Follow
Share

I am beginning to think my bedridden husband needs a permanent catheter. He is on diuretics and is constantly wet. Our incontinence supplies are not covered by insurance and are expensive since he needs extended sizes. He has absolutely ruined the flooring under his bed (twice) It is buckled and I have worries about the floor rotting through. His skin is in awful shape with something like blisters (not Shingles) from exposure to urine all over his lower back and crotch area. I hate to see him catheterized because any hope of going out and about would be dashed forever. It’s hard enough to maneuver him now much less with a catheter attached. I also worry about infection. He may need an external catheter, and I have the feeling those leak. Any advice, suggestions and shared experiences appreciated.

This question has been closed for answers. Ask a New Question.
Find Care & Housing
Ahminjoy, my dad's insurance (as I mentioned, not through Medicare which he doesn't have) does totally pay for the twice-monthly home RN visits (through Pathways Home Health), with a small copay every few months for extra supplies the nurse orders for us to have on hand (like an extra catheter, in case one somehow were to come out).

I have to say it is great to have a nurse looking dad over regularly. He or she takes vitals and also looks at dad's skin. It's very reassuring and has helped us nip problems in the bud.

Also we can call their nurse 24 hour line if we have a question, and they can also send out a nurse in an urgent situation, which we've utilized three times that I can recall. So much better than having to bundle dad up, get him into his power chair and into the wheelchair van and trundle off to the ER.

So if a supra pubic is appropriate and also could possibly qualify you for home health visits at low cost, it might be worthwhile for that consideration as well.
Helpful Answer (0)
Report

I'm going to be blunt;
A condom cath doesn't work well on old men. Reason being, they have "shrunken up", so to speak.

I've applied many condom caths on elderly men, there is not enough penis to put the condom on. The pubic hair gets in the way and, with the sticky tape, you wind up ripping out the hairs.

In my experience, they either leak or come off.
The only ones that stayed on we're on younger men with more "flesh". Even then, once they started moving around, the condom wiggles loose.
Also, totally impossible to use on a retracted (or sunken) penis.

Just my experiences.
Helpful Answer (1)
Report

Thanks everyone for your good advice. I don’t believe a condom catheter would work as he is retracted. I’m hoping that if the doctor/urologist does approve an SP, we can have a HCRN come out. Getting him from place to place is, quite frankly, very, very difficult and if he needs to be lying down for the monthly care, he’s better off in bed at home as he cannot get in or out of the wheelchair without a lift.

I’m sure that there will be issues with Medicare. I want to be very sure we won’t be incurring any high costs, but diapers are not cheap, and either are the various creams and salves for his skin issues. A skin care nurse can help me get them cleared up, but they only come back with repeated exposure to urine.

We have a lot to discuss with his physician and you’ve all given me wonderful ideas and made valid points. Thank you all!
Helpful Answer (0)
Report

Good points from Veronica.
Suprapubic catheters do have many benefits but potential bad effects as well. 
With supplies, however, I remember that insurance would only pay for a limited # of Foley/urine drainage bags and the family had to wash out and disinfect the bag many times during the month. I remember the bags drying out in the BR. 
Plus in my area, SP patients had monthly standing orders to see their urologist once a month to change the catheter. I did not have to do this as a HCRN.
The SP is still a catheter and thus a potential source of infection.
Trying the condom catheter as Veronica stated may be a good option for him - at least give it a try.
Either way the SP patient needs daily hydration to prevent UTI and hopefully he washes his hands frequently. Give him a bottle of Purel (can use anytime between handwashing & in a hurry) and teach him how to use it.
Helpful Answer (0)
Report

I have experience with external cathers they don’t leak if it is checked every hour there is a small gauze that has a sealant so each time it gets full it’s removed cleaned and another put on then at night I used a diaper and bed pad my client was a paraplegic and weighed 387 there were accidents but not bad
Helpful Answer (1)
Report

Another problem with urethral catheters is that the patient can develope bladder spasms which are very painful. Infection rate is very high and they often tend to block so irrigation is essential using a sterile technique
It may be worth trying an external cather called a Texas catheter. if it works all well and good but they can be difficult to get on and tend to leak and fall off.
The skin issues are another major problem and will be very difficult to heal up as long as the skin is constantly soaked.
As far as being able to go out using any type of catheter that should not be more difficult than at present. Nothing shows when the person is fully clothed. If you are nervous the first few times put Depends on as well and sit him on a chux in the car.
i do not see this a s a step in the downward slope I see it as recognising the problem and finding a way to deal with it. much better than pretending all is fine and dandy.
i think it was on the whine thread that a number of female contributers admitted to some degree of urinary incontinence once the subject was out in the open. We know that many members are caring for older loved ones who have these problems but some caregivers are as old or older than the loved ones others are caring for if that makes sense. We may not all be demented but physical problems have no favorites.
Where there is a will there is a way and I am sure you will find yours and hubby will be very pleased with the outcome.
Helpful Answer (4)
Report

