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Suprapubic Catheter Is Leaking




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#1 fastwheels

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Posted 22 January 2008 - 05:03 PM

can any one help me ive been leaking a couple of weeks now the nurses said there is no infection there my bladder spasms are not that bad im taking oxbutynin for the bladder spasms its just getting my clothes damp around the opening of the suprapubic cath

can any one help me

BAG THANKS
FASTWHEELS

#2 Apparelyzed

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Posted 22 January 2008 - 05:12 PM

Hi,

Is the balloon fully inflated?

If the balloon becomes deflated due to a leak of saline, you can get a leak around the catheter site.

When was it last changed?

Regards

Simon

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#3 fastwheels

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Posted 22 January 2008 - 06:52 PM

it got change over 3 weeks ago

#4 Apparelyzed

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Posted 22 January 2008 - 07:55 PM

Ok, here's what we do.

When we change the catheter, we blow the balloon up on the new catheter with saline before we put the catheter in. Then we deflate the balloon prior to insertion.

This is to make sure the balloon inflates, and more importantly, deflates correctly.

If you inflate the balloon with 10mls of saline, you should get about 9mls out when the balloon is deflated. Keep the syringe attached, as you can use this to inflate the new catheter when you put it in.

If you are leaking fluid several weeks after having a new catheter, it is usually because of one of two things.

1. There is a local infection.

2. The balloon on the catheter is not properly inflated.

In case "1", you can usually get rid of the infection by cleaning the catheter site daily, and spraying around the site with antiseptic spray.

In case "2", if you get a syringe, deflate the catheter balloon, and see how much saline is in there. You should have 7-8mls. Any less and you may leak, as the balloon can act as a seal around the hole.

Be carefull not to pull the catheter out whilst the balloon is deflated. Once you have checked the saline level, just push the saline back into the catheter, and top up if needed.

In rare circumstances, if the catheter is not in the bladder properly, the urine will pass around the catheter site, but you would definatly know if this was the case, as you'd be soaked.

Sometimes, you just need to change the catheter, because if it sit's awkwardly in the bladder, it can sometimes cause irritation, and induce leaking.

Hope those idea's help.

If in doubt, call your district nurse / spinal unit, and see what they suggest.

Regards

Simon

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#5 Motor

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Posted 28 January 2008 - 07:01 AM

can any one help me ive been leaking a couple of weeks now the nurses said there is no infection there my bladder spasms are not that bad im taking oxbutynin for the bladder spasms its just getting my clothes damp around the opening of the suprapubic cath

can any one help me

BAG THANKS
FASTWHEELS

HEY HOW ARE YOU. WHERE ARE YOU LEAKING FROM? THE HOLE IN BELLY OR FROM THE PENIS? LET ME KNOW I HAD A SIMILAR PROBLEM.

:H2kOther (26):
"CHEAP WOMAN AREN'T GOOD AND GOOD WOMAN AREN'T CHEAP"
"NEVER 4GET 9/11/01 THEY ARE GONE BUT NOT 4GOTTEN"
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"LIVE EACH DAY LIKE ITS YOUR LAST"
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#6 Motor

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Posted 28 January 2008 - 07:06 AM

Ok, here's what we do.

When we change the catheter, we blow the balloon up on the new catheter with saline before we put the catheter in. Then we deflate the balloon prior to insertion.

This is to make sure the balloon inflates, and more importantly, deflates correctly.

If you inflate the balloon with 10mls of saline, you should get about 9mls out when the balloon is deflated. Keep the syringe attached, as you can use this to inflate the new catheter when you put it in.

If you are leaking fluid several weeks after having a new catheter, it is usually because of one of two things.

1. There is a local infection.

2. The balloon on the catheter is not properly inflated.

In case "1", you can usually get rid of the infection by cleaning the catheter site daily, and spraying around the site with antiseptic spray.

In case "2", if you get a syringe, deflate the catheter balloon, and see how much saline is in there. You should have 7-8mls. Any less and you may leak, as the balloon can act as a seal around the hole.

