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Sunday, November 25, 2012

Do It Yourself Catheterization: Learning by The Seat of My Pants

When someone once told me that I would "make a good nurse",  I tell you, I nearly laughed out loud.

For certainly, nursing not the type of work I am cut out for as I will be the first to admit that I am extremely squeamish about such things as bodily functions. Case in point: one day, last month, when Bob had a particularly nasty bowel movement, I ended up fleeing out the back door, dropping to my knees, gasping for breath and trying not to puke all over the wheelchair ramp. You'd think I'd have gotten used to this by now. But alas, I have not.

Finally that day, I collected myself and walked back into the house where the smell alone sent me flying back out the door, all the while screeching at the top of my lungs, "I'm sorry, sweetheart! But I cannot do this!!!"  There I sat outside, gulping down the fresh air considering my options which were, um, call 911 and ask them if someone please could come over and clean up my husband because, lord almighty, I just can't do it.... Or leave him lying in that putrid mess for all of eternity... Or get in the car and just drive away from the horror of it all... Or, get a grip, Diane, go back in there and face it like a man--er face it like a nurse! Which is exactly what I had to do, and it wasn't pretty--

But I digress from the topic of this post which is another nurse type job I have recently acquired: i.e. Intermittent Catheterization.

Intermittent catheterization is just that, a way to temporarily catheterize a patient (i.e. Bob) when he can't pee. I had toyed around with this idea in the past, especially on those days when Bob spends 3-4 hours trying to pee, but the mere thought of taking a rubber tube and sticking it you-know-where sent shivers down my spine. So I kept hoping, against hope, that this little problem would clear itself up. Unfortunately, it hasn't.

It wasn't until last month when I had to take Bob to the urologist, once again, to have him catheterized for a urine sample for Pain Management because, once again, he could not pee while at Pain Management, that I asked the urologist if he could show me the technique. My thought being if I can do it myself, it will save us forty bucks next time Bob can't pee at Pain Management. Plus it may come in handy on other occasions.

The doctor sent his nurse in with an intermittent catheterization kit to give me a quick lesson. First, the nurse showed me how to sterilize the tip of Bob's penis, then she draped his lap with various blue disposable pads, and I'm thinking, oh boy, this is going to be messy. She brought out a tube of lubricant and a gauze pad and squeezed a big glob of K-Y type jelly out onto the pad. Then she brought out the catheter.

I swear I nearly fainted because that catheter looked like it was TWO MILES LONG and I couldn't believe she was going to be inserting that thing into Bob.

Of course, I exaggerate. The tube itself is about 16 inches long, but still...  I could feel myself beginning to turn green at the gills as the nurse sort of rolled the end of the catheter in the K-Y jelly, telling me to keep the tip of the catheter pointed at Bob's nose. Then she stuck that thing in him and told me to guide it through to "get the feel of it". Which I did.

All the while holding my breath, because that tube just kept going in and in, and I kept stopping because it really seemed too much, I mean, jeepers, how much of this hose can I stuff in there?--at which point the nurse would tell me to keep pushing it in because, she said, the trick here is you do not stop shoving that thing in until you see the urine start to flow.

Finally, after what seemed 100 years and miles of hose, the urine did flow. And when it stopped, the nurse had me glide the long tube back out. And when it came out, out flowed from Bob more pee plus some crunchy looking pee sediment all over the blue pads. The whole scene, to me, was really quite horrifying and I felt as though I was watching it from outside of my body, like a person in shock or a near death experience. I was beginning to think I'd bitten off more than I could chew with this one. As the nurse happily cleaned up the mess, I asked her about the crunchy bits and she said that it was quite normal and was called, um, something which I don't remember but surely is the medical term for "crunchy looking pee sediment."

So that was my lesson and the nurse told me I did a good job, and she left me armed with 5 sample catheters, written instructions and a tube of jelly and said she'd be faxing off a prescription to a medical supply company for more. I, of course, left that office praying I would never ever have to do this on my own.

