bladder irrigation w/dakin's soln?

[aging1]

I've found this referred to in old texts, but can't find anything current.

We have a patient whose catheter plugs with purulent matter every 1-2 weeks, despite biweekly irrigations. The sides of the connector become narrowed by hard, white deposits, and irrigations produce large amounts of purulent and stringy matter. He's had many rounds of various antibiotics/antifungals, is otherwise asymptomatic. At one point he was diagnosed with a chronic fungal UTI.

I would think 1/4 strength, or even more dilute, would manage the purulence and spare him the discomfort of frequently occluded catheters, but I wonder about absorption via the bladder or damage to the walls (though I'd think they couldn't be much more damaged. . .)

Any thoughts or experience with this? Other irrigants, such as something alkaline (baking soda is a great antifungal)?

Thanks for your thoughts, and for this forum!

[morte, LPN, LVN]

perhaps working from the "top" down would work? ie Alkalinizing the patient's diet..?

[NRSKarenRN, BSN, RN]

Dakins is not appropriate for bladder irrigation and should rarely be used for external application as too caustic an irritant to skin tissue.

See the Infectious Diseases Society of America (IDSA) recomendations:

Diagnosis, Prevention, and Treatment of Catheter - Infectious ..

For chronic foley catheter patients with recurrent UTI's, I suggest trial of silver impregnated catheter be used first.

Can silver alloy catheters reduce infection rates? | Practice | Nursing

• Bacteria can be free-floating or can colonise into biofilms that attach themselves to the catheter surface and may cause catheter blockage
  

• Biofilms can develop a resistance to antibiotics
  

• Silver alloy urinary catheters can reduce biofilm formation and colonisation by releasing silver ions into the urinary tract
  

Highly suspect that white stringy matter is biofilms that they catheters greatly reduce.