I am a hospice nurse with a brain ca patient of 25 years survival. She has voluntary movement of her eyes, mouth and fingers on one hand. No voluntary movement elsewhere. She has had a foley for 10+ years and it has leaked continuously, even immediately after changing it, for the past year. I am using a 24fr with a 30cc balloon filled to 40cc. She has a large bladder capacity and without meticulous peri cares, she develops skin breakdown on her buttocks which goes from a small Stage I to a huge Stage III almost overnight from the contact with urine. She had three months of Ditropan which did not appear to make a difference. I have spoken with her oncologist, gynecologist, and urologist. All suggest we remove the foley and allow her to be incontinent as the only option. She refuses. She is up via Hoyer and out of the house almost daily with RTC care-givers. The oncologist says a supra-pubic is not an option and the patient also declines to consider one.
I have searched unsuccessfully for a foley >24fr or with a larger balloon to try (is this a bad idea?).
Any suggestions would be much appreciated.