And for a few days, I lucked out. Bob was peeing just fine.

Then came the fateful day when Bob could not pee. So I got out the catheter, jelly, and quickly re-read the written instructions. I inserted the tube and things were going quite well until that tube sort of just stopped gliding. I mean, it wouldn't go in any further and there was no urine flow and I'm thinking, what the hell? Because this isn't right. So I try gently moving the tube around, thinking it's taken a wrong turn, gone the wrong way, hit a brick wall---but still the tube won't budge and Bob begins to make noises that I'm hurting him, so I start to back the tube out when the urine does begin to flow, but NOT into the tube. The urine is actually flowing outside of the tube. I mean, basically, Bob is peeing down the sides of the tube, and pee is running all over my fingers, and GA! on the bed and everywhere but in that damn tube where it's supposed to be. Quickly, I pull the tube out and get the urinal to catch the rest. But I tell you, I had one mess on my hands (not to mention that Bob was quite upset) and had to change not only Bob's clothes but all the sheets on the bed to boot.

By now, I'm thinking I need a "refresher course" so I look up and watch every darn video I can find on the internet on intermittent catheterization. Still, I cannot figure out what I did wrong and am really dreading trying it again

Meanwhile, I get a call from the catheter company telling me that they received the order for Bob's catheters and are faxing it to a local medical supply house. She asks me how many catheters I have and when I tell her "four" she says she'll send me ten more free samples to "hold you over" until the order is processed. Before the box of samples even hits the door, a sales rep from the medical supply company calls regarding Bob's order. And he will not talk to me.

It's not the first time this has happened.

The rep insists on speaking with "Robert" because this is a "private matter" regarding medical supplies.

In fact, he won't even confirm that this is the order for catheters when I ask him. Even when I tell him that Bob had a stroke and has aphasia and is not going to be able to "talk" to him etc. and that I am his wife... he still insists on speaking with Bob. Finally, I tell him Bob can answer "yes" and "no" questions and if I put Bob on the phone, can you ask him if it's OK to speak to me? The rep agrees.

So, I put Bob on the phone. Bob says "yes" and hands the phone back to me and the rep tells me that he has an order for 30 catheters per month. I tell him I don't believe I'll be needing quite that many, and he asks how many do I need? I tell him that I'm not sure, we just started doing this, but maybe only ten a month and by the way, how much do they cost? He says our co-pay is 20%. I ask how much is that? He says he doesn't know, but it's 20% of the total cost. So, I ask, well, how much is the "total cost"? He tells me he "doesn't know" but he is sure that "ten will cost less than 30".

Well, duh.

I tell you, the medical field is the only business that can get away with this shit. Making a person order something without even knowing the cost and expecting that you pay for it. But I order ten and they arrive within a few days without an invoice...

And they look different than the ones I got from the nurse. These new catheters are called "Magic Catheters", and each individually wrapped catheter is packaged with a little lubricant pouch. I dig through the box, to see if there are some instructions or something, but there is only a reorder form. Though I think having the lubricant in packets would be handy for traveling, as I won't have to take the big tube of lubricant with us. So, I stuff one of the new "Magic" caths into Bob's backpack.

For a few more days, I remain rather lucky, not having to cath Bob. In fact, on a couple of those days he does some trouble peeing, but all I have to do is ask him if I should get out the catheter kit--which immediately elicits a look of horror on Bob's face after which, he immediately pees. Perhaps out of fright.

The second time I attempted the intermittent catheterization was last week in the locker room at Rehab. Bob just could not go, so I mentioned the "tube" and he actually agreed to let me try it. This was one of the new "Magic" catheters. So I take out the foil lubricant packet and attempt to open it. Attempt is the key word here, because the foil packet just will not tear open. Finally, though, after enough attempts and much cursing, I manage to tear off the end, but when I pour the lubricant out it's like liquid, not jelly at all. I'm thinking this is really weird. But I manage to  get some lubricant on the tip of the catheter, and I put the tail of the catheter in the urinal and then attempt to slide the cath into Bob. Attempt again, a key word. Because the darn thing is not going in very easy. In fact, it's like pushing the proverbial square peg in the round hole. And now I wish I had one of the other catheters with me, the kind the nurse gave me, because this "magic" catheter is way too bendy and the lubricant certainly sucks... and this not working at all.