Be carefull not to pull the catheter out whilst the balloon is deflated. Once you have checked the saline level, just push the saline back into the catheter, and top up if needed.

In rare circumstances, if the catheter is not in the bladder properly, the urine will pass around the catheter site, but you would definatly know if this was the case, as you'd be soaked.

Sometimes, you just need to change the catheter, because if it sit's awkwardly in the bladder, it can sometimes cause irritation, and induce leaking.

Hope those idea's help.

If in doubt, call your district nurse / spinal unit, and see what they suggest.

Regards

Simon



Hey Simon pleasure to meet you. great site here, and run well by you. you are the site police and you are good. Any way my supa was leaking so i went from a 16 to a 20 cath which is wider tube and it stopped leaks. As for detrol and stuff like that even if it does work you than usually get consipated. Only my opinion as I am not a doc. Oh yeah I also use 11-12 mls of saline. Work for me.
:H2kOther (26):

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Edited by Motor, 28 January 2008 - 07:22 AM.

"CHEAP WOMAN AREN'T GOOD AND GOOD WOMAN AREN'T CHEAP"
"NEVER 4GET 9/11/01 THEY ARE GONE BUT NOT 4GOTTEN"
"I MUST CRAWL BEFORE I WALK (AGAIN)"
"LIVE EACH DAY LIKE ITS YOUR LAST"
"RIDE IT LIKE U STOLE IT"
Richie aka MOTOR :-)

#7 fastwheels

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Posted 28 January 2008 - 09:28 AM

im leaking from the belly ive had the suprapubic opp done over 8 weeks ago is this why im leaking or ive got a infection the area of the SPC is a bit red but its not that bad


big thanks
fastwheels

#8 Becca82

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Posted 28 January 2008 - 03:53 PM

im leaking from the belly ive had the suprapubic opp done over 8 weeks ago is this why im leaking or ive got a infection the area of the SPC is a bit red but its not that bad


big thanks
fastwheels




Hey, just wanted to put my two pennies worth in on the whole site leaking thing!
do you have a lyofoam dressing around the site? my partners supra doesnt 'leak' as such, but there is always a sort of discharge, for want of a better word!
i mean if your soaking, and its urine, then there is obviously a problem, but if its just the sticky dischargy stuff then a square of lyofoam with some micropore tape on top is the best thing for it. we have one that has a layer of charcoal stuff in it, and that absorbs not only the fluid, but also stops it from smelling!
the dressing needs to be changed every 2-3 days!

Also, im not so sure about the whole inflating the cath balloon before you put a new one in thing!....if it works for you thats great, but once the balloon has been inflated it never fully retracts, and so leaves what we (district nurses and i) refer to as 'teeth', a sort of lip where the balloon inflates out the side of the cath tip, and this can cause some discomfort when taking the cath out (when changing), so you would think it would do the same when trying to insert a new one that had already had the balloon inflated...i could of course be wrong having never tried it, just a warning though if you do decide to try it and cant get the tube in because of the lip!!

Also, what caththers are you using? and what size are they? as previously mentioned the size could be affecting the leaking!

we use a size 20 400mm (length) 5-10ml balloon all silicone one, as my partner seemed to be alergic to the ones that were made from laytex, and so caused his site to be constantly gungy etc!
There are apparently some new silver tipped ones that are again supposed to be great for stopping infections!

finally, you say you take oxybutinin....if you find that you are having adverse reactions to taking it, such as a really dry mouth etc then ask yout Gp about oxbutinin patches. My partner uses them, and they are hassle free, and dont have the usual side affects associated with the tablets. They release 3.9mg over 24 hours, each patch contains 36mg, and need to be changed on every third day. they are transdermal, and can be applied to hips, abdomen thighs etc. made by Kentera, we have found them to be excellent!


Good luck, and hope it all gets sorted for you!

Beca

#9 Apparelyzed

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Posted 28 January 2008 - 04:30 PM

Also, im not so sure about the whole inflating the cath balloon before you put a new one in thing!....if it works for you thats great, but once the balloon has been inflated it never fully retracts, and so leaves what we (district nurses and i) refer to as 'teeth', a sort of lip where the balloon inflates out the side of the cath tip, and this can cause some discomfort when taking the cath out (when changing), so you would think it would do the same when trying to insert a new one that had already had the balloon inflated...i could of course be wrong having never tried it, just a warning though if you do decide to try it and cant get the tube in because of the lip!!


