cleaning straight caths between use.

nurse T · Jul 12, 2001

Hi LPNandlovenit, I have had a case where the Pt swished her cath in some soapy water, rinsed and allowed to air dry. Had another who spit in hers to lubricate it prior to insertion, yuck! Doc said, 'oh well, it's her own cooties." Niether one ever had any problems.

MayeRN · Nov 2, 2001

One of my co-workers had a patient who soaked her caths in water with a little bleach!!! One has to wonder!

Home Health Columnist / Guide · Jan 3, 2002

Finally got info in the mail from Bard re this topic.

Check out National Association for Continence (NAFC) :

http://www.nafc.org.

Info from their pamplet :

Clean intermittent catheterization

1. Procedure requires clean hands and fingernails with nails trimmed, clean catheter and clean meatus!

2.Reusable catheters clean using plain liquid soap without deodorant or fragerance, wash well and rinse until soap residue is gone.

3. Shake excess out then place on clean paper towel or in a clean basin to air dry.

4. Clean reusable catheters can be soaked in homemade vinegar solution: ONE PART WHITE VINEGAR to THREE PARTS WATER

(room temp). Soak for thirty minutes, rinse thouroughly, shake out excess water and air dry.

5. Storage: clean zip top bag, tampon case, toothbrush holder or small camera case ( if need to travel with client...ideas I didn't think of).

6. Discard catheters whe it becomes hard. brittle,crackes or if color of cathe changes.

-------------------

Medicare guidelines for replacement equipment + supplies covered( most insurances follow these guidelines):

Patients must have Permanent urinary retention or incontinence ( not expected to be medically or surgically corrected within a 3 month interval).

Intermittent caths, nonsterile technique, patient or caregiver performing:

1 per week=4 per month.

Nonsterile lubricating gel 8oz per month

Intermittent caths, sterile technique---

Pt resides in a nursing facility; is immunocompromised, pregnant spinal cord injured female with neurogenic bladder;raddilogically documented vesico-ureteral reflux; distinct, recurrent UTI's( twice within 12 months) prior starting sterile catheterization.

one cath and individual packet of lubricant or an intemittent cath kit---approx 4-6/day.

These clients DME charges routinely reviewed re need and documentation. Karen

----------------

Indwelling Catheter supplies per month:

1 catheter

one insertion tray

1 bedside drainage bag

2 leg bags

anchoring device: 1 catheter leg strap or 5 yards of tape/month

Non-routine cath changes are covered when documentation substantiates medical necessity (tell why non-routine change occurring in nursing notes/60 day summaries)

1. Cath accidentally removed/pulled out.

2. Catheter malfunction: eg ballon doesn't stay inflated

3. Catheter obstructed by encrustation, mucous plug or blood clot

4. History or recurrent obstruction or UTI and acute event is prevented by a scheduled change at intervals of less than once per month.

----------------

Condom catheters for males: 35 per month

Female meatul cup: one per week and one pouch per day

Adhesive anchoring devices for percutaneous cath/suprapubic tube/nephrosotmy tube covered one per month.

ANY UTILIZATION OVER THESE AMOUNTS NEEDS LETTER OF MEDICAL NECESSITY FROM DOCTOR (NP's can't order under current MC rules).

Hope this helps.

hoolahan, ASN, RN · Jan 3, 2002

Karen, that is excellent info!!!! Where did you find out how much Medicare will pay for, is there a DME section of the hfca site? I need to check that out!

I have one question, what is a "female meatul cup?"

Home Health Columnist / Guide · Jan 4, 2002

Learned amounts from when my HH agency also had DME company and included in info sent to me. I have a book at the office listing DME info re amounts approved per month too.

Re meatal cup:

A meatal cup female urinary external collection device is a plastic cup which is held in place around the female urethra by suction or pressure and is connected to a urinary drainage container such as a bag.

A pouch type female external collection device is a plastic pouch which is adheared to the periurethral area with adhesive and is connected to a urinary drainage container such as a bag.

http://www.umd.nycpic.com/ch16_prosth-urological.html

Thinking of posting re wound supplies approved per month if interested.

hoolahan, ASN, RN · Jan 4, 2002

I am VERY interested in this!! One of the agenies I work for is very stingy with supplies, always has been, but worse since PPS. It seems like some of the sup's feel they have made a personal accomplishment by cutting the amounts of supplies I requested. Very frustrating, often get to a home, and no supplies there. How much can you take with you for the unexpected? Particularly difficult when you go the supply cabinet and there are no supplies on the shelf!!

I hope others will be interested too.

PS I heard a new one last month, I figure I'll share. Now, in order to get a motorized W/C from Medicare, they require a PT eval for the need for motorized chair, if you are not sure what needs to be done, check with your local DME providers, they will assist you to get the correct forms for PT and/or MD to complete. The PT came to see my pt early last month, and said 30 days til arrival of chair. Can't wait to see how she likes it. I am hoping it will give her the independence she needs to get out of the house for some recreational activities too.

