Straight cath BID?

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I have a pt that has had UTI's off and on for over 8 months. He went to urologist they told wife to straight cath twice a day. THe wife said she has done it before but is very upset. I explained to her that I can not come twice a day or daily on a long time basis. I called the urologist they said they showed her how to do it and that she told them she will do it. But someone with chronic UTIs including ESBL. I told her when the supplies come I will show her and then supervise her. What do you do if you do not feel that this is good for the pt?

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Why do you not feel this is good for the patient?

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It can introduce more bacteria. ANd I do not feel that the wife can handle this on a daily basis, she is in her 60's and already is upset about it before she even started.

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The risks associated with intermittent catheterization are less than the risks associated with retention and incomplete emptying. The risks associated with urinary retention are UTIs, sepsis, hydronephrosis, renal failure, and death.

I am assume since the wife is the one who is being taught the procedure, that the patient is not able to do self ICs. Have you asked the wife what bothers her most about doing the procedure?

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Specializes in Peds/outpatient FP,derm,allergy/private duty.

She sounds like she needs more education and support because she's nervous. Maybe there are some psychological issues with respect to her doing a procedure on his genitals. I wouldn't give up and believe me a urologist is not someone I would second-guess!

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The wife has very high anxiety normally. I plan on supervising her the first time she does it. Spoke with my physical theripst who knows the family better than I do. She agrees she does not think she will be able to do it either.

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Specializes in Peds/outpatient FP,derm,allergy/private duty.

That's too bad -- I hope they can figure something out - my agency wouldn't be paid to send a nurse out only to do that one thing either.

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Just because the wife is highly anxious does not mean she can't do it. Like one of the posters stated intermittent self cath is "less harmful" than having a patient with urinary retention and complications from that. I have utilized OT, making joint visits for help in teaching patients to self cath and becoming confident that they can do it. That may be an option. Making sure patient/cg uses proper technique and giving positive feedback along each step of the way during the procedure usually makes for less anxiety, also you can write down each step....ie, gather supplies (then list each item they need), wash hands, yadda yadda ya.. if you write down each step completely and concisely can eliminate some anxiety. When you carefully teach the patient/cg risks of non compliance vs benefits they often come to an acceptance.

I have this same difficulty with patients that come out of the hospital with IV therapy at home. Usually the patient has been in hospital setting for quite some time and they are anxious to get home. So hospital coordinators meet with them and explain they can come home IF they are willing to self administer meds after being taught. They agree they will do that because what they hear from the coordinator is you can go home.. not you will have to learn to do your own medication.

Then they come home and suddenly say, "I can't be a nurse and do IV medications, it is too dangerous to do IV meds by myself at home". I am firm with these people and I tell them I will teach, I will guide, I will support, I will put things in place for them (IE in writing step by step) to be successful, and if at any point they have problems or questions they can pick up the phone and call my agency and get help. OR if they want to pay our agency with a check/cash $150, each time nurse walks in the door, out of pocket because insurance will not cover then they start to change their minds. It is all about how you approach the subject with your client/cg and how far you are willing to go with teaching to help them be successful.

Good luck!

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Specializes in ICU.

I can't for the life of me see what the wife thinks is so hard about this. You marry someone and live with them, have relations with them, but can't learn to do a simple nursing 101 straight cath to help your own husband? I don't mean to sound so harsh, but in today's world, everybody seems to think everything "is somebody else's job." Sounds like the husband better learn to take care of himself, because it doesn't sound like the wife is willing to help him.

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It isn't about whats best for the wife, it's whats best for the patient and at this point SC is (apparently) the safest choice for the husband. Indwelling caths are really convenient for caregivers but create a whole new set of health concerns (and cause discomfort) for the recipient.

If she can't get a handle on it with support and instruction she'll have to pay for someone to do it or place her husband in a facility where he can get the care he needs. Harsh but realistic.

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