Hi,

I can't say I've had any problems with "teeth" after deflation, but I can see what you mean. I think the "teeth" tend to appear after the balloon has been inflated for a prolonged period of time, e.g. a few weeks.

I was told to do this by my spinal unit when I first had my supra-pubic catheter put in, and have always done it. In the last 15 years, I have had 3 catheters in which the balloon hasn't deflated after testing, due to a faulty valve.

Needless to say, if this catheter was in the bladder, and didn't deflate properly, there could be big problems!

I guess the catheter could be cut in half in an emergency, but there may still be saline left in the balloon, which was not properly deflated due to the loss of suction which you get when you empty the balloon with a syringe.

I also use a dressing around the catheter site. I use Mepore Dressings , which are self adhesive, and available on prescription.

Simon

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#10 Becca82

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Posted 28 January 2008 - 04:53 PM

Also, im not so sure about the whole inflating the cath balloon before you put a new one in thing!....if it works for you thats great, but once the balloon has been inflated it never fully retracts, and so leaves what we (district nurses and i) refer to as 'teeth', a sort of lip where the balloon inflates out the side of the cath tip, and this can cause some discomfort when taking the cath out (when changing), so you would think it would do the same when trying to insert a new one that had already had the balloon inflated...i could of course be wrong having never tried it, just a warning though if you do decide to try it and cant get the tube in because of the lip!!


Hi,

I can't say I've had any problems with "teeth" after deflation, but I can see what you mean. I think the "teeth" tend to appear after the balloon has been inflated for a prolonged period of time, e.g. a few weeks.

I was told to do this by my spinal unit when I first had my supra-pubic catheter put in, and have always done it. In the last 15 years, I have had 3 catheters in which the balloon hasn't deflated after testing, due to a faulty valve.

Needless to say, if this catheter was in the bladder, and didn't deflate properly, there could be big problems!

I guess the catheter could be cut in half in an emergency, but there may still be saline left in the balloon, which was not properly deflated due to the loss of suction which you get when you empty the balloon with a syringe.

I also use a dressing around the catheter site. I use Mepore dressings, which are self adhesive, and available on prescription.

Simon



Hi Simon.

Why do you think there is no consistency with advice given to spinal patients??
I can see why non spinal specialists might have differing opinions, but you would hope that all SCI patients were being told the same thing on discharge from spinal units!
I have just double checked with my boyfriend, and he has never been told, or heard of inflating the balloon beofre insertion!
He was at Stoke M, and as far as he is aware, everyone he knows from there who also have SP cathethers dont inflate baloon either!

Like you stated, if there are dodgy valves that dont deflate properly, then you would assume that it would be common practice to check that they work ok!! Fortunately so far we havent had any issues, but that doesnt mean that there might not be in the future i guess!!!
(do different cathethers have different valve systems??)

And no, cutting the cath in half to release the saline doesnt work....i know thins because i managed to slice through my boyfriends tube a couple of years ago (dont ask) and he said oh it will be fine, just tape it up for now....the next day when we were having dinner, i suddenly realised that the balloon might be draining,and literally the second i said it my boyfriend says he thinks the tube came out!
We tried to do an emergency insertion of a new tube but the hole had already closed up.....which meant a trip to A&E (a whole other story) where nothing could be done so he ended up having to go in for out patient visit to the hospital to have it re-done....4 weeks later!!!

So yeah, word of warning, you cant monitor the saline levels unless you can use the syringe!!!

so then, balloon inflation prior to insertion experiment begins!!

(im sure your right about the 'teeth' being worse over prolonged lenth of time-be intersting to see!)

thanks simon!

becca

#11 Apparelyzed

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Posted 28 January 2008 - 05:26 PM

(im sure your right about the 'teeth' being worse over prolonged lenth of time-be intersting to see!)


