Leaking foley catheter

[oldnewnurse]

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.

Thank you.

oldnewnurse

[SuesquatchRN, BSN, RN]

What creams are you using for protection? Periguard works very well. Calmospetine is also good but nigh unto impossible to get off.

I can't imagine that removing the FOley and leaving her to void into her chucks will help her poor buttocks.

[oldnewnurse]

Thank you for your reply.

We use zinc oxide/bag balm (no dressing) when the buttocks are only reddened. We use Xenaderm cream (again no dressings) when we are at Stage II and Allevyn dressings (no creams) when we are at Stage III.

We do OK at healing her up and if we have a good bunch of caregivers we do OK at keeping her healed up. She just hates to be wet all the time, especially when she is up and out of the house. She has a perception that she has an odor and while she is dressed to the nines, has full makeup applied, her hair coiffed (it takes the caregivers about three hours daily to get her ready to go out), a w/c that costs 20grand plus, a fabulous van where she can be changed while on the road and yet she is wet before she gets in the w/c. Of course we use both Depends and Attends (as a source of extra protection inside the Depends and then pull it out a few hours into the day).

Barriers and peri care are of course the answer to the breakdown. I just wish there were something I could do to divert the urine.

Thanks again.

[SuesquatchRN, BSN, RN]

I had no idea she was so out and about!

Sorry I can't help with the diversion.

[zacharyddv1]

Nothing too do, foleys are not designed for long term usage. They will start to leak after a few months of long term use. Just think about it, the bladder is a muscle and if u don't use it you will lose it. Increasing the foley size will not help, nor maximizing the bulb.

[jujuseah, RN]

There are silicon foley catheters right? They last longer.