Mijourney · Jan 4, 2002

Hi. Thanks Karen for the great information on catheters. Hoolahan, I'm not surprised about using PT for equipment evals. I guess when you think about it it does make sense for therapists to evaluate things that they need to teach the patient about. It's just like us evaluating equipment like pumps and monitors that we would teach a patient or family on.

nur20 · Jan 4, 2002

NRSKarenRN that is good information to know because i have been laboring under the illusion that technique and catheter should be sterile.One stick, one use. I think i prefer it that way.I've had problems with some supplies but never caths.

daisymae · Feb 17, 2002

Just saw your comments. I needed info for a patient. found the NAFC site and downloaded a copy of their newsletter for my patient and his wife. Timely find of info.... Thanks Daisymae

PattiRN · Apr 19, 2002

Originally posted by NRSKarenRN
Learned amounts from when my HH agency also had DME company and included in info sent to me. I have a book at the office listing DME info re amounts approved per month too.

Re meatal cup:

A meatal cup female urinary external collection device is a plastic cup which is held in place around the female urethra by suction or pressure and is connected to a urinary drainage container such as a bag.

A pouch type female external collection device is a plastic pouch which is adheared to the periurethral area with adhesive and is connected to a urinary drainage container such as a bag.

http://www.umd.nycpic.com/ch16_prosth-urological.html

Thinking of posting re wound supplies approved per month if interested.

I don't get it. Under PPS the HHA must provide the supplies. So how can an agency limit supplies that must be supplied? And further more I am under the impression we get paid one flat rate for an episode so amounts of supplies are included in this.

hoolahan, ASN, RN · Apr 24, 2002

Exactly Patti, that is why agencies are tightening the reins. Supplies are very very costly, so if too many are ordered, less is available to the agency from the "pot."

Let's say you have 2 identical pt's. POst-op CABG, just out of rehab facility. Both need SN, PT, and are doing fairly well, but one developed an infection in the leg, and has a wound w/ large amounts drainage. You could do daily dressing changes and teach family, or use a more expensive ca alginate to absorb more and do less changes. But Medicare may allow $1800 (I'm guessing, I don't have the charts in front of me) for the first pt, and $2200 for the one w wound. A diff of $400. The wound supplies may cost $50 to $100 per week, plus additional nursing visits could possible be needed at about let's say $100 (check out this article for more on wound care cost comparisons http://nursingcenter.com/library/Jo...ticle_ID=100496 )

So, you can see why agencies want to keep supply costs under control, sometimes to the frustration of staff and pt's. I have one pt now who has chronic wounds. WE have had him on service for 2 years under Medicare! He lives alone and only has one neice from out of town who comes on weekends to do her dressing change. He is unable to reach it himself, and to make matters worse, he does things like rub olive oil on the broken periwound skin b/c it itches, or he'll scratch it with a wire bristle brush. Trust me, several supervisors have gone out to assess the situation, and we still have him on service. With the cost of his supplies, we are losing money big time on this man, but the agency will not abandon him. We are working closely w the wound care center to be sure we are doing every thing possible to heal these wounds.

Anyway, under PPS an agency is theorhetically supposed to make some money and lose some money on cases and it will "all balance out in the end." But, the reality is, I think most agencies are losing more than they are making. My former agency would not accept pt to service unless they spoke w a willing caregiver to teach the wound care to. I do understand the need to be frugal, but when you are the nurse in the field and don't have a duoderm in your bag for a new pt with a stage 2 sacral decub, it is frustrating!! Supply deliveries are delayed b/c a supervisor screens each request in order to approve it. She will call us and check to see why we asked for a particular thing, and if we explain a reasonable need for it, we get it. BUT, it doesn't solve the problem of getting the supplies in advance from the office. The sup's claim nurses aren't filling out the charge forms, and maybe that is true, but not all nurse don't fill them out, yet all nurses and pt's are "punished" when there isn't

a roll of tape to be had on the shelf. And managed care co's say they will reimburse, but then they don't. So each time we used to take start-up supplies, maybe 50-100$ worth, that was money we'll never see again, so for managed cares, we have to tell families to purchase supplies.

I have one pt who has MS, is bed bound, can only move one arm. She has a foley 20 Fr w 30cc balloon. Managed care co. From time to time, she has such a large bowel movement, she forces the foley right out!!! Imagine, ouch!! Mind you this isn't an everyday problem, and she does not always have constipation. But we did use up visits before the auth period ended shortly after I became her CM, so I had to ask for more, explaining that the foley has a history of coming out (I mean that's why there's a 30cc balloon right?) but the managed care co gave only 1 visit more, and asked I supply evidence of a bowel program. I am frankly just thrilled she does have a BM q day!! I wouold say her current program is effective, and BM's are not hard, just sometimes very large, depends on what she ate. Any ideas? I am taking out written materials for high fiber and to increase fluid intake, but honestly, I think it's just something that can't be helped. I am not going to suggest a stool softner be used q day, b/c stool is not hard, and her elderly mother takes excellent care of her, and she doesn't need to have to clean up 3 bm's a day, ya know? But, this is the hoops we have to jump thru for managed care companies!