Finally, I get it the darn thing in, but when I try to push it further, the head of Bob's penis sort of blanches white, then turns a strange GREEN color. Which, of course, totally freaks me out. So I take the catheter out, re-lubricate it with what's left in the foil packet and try again. Same results. Except now the head of his penis is not only turning GREEN, but the GREEN is turning PURPLE! GA! And Bob is literally screaming in pain. Horrified, I pull the thing out. So forget it. I'm all shook up and I give up, and poor Bob has to go to his Rehab appointment with a full bladder.

After Rehab, he still can't pee. We get home, and he still can't pee. I get back on the computer to watch more intermittent catheterization videos (fun fun) because I am evidently doing something terribly wrong. Like holding the penis at the wrong angle? or What? I finally watch one video with a nurse who mentions to lubricate the tip of the catheter a full two inches. So I think, OK, maybe that's it.

I get out the "old faithful" catheters that the nurse gave me and the tube of jelly. Now this is my third attempt at intermittent catheterization. The thing glides in easily enough and it keeps going and going and I'm thinking, Bob should be peeing by now, but I don't see a thing. So I keep gliding it in, deeper and deeper and suddenly Bob cries out in pain. So I pull the thing back out. And honest-to-God, I cannot figure out what I am doing wrong. And I'm about to give up totally on this whole catheterization idea, when I look down into the urinal and find---it's full of urine! Whoo hoo!  I did it!!!! And didn't even realize it.

Just yesterday, I finally opened the box of "free samples" that the catheterization company sent me. I was hoping, really hoping, it was the "old faithful" type of catheter in there, but to my chagrin, the box is filled with more "Magic" catheters . So I took them out of the box and was about to put them away when I noticed some papers at the bottom of the box and, lo and behold, there is an instruction pamphlet. What a concept! So I sit down and read it.

I find out, these "Magic" catheters are something called a "Hydrophilic" catheter. I had never heard of such a thing. The instructions inform me: This catheter becomes slippery when wetting with water, eliminating the need for a separate lubricant. For your added convenience, this catheter is packaged with its own sterile water. Simply release the water from the foil packet and then tip the un-opened catheter package end-to-end. The catheter acts like a magnet to attract the water and activate its slippery coating.

Oh dear god. Well, that explains a lot.

So now I am armed with instructions. Wish me luck.


Rebecca Dutton said...

Things will get better with repetition. I hope you don't blow another gasket before you get to experience success.

barbpolan said...

Since you asked: good luck!

SSTattler said...

Many years ago, I was an "Orderly" in the hospital. The "... nasty BM" it was OK and it is just part of my job. I think you're fine and you "... armed with instructions" and I'll just say Good Luck!

Jenn said...

Well holy sh**! You are sure an incredible woman, there's no doubt in my mind. I'm speechless after that.

Joan Price said...

I actually found this blog looking for urinary catheter instructions, myself. My husband needs one, as well, and I want to learn. Your post has me a bit nervous, but I'm glad to see you finally did it. Gives me a bit of hope. Thank you for sharing your story, and I wish the best for you and your husband as you continue to journey down this difficult path.

Brendan Kenny said...

I just began using a catheter and learned that it is a tough road of learning. My physician recommended that I use a Speedicath mainly because it is easier and faster to insert. Has anyone had experience with this before?

Barbara M. said...

Wow, as a nurse I've worked with a lot of patients who have conditions that make it necessary for them to use catheters on themselves, but I've never really thought about what it would be like to try to catheterize somebody else.

I don't know if this will be helpful, but I've had a handful of people tell me that you just have to try a bunch of different brands and styles until you find the one that really works for you. She said it was like shopping for jeans :)

Good luck down the road.