Bladder Irrigations


I’ll try to keep a long story as short as I can… Mother has had a long term Urinary Catheter for about 6 years for Retention.
She has had numerous Infections, some leading to Hospitalisation and IV antibiotics. The long term catheters that are supposed to last 12 weeks have rarely done so with Mother.

For months we have tackled endless blocking between us (myself and Mother) usually up in the night, hot water bottles on the tummy, pain killers, pinching the tube to remove blockages etc. Sometimes a Nurse would do a washout, sometimes they would arrive, see urine in the leg bag and say it was ok.

September another UTI started, 2 different courses of Antibiotics at home, no improvement, due to symptoms (Very high blood pressure, delirium, high temperature, confusion, blood test showing low sodium) Mother admitted to Hospital near the end of October.

Obviously I was unable to visit, except Dr asked me to go in twice to see if she was anywhere near her ‘baseline’. Told him she wasn’t really, only seemed a bit better, but she was sent home after a 2 and half week stay and 2 lots of Antibiotics and I was told her Inflammatory Markers were 'in the ‘normal range’. Also told staff over the phone, more than once, Mother had been like this before and needed IV Antibiotics.

Mother came home on the Wednesday afternoon, spent her 92nd Birthday on the Friday feeling unwell and hallucinating, so more oral antibiotics prescribed by GP, then on the Sunday and 5 Catheter changes later (by Nurses), and the same symptoms as mentioned before, I had to call an Ambulance again and Mother was taken back in Hospital.

Two lots of IV antibioitics followed. Mother was deemed ‘medically fit’ and able to come home on oral antibiotics to get rid of the last remaining bit of infection, and I was asked was this ok. I said not if she was going to end up back in there in a few days. Things changed in the Ward and Mother ended up staying longer.

Mother then ended up having 2 or 3 Bladder Washouts a day for over a week due to the blocking (she is on a fluid restriction for other issues so cannot just drink more water).
This has been cut down to once a day and she is due home this weekend with a Nurse coming in daily to do them.

I was wondering if anyone else out there has these daily washouts and if so, what kind is used?
Are they successful?

I understand there are Saline ones and Acetic Acid ones, some in flat little ‘bags’ with a tube on and some in little ‘concertina like’ bottles. I’ve also seen and Out of Hours GP just use a big syringe filled with saline water.

I’m very apprehensive, as I always am when Mother is sent home. I just hope things are better this time.
Sorry to waffle.
Thankyou for reading.

My wife now has a Supra Pubic catheter, but she did have an Urethral catheter for a while, (she used to pop those out regularly (balloon still inflated) because of bladder spasms.

The only washouts that she’s had on her SPC have been with saline solution. She’s had one that blocked quite badly and we had that changed early.

She does get by-passing issues at times, but these are usually caused by constipation - when the bowel is full it presses on the bladder and stops the catheter from draining freely - the wee has to go somewhere and reverts to it’s usual route.

!2 weeks is long change routine, my wife started at 10 weeks but that has now been reduced to 8 weeks. If there are suggestions of blocking - usually initiated by my wife saying that she feels as though she needs to pee but can’t, then I have to give the catheter tube a twiddle and push it back into the bladder by about 10mm. I don’t know if this would be effective with a Urethral catheter. I would try and get the DN to do a more frequent change, I know from reading elsewhere that weekly changes are not uncommon, 12 weeks is just far too long if you’re having regular blockages and all the consequent extra laundry.

Drinking something more acidic can help to reduce blockages, I’ve tried giving her Lemon Juice, (just the usual stuff that you buy to go on your pancakes), at a rate of one tablespoonful in a litre of water, but unfortunately that made her a bit loose without actually getting as bad as diarrhoea, (probably caused by the preservatives in the Lemon juice). The DN suggested Lemon Barley Water instead.

Fortunately she’s not had a UTI since she’s had a catheter - I think one of the main sources of infection is possibly from bag changes when the catheter and therefore also the bladder is open to the air: there are a couple of Facebook pages for those with bladder problems and something I see endorsed on there (wrongly imo) is to remove the bag briefly from the catheter at night when attaching the night bag. This is to help the flow from the leg bag to the night bag. I see this as being an unnecessary step and I never do it, I try and ensure that the leg bag is at least 25% full when attaching the night bag and pushing that into the leg bag, (without squeezing it back the wrong way). The only time my wife’s bladder is exposed to the air is for a few seconds once a week when I change her leg bag, (always change for a new night bag on the same day), even then I clamp off the catheter tube with an old and very worn pair of forceps - I use those cos they don’t clamp it too tightly like a good pair would.

Thank you for all that Ayjay.

Nurses have, in the past, tried to ensure Mother has a Catheter change at 6 or 7 weeks, or as soon as it has started to play up to an unbearable degree. But they say that more changes risk more infections, which also makes sense. Its a difficult one.

I also read on here about someone having a weekly Catheter change, but this has not been suggested by ‘the people in the know’. Maybe they thought that might lead to higher risk of infection - I guess everybody is different and different things work for different people.

I also read about Lemon Juice and have added that to my ‘big shop’ list for today, although I think I’d have to try Mother with half a real Lemon squeezed into a mug of water because I have to measure all her drinks (and add Thickener due to her swallowing issues - someone even suggested the thickening powder could be causing all the debris but we always make sure it is completely dissolved).

I’ve never heard of the bag being disconnected from the Catheter at night for a brief spell - don’t think that would be a good idea. Like you we always try to ensure there is some in the Leg Bag to send through to the Night Bag to prevent possible air locks(?). If the urine in the Leg Bag does not go through to the Night Bag immediately, it usually does if I hold the Night Bag tube horizontally along its length level with the Leg Bag.

We have once nightly use Night Bags, meaning its a new Night Bag every Night.

I change the Leg Bag every 5 days and hold the end of the Catheter tube as tightly shut as I can with one hand (wearing disposable gloves), sling the old Leg Bag into a disposal bag in a bowl strategically placed on the bed with the other hand, then grab the new Leg Bag and insert as promptly as possible. Although I appreciate not everybody can do it this way.

I guess we just have to try different techniques and see what works. Hopefully daily washouts will help Mother.

Take care.

One more thing: with very frequent or persistent infections requiring anti-biotics, they should be culturing a sample to ensure that the correct anti-biotic is used - it’s much more effective than just dipping a urine sample and saying “Yes, you have a uti”.

My wife had an infection at the stoma when her SPC was first fitted, it wasn’t until they took a culture of the goo from the site that she had the right anti-biotics, (the fourth lot) and it was gone in about three days, never to return.

Thank you Ayjay.
I will remember that for future reference!

Best wishes.