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Dr/Nurse Hive….alternatives to catheter for women


Ottakee
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We need help.  My mother has congestive heart failure and is in a power wheelchair.  She cannot toilet on her own and often the help at the assisted living takes too long to get to her.   She is on a diuretic so very frequent urination.

She tried several type of catheters but bladder spasms pushed them out and caused a great deal of pain.

She used a pure wick at the hospital and that was good but not an option when she wants to go to the dining room, go out to the store, etc.

Right now she is using disposable briefs but then her bed sores aren’t healing well.

Trying to come up with options for keeping her dry but yet able to be mobile.

There are condom catheters for men, anyone know of any options for women?

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When she uses a catheter is it a straight cath or does she have a foley with a bag?

My knowledge is limited to my mom's situation.  My mom has been on a bag catheter for a couple of years now. 

Ultimately anything that involves a straight cath or a foley will have risk of infection. In my mom's case, she straight cathed for years and then had to go to the foley because she couldn't do it anymore. Next week she is having a catheter placed directly to her bladder through her side because she can no longer even use the foley.  I am not sure that is an option most people want, but it exists.   

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41 minutes ago, Drama Llama said:

Are you sure you can't use the purewick option with the battery in the power chair?  I don't understand why it wouldn't work. 

Is there a way to place the canister/suction on the side/under a chair?

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55 minutes ago, cintinative said:

When she uses a catheter is it a straight cath or does she have a foley with a bag?

My knowledge is limited to my mom's situation.  My mom has been on a bag catheter for a couple of years now. 

Ultimately anything that involves a straight cath or a foley will have risk of infection. In my mom's case, she straight cathed for years and then had to go to the foley because she couldn't do it anymore. Next week she is having a catheter placed directly to her bladder through her side because she can no longer even use the foley.  I am not sure that is an option most people want, but it exists.   

It was the foley with a bag but it was super painful for her to have in as her bladder kept spasming and pushing it out, even with the balloon filled.  She tried 2 different styles and placements over the course of a week.

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3 minutes ago, Ottakee said:

Is there a way to place the canister/suction on the side/under a chair?

I have zero experience, because my power chair user was male.  But we put all sorts of equipment on the chair.  This one is reasonably small, battery powered, I can’t imagine why you couldn’t.

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1 hour ago, Ottakee said:

It was the foley with a bag but it was super painful for her to have in as her bladder kept spasming and pushing it out, even with the balloon filled.  She tried 2 different styles and placements over the course of a week.

I understand. I had to get one for a day or two when pregnant and I hope never to have to again!

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I have seen underwear advertised for bladder leaks, like period pants but for bladder leaks. Perhaps it would be less irritating on her skin. Not a whole solution but perhaps a tiny help? I know an elderly female with a catheter through her side. She had terrible bladder spasms and couldn't tolerate the other catheters. 

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6 hours ago, mum said:

I have seen underwear advertised for bladder leaks, like period pants but for bladder leaks. Perhaps it would be less irritating on her skin. Not a whole solution but perhaps a tiny help? I know an elderly female with a catheter through her side. She had terrible bladder spasms and couldn't tolerate the other catheters. 

Those underwear wouldn’t hold the huge volume of urine.   Even the maximum absorbency briefs with extra pads in them are struggling to hold it all, even with frequent changing.

the side catheter is an idea but not sure we could get that since she is on hospice.

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Purewick is the closest thing we have to a condom cath for women. It sounds like the best combo would be purewick at home and briefs while up in the chair. It may be time for her to have more help than assisted living can offer if she is sitting in soiled briefs for long periods of time. For her wounds, is she seeing a wound care nurse? They might be able to suggest barrier creams to help her skin keep from breaking down. Destin Max is a favorite on my floor. Alternatively, something like cavalon could be applied to intact skin as a protectant (but my only experience is with peds and I would want someone who has experience with elderly skin to sign off on that). If it gets to the point that you need to revisit placing a Foley catheter, I wonder if she could be given an antispasmodic to help tamp down on those bladder spasms (ouch! I can't imagine pushing the balloon out). 

Sorry there are no easy answers. Things get so tricky at this stage.

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5 hours ago, Ottakee said:

 

the side catheter is an idea but not sure we could get that since she is on hospice.

My dad said it is called a suprapubic catheter. FYI in case you want to look it up. It does involve surgery. If she is on hospice, I agree that they probably won't want to do surgery. 

I'm going to ask a question that you might  not be able to answer. When I hear about bedsores, to me that generally means (if a person is disabled in some way) the facility is not doing their job to rotate the person in bed and use the proper cushioning, etc. to avoid them.  What is the facility telling you about this?  ETA: i just saw you said she is in assisted living. Can you clarify--is she AL and also hospice? That's a new scenario for me.

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5 hours ago, cintinative said:

ETA: i just saw you said she is in assisted living. Can you clarify--is she AL and also hospice? That's a new scenario for me.

I'm not the OP, but my MIL was on hospice in AL. The AL facility offered stepped up care, so as her needs increased, we used the higher levels of care. They allowed her to stay when she went on hospice. Eventually, we found a wonderful woman to stay with her overnight to help as needed. I was with her all day. We also looked into hiring a private nurse for a brief bit (in addition to the hospice nurse daily visits), but she passed before we found someone. I believe hospice also offered someone to come in to help with daily (or every other day) care.

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6 hours ago, cintinative said:

My dad said it is called a suprapubic catheter. FYI in case you want to look it up. It does involve surgery. If she is on hospice, I agree that they probably won't want to do surgery. 

I'm going to ask a question that you might  not be able to answer. When I hear about bedsores, to me that generally means (if a person is disabled in some way) the facility is not doing their job to rotate the person in bed and use the proper cushioning, etc. to avoid them.  What is the facility telling you about this?  ETA: i just saw you said she is in assisted living. Can you clarify--is she AL and also hospice? That's a new scenario for me.

The sore was from her fall that started this whole thing.  She fell in the bathroom and was on the floor for 11 hours as she had taken off her fall detection device.

She is able to reposition in bed and has a recliner chair and her custom power wheelchair.  She just can’t walk at all.

Care at the assisted living is very good and sore is now almost completely healed.  We just don’t want any more skin breakdown.

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10 minutes ago, Ottakee said:

The sore was from her fall that started this whole thing.  She fell in the bathroom and was on the floor for 11 hours as she had taken off her fall detection device.

Oh that is horrible!! I am glad to hear that her sore is healing. 

I definitely learned something new today--I had no idea you could be AL and eligible for hospice.

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6 minutes ago, cintinative said:

Oh that is horrible!! I am glad to hear that her sore is healing. 

I definitely learned something new today--I had no idea you could be AL and eligible for hospice.

Yes, a lot of the people there are on hospice.   We pay the rate for her room and level of care and hospice provides extra support.

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When my grandpa went on hospice it just meant that he was no longer provided medical treatment to extend his life, just palliative care.  His life in assisted living was unchanged.  He died of a series of strokes over a few days. 

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