulled. It can be a struggle sometimes for the carers to get him dressed also.

I have to say I would prefer regular washouts to a suprapubic catheter.

Sorry, I meant that it shouldn't be an issue when attending clinic.

Oops, thanks

don't know if the clinic has hoists, tbh, but there will be plenty of people around to help transfer him. If you still think he'd need hoisting then I suggest you ring them a day or two before the appointment, and they could arrange to get a hoist down from a ward. In that case, take his sling with you.

Good thinking Tissy, thanks

just a thought but given his age, maybe he has Benign prostatic hypertrophy and the frequent catheterisations have caused trauma???? is it frank haematuria?

Yes it is. I wondered about his prostate too. Before he was unwell, the GP was monitoring his bloods with regard to his prostate. That has gone by the wayside.

If the prostate is the problem, what is the solution. I really don't think we would want to go down the road of surgery with a 91 year old with COAD, glaucoma, steroid dependency and alzheimers!

Hi Mears,was the recatheterisation recent?If so the haematuria could be mechanical trauma from this.Does your dad have a dn?They could maybe do the washouts??DP has had an indwelling suprapubic for nearly a year (He has Wegener's that started in his prostate and it was size of melon when dx,hence the suprapubic, as impossible to site catheter urethrally )The dns change the suprapubic,usually (a size 16))If dns can manage it this would maybe mean less problems for your dad being sent from pillar to post at urology clinic?

Hi,
I have a long term indwelling catheter myself due to a spinal cord injury, so i can give advice from a patients point of view. I often get blood clots coming through into the bag, caused by the balloon in the catheter rubbing the lining of my bladder. I was told that washouts are not a good idea as they introduce more infection into the bladder. Has he been tested for an infection, as i fid that can cause more bleeding. I can't comment on catheter size as i use a 12ch myself.

Oh sorry,just re read OP !!

Haematuria can be present with some infections as others have said it could be prostate linked too.

If he has to go to OP could they get a stretcher ambulance for him so he doesn't have to be hoisted and can remain laid down?Your gp may be able to arrange transport given notice.

CSU has been sent today. He is already on long term antiotic therapy because he is on steroids and GP is worried infection could be masked.

He was fine till the first incident of trauma. Cathereter was changed and urine was clear for a while. Out of the blue he becomes haematuric, passing clots. When that happend DNs change the catheter if washout doesn't help. Urine then is clear for a week or so, then clots appear again. Last night mum says he was passing a lot of blood and clots so overnight DN service visited and did a washout. There is some haematuria tonight but not much. I have pushed fluids with him to try and flush out his bladder. He has has 3 changes within last couple of months I would say.

Thanks for all your posts by the way.