Ahmijoy: Bumping up. And good luck.
Helpful Answer (1)
Report

Ahmijoy, my father is 85, has dementia and is immobile. We have been using external "condom catheters" for almost a year. They have been a God send. Before we started using them we were having to give him a urinal like every 20 minutes day and night (he also has limited dexterity). We went through Liberator Medical after about 4 months of buying them off of Amazon, using cash out of pocket. They handled the insurance/Medicare and also sent free samples of different catheters and leg/bed bags. Catheters are handled differently than adult diapers, bed pads etc. as far as insurance goes. Hope this helps some. I feel your pain and frustration. Best of luck. Also he has had no infection/UTI issues 😊
Helpful Answer (2)
Report

As a retired infection control nurse I have helped hospital staff realize that in dwelling catheters are a last resort because patients get infections 100% of the time. A skin care nurse can give you many options for managing skin care and environmental care for urinary incontenence. This includes condom catheters and intermittent catheterization. Also include a urology evaluation for a neurogenic bladder which can have a symptoms-of sudden gushes of a large amount of urine or constant leaking.
Helpful Answer (5)
Report

You're welcome, Ahmijoy!

I forgot to mention regarding mobility: as SueC mentioned it shouldn't affect that at all for your husband (maybe even improve it, as you won't be as concerned with changing his briefs?). My dad is in a wheelchair, and with his leg bag neatly strapped away under his sweatpants, we bop around all over the place. The leg bag is large enough that I can't remember the last time we had to empty it "on the road" (not literally on the road, of course!).
Helpful Answer (4)
Report

This sounds like a great solution. I have dealt with him being catheterized at home years ago and I remember it was ALOT less work and mess than wet diapers, bedding, skin and floors day after day after day. I guess I’m just loathe to “pull the trigger”, so to speak as this seems like just another depressing step down for us.

He needs to check in with his physician in the next few weeks and we will discuss it between the two of us and then approach the doctor.

Thanks so much for your help!
Helpful Answer (3)
Report

Ahminjoy, we haven't had an issue with infections and my dad has had the catheter since October 2016. He does show a low level of bacteria in his urine when it is tested but his spinal cord injury doctor who advises us about issues like this says this is normal and that we don't need to treat it unless he becomes symptomatic (fever, etc.).

I can't speak to Medicare as my dad has CA retired teachers' healthcare instead but we are sent supplies monthly for catheter care: a box of gloves, 4 leg bags with elastic straps to secure them around the calf and ankle, 4 bedside bags (larger bags for nighttime) that clip onto the side of the bed, 4 "cath secures" (a large sturdy sticker that you apply to the upper thigh with a little port for the tubing to velcro into, to keep it in place), some kits with syringes and sterile water for doing a flush of the catheter, and other miscellaneous items that I am forgetting right now.

There is some work involved (though I assume less than changing and cleaning up
wet diapers). Besides of course emptying the urine that collects in the bags a few times a day into a small urinal to then dispose of in the toilet, each morning we remove the lightly taped gauze bandage, gently wipe around the catheter with sterile cotton balls with wound wash spray and then some betadine spray, put on a fresh gauze bandage, and then switch the bedside bag to a leg bag. We rinse out the bag not being used with warm water and hang it to dry in the shower (then discard at end of the week; seems to be basically odor-free when rinsed well). Before changing from the bedside bag to the leg bag we flush the catheter with a syringe full of sterile water (not all patients need to do this every day, apparently, but we do as advised for my dad's particular situation of a lot of sediment and mucous in his urine.)  At nighttime, we switch from the leg bag to the bedside bag again. As SueC mentioned we wear gloves while doing all these things and usually have a clean wash cloth around just in case.

Hope this info gives you an idea what's involved and is helpful.
Helpful Answer (3)
Report

I second a Suprapubic cath. It is surgically placed in the lower abdomen. The hole (stoma) is where the catheter is placed that goes directly into the bladder. A balloon inside the catheter is inflated with sterile water to keep it inside the bladder. The catheter drains into a tube, connected to a bag. It's very easy to empty it. You can put on a "leg bag" and use it under pants. There should be no problem to go out, as long as you have access to a bathroom after a couple hours.
It is not painful. The visiting nurse changes it every 2-4 weeks using sterile technique. You would just have to wash around the hole with a moist tissue or gauze and cover the stoma with a gauze.

This type of catheter is much better for long term use than a urethral catheter. After awhile the catheter that is inserted into the penis starts eroding the urethra and can wear the meatus (tip of penis) away.

I would talk with his doctor about this or have him recommend a urologist. Medicare should pay for this as it is a medical necessity. Infections aren't really a problem with the patients I've had. Always wash your hands , then use gloves, before and after any cleaning or tubing changes.

Good luck.
Helpful Answer (4)
Report

Thanks, SnoopyLove. No, hubby doesn’t have dementia,so him pulling it out wouldn’t be an issue. How does your dad do with infections? Is the nursing care paid for by Medicare? Thanks!
Helpful Answer (2)
Report

I'm sorry, Ahmijoy. Definitely sounds like a less than optimal situation. I don't have any experience with an external catheter, but my dad has a supra pubic catheter which has worked great. Home health nurses come out every other week to check it/change it once a month. We clean around it and change the bandage once a day, and have a leg bag during the day and a larger bag at night.

Not sure if your husband has any dementia, if so I'm not sure if a supra pubic catheter would be safe (it could be pulled out).

I hope you are able to gather information, talk to your husband's doctor and find some workable solutions.
Helpful Answer (2)
Report

This question has been closed for answers. Ask a New Question.