A liittle story about "teeth"!

I used to leave my catheter untill it started to block off, as I can tell a couple of days prior to it blocking that it needs changing.

However, one time, after 12 weeks, the catheter seemed fine, but we thought that after 12 weeks, we should change it anyway.

We planned on changing it in the morning, and just as Karen was getting set up for the change, it blocked, no problem, we were all set up, and it would be changed in a couple of minutes.

After deflating the balloon, Karen gave the catheter a pull to take it out, but it just wouldn't budge!

I could feel the signs of autonomic dysreflexia coming on, so we drained the bladder via the urethra.

In the end, 2 hours later, I had to go to the Urology ward at Leicester Hospital to get it removed. The balloon had stretched, and as it was pulled, it was causing the bladder to go into spasm, gripping the catheter even more!

They had to pour Lidnocaine around the wound to relax it, and then the catheter came out.

Whilst on the ward, my AD had really kicked in, and I've never sweated so much, and my fingers were freezing as shock was starting to take a hold.

Morel of this story?

Don't leave your catheter in for longer than 6-8 weeks, even if it's draining ok!

Simon

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#12 kewlcatkez

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Posted 28 January 2008 - 05:51 PM

(im sure your right about the 'teeth' being worse over prolonged lenth of time-be intersting to see!)


A liittle story about "teeth"!

I used to leave my catheter untill it started to block off, as I can tell a couple of days prior to it blocking that it needs changing.

However, one time, after 12 weeks, the catheter seemed fine, but we thought that after 12 weeks, we should change it anyway.

We planned on changing it in the morning, and just as Karen was getting set up for the change, it blocked, no problem, we were all set up, and it would be changed in a couple of minutes.

After deflating the balloon, Karen gave the catheter a pull to take it out, but it just wouldn't budge!

I could feel the signs of autonomic dysreflexia coming on, so we drained the bladder via the urethra.

In the end, 2 hours later, I had to go to the Urology ward at Leicester Hospital to get it removed. The balloon had stretched, and as it was pulled, it was causing the bladder to go into spasm, gripping the catheter even more!

They had to pour Lidnocaine around the wound to relax it, and then the catheter came out.

Whilst on the ward, my AD had really kicked in, and I've never sweated so much, and my fingers were freezing as shock was starting to take a hold.

Morel of this story?

Don't leave your catheter in for longer than 6-8 weeks, even if it's draining ok!

Simon



Hi Simon,

I have know that happen to one or two people myself! One person had an indwelling catheter and a District Nurse used to change it for him. Well, the story goes that she was off ill and he was told to go into the drs Surgery to have a Nurse there remove it. However, he was busy and unable to do so..soooo

He cut the bit where you put a syringe to take the water out and deflate the balloon!!!!! this resulted in it getting well and truly stuck! please do not ever cut them there!

The fella ended up having to go into Theatre to have it surgically removed.

Another time, I nursed a guy on CCU who had a Suprapubic catheter ( he had CP and also happened to have a heart condition too). He informed us after being there a few days that he should have removed the Catheter a few weeks prior! We though that it would be fine, as we have had people say that before. It was MY patient, so my job to do this! You guessed it, it got stuck! We wound up having to get a Urologist to come and see to it, since nothing we could do would shift it!

so be warned!

( I have to add that the second guy was a right joker and though it was Hilarious!..I didn't for some strange reason! LOL)

Take care,

K
Ex Nurse (med retired)
Connective tissue disorder & associated paralysis.

#13 russ1

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Posted 28 January 2008 - 10:47 PM

Does no one else use prefilled catheters - the saline for the bulb is preinserted and once the cath is in you just remove a clamp and squeeze the saline to fill the bulb. Still need a syringe to get the saline out mind.

I had my SPC in Stoke too and no-one ever suggested test filling the bulb, was shown again by district nurse when she taught me to do my own and again no test prior to insertion. We were told to change the caths every 4 weeks but I usually do mine every 6 weeks out of lazyness which is daft really as it only takes a couple of minutes.

I don't use a dressing unless the wound is weeping a little which it does from time to time with no apparent reason. To the OP my wound took nearly a year to heal up fully and would weep up till then but it wasn't a leak as such in that there was no quantity of fluid.
Russ - T2complete

#14 Motor

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Posted 29 January 2008 - 03:51 AM

im leaking from the belly ive had the suprapubic opp done over 8 weeks ago is this why im leaking or ive got a infection the area of the SPC is a bit red but its not that bad


big thanks
fastwheels



I forgot to also tell you that my doc found that if he inflated my baloon with 11 to 12 mls of saline instead of the usual 8-10 I had less leakage.
:wink05:

Edited by Motor, 29 January 2008 - 03:52 AM.

"CHEAP WOMAN AREN'T GOOD AND GOOD WOMAN AREN'T CHEAP"
"NEVER 4GET 9/11/01 THEY ARE GONE BUT NOT 4GOTTEN"
"I MUST CRAWL BEFORE I WALK (AGAIN)"
"LIVE EACH DAY LIKE ITS YOUR LAST"
"RIDE IT LIKE U STOLE IT"
Richie aka MOTOR :-)

#15 Apparelyzed

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Posted 29 January 2008 - 09:00 AM

im leaking from the belly ive had the suprapubic opp done over 8 weeks ago is this why im leaking or ive got a infection the area of the SPC is a bit red but its not that bad



I seem to remember my catheter site taking quite a long time to heal, around 12 weeks.

The problem is, when the catheter gets changed during this period, it causes trauma to the wound, and it has to start healing again.

Keep the site clean, and put a dressing over it untill it has healed. Also, give it a spray after cleaning with an antiseptic spray. Be gentle when cleaning the wound though, as you don't want to damage the healing process.

If you are worried, get it checked out by a doctor, but unless there is a local infection, and it has only started to "weep" since changing the catheter, my guess it's local trauma.

Regards

Simon

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#16 kewlcatkez

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Posted 29 January 2008 - 10:30 AM

Something I was just thinking about is that often a client would have a leaking catheter - whereby it was bypassing and some nurses would suggest that a Larger size catheter ( fr gage) was used. However, Urologists advised that this was actually counterproductive.

Sometimes the leaks are caused by bigger french size, and bigger balloon size too.

I know that Motor said that a bigger balloon solved his problem, but I am under the impression that this is the exception rather than the rule. Yes it is more of an issue with Urinary Catheters, but is also relevant to Suprapubic. The Catheter still goes into the Bladder neck. Of course because it is going through the abdomen as opposed to the Urethra, a bigger size would be used generally ( than used in a urinary cath). It is just important to bear in mind that the balloon and cath french size may be too big for the goings on inside...

Here is a quote I found by searching for 'larger catheter size worsens leakage" ( so you don't have to take my word for it!)

""Catheter leakage or bypass -- Leakage of urine around the catheter happens in most persons. Leakage may be due to involuntary bladder spasms (detrusor hyperreflexia or overactive bladder), infection, the catheter or balloon size being too large, or the bladder is irritated from catheter use. Bladder spasms are common after bladder or prostate surgery. If urine leakage occurs and the catheter falls out, this is probably due to involuntary bladder spasms from too large a catheter, too large size balloon (> 5cc), catheter composition; or catheter blockage.

The general belief is if the catheter is leaking then a larger size should be used but this will only worsen the problem. Remember a catheter may occasionally leak. There is no reason to be alarmed unless the catheter leaks continuously or if there is no urine in the drainage bag.
""


taken from HERE

Hope this helps,

Take care,

K
Ex Nurse (med retired)
Connective tissue disorder & associated paralysis.

#17 kewlcatkez

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Posted 29 January 2008 - 10:38 AM


im leaking from the belly ive had the suprapubic opp done over 8 weeks ago is this why im leaking or ive got a infection the area of the SPC is a bit red but its not that bad



I seem to remember my catheter site taking quite a long time to heal, around 12 weeks.

The problem is, when the catheter gets changed during this period, it causes trauma to the wound, and it has to start healing again.

Keep the site clean, and put a dressing over it untill it has healed. Also, give it a spray after cleaning with an antiseptic spray. Be gentle when cleaning the wound though, as you don't want to damage the healing process.

If you are worried, get it checked out by a doctor, but unless there is a local infection, and it has only started to "weep" since changing the catheter, my guess it's local trauma.

Regards

Simon


Hello again Guys,

I think the thing to remember is that the body will always try to close and heal a wound. Unfortunately the body is unable to realise that the 'wound' of a Supracatheter is needed and ok, so it tries to close it the same as a puncture wound which you want to heal.
Of course, like in Naval piercing, where there is a bar, with the catheter there is a catheter tube in the way and preventing the 'wound' from healing.
Therefore there will be periods of 'flare' up of inflammation and a lil discharge. Its managing it really, like Russ1 and Simon do.

Take care,

K
Ex Nurse (med retired)
Connective tissue disorder & associated paralysis.

#18 doublelibra

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Posted 08 February 2008 - 02:30 AM

My suprapubic cath leaked like a sieve when I had a 30cc balloon, and the problem was solved when I changed to a 5cc filled w. 10cc of water. However, I do have spasms and leakage if I use an all-silicone tube because it is so rigid. I use silicone COATED latex. I had to use Ditropan for the first couple of yrs., for spasms, but I don't need it any more. My tube had drainage the first yr. or so, and I used bactroban or triple antibiotic ointment and used a drain sponge 4X4 around it (one of the gauze 4X4's with a little split on one side). Now I have no drainage, and use no ointment or dressing. I keep the site very clean. I Wash w. soap & water 2X/day, and change the tube every 3-4 weeks. I drink lots of water and almost no pop, which is bad for the urinary tract. I have maybe 1or 2 cans a week or less. I have only about 1 UTI (urinary tract infection) per year or less, and that's really good for a quadriplegic. We need to be very careful, because UTI's are listed in many sources as quads' second leading cause of death!

Doublelibra

Edited by doublelibra, 08 February 2008 - 02:36 AM.


#19 bocktribe

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Posted 28 August 2009 - 05:13 AM

Hi.
I am going on TEN YEARS of having a Super Tube (supra pubic). I was having a little leaking with my latex cath. I have switched to a silicone one and am leaking lots. I have tried 4cc to 10 cc of water in the balloon with no difference in leakage. I have always just used tap water in the balloon. Totally sucks to leak! I will keep trying to overcome the odds.

#20 Motor

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Posted 28 August 2009 - 02:04 PM

Hi.
I am going on TEN YEARS of having a Super Tube (supra pubic). I was having a little leaking with my latex cath. I have switched to a silicone one and am leaking lots. I have tried 4cc to 10 cc of water in the balloon with no difference in leakage. I have always just used tap water in the balloon. Totally sucks to leak! I will keep trying to overcome the odds.



The hole or opening (stoma) your cath is going in has stretched. Time to go to a larger cath. I started at 16 french and now use 20 french. 11 cc of salin in balloon. Works ok with leakage once in a while. I change it every 4 to 6 weeks.

Good Luck
"CHEAP WOMAN AREN'T GOOD AND GOOD WOMAN AREN'T CHEAP"
"NEVER 4GET 9/11/01 THEY ARE GONE BUT NOT 4GOTTEN"
"I MUST CRAWL BEFORE I WALK (AGAIN)"
"LIVE EACH DAY LIKE ITS YOUR LAST"
"RIDE IT LIKE U STOLE IT"
Richie aka MOTOR :-)

#21 alex4bs

alex4bs

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Posted 28 August 2009 - 06:23 PM

nursing care change my inter tube about every 12 weeks nurses dont pre inflate liquid baloon telling me no because balloon will be very hard to insert as its not so small as when insert erted nomal i take alexclin anti biotic



This website is a way for those with spinal cord injuries to share experiences and advice. Any medical matters, treatments or alternative therapies discussed on this website should be thoroughly reviewed by a medical professional or therapist before being acted upon. Under no circumstances should you alter prescribed medication or a medical care plan without consulting your doctor or care plan supervisor first.