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Permanent Catheter for Person with Dementia
Hello Anja5, and a warm welcome to you. I am an RN whose mother had Frontotemporal Dementia and whose step-dad, MIL and GMIL all had Alzheimer's Disease.
You are a good advocate for your father and are trying to do what is best for him. I was wondering, who brought up or requested the indwelling urinary catheter? If it is simply for staff convenience, and there is no physical need to assist voiding because the person cannot void, that is considered a negative reason for catheterization.
The procedure itself is not comfortable, especially for a person with dementia who may see this as a threat to themselves. Also, just the mere act of inserting a catheter no matter how the RN uses good technique, causes risk of infection and an indwelling catheter is also a high risk for recurring infections. The catheter has to be replaced from time to time and this again causes the trauma with the necessary procedure and risk. When a catheter has been inserted, the nurse uses a syringe with water into a port to inflate a "balloon" so the catheter is held in place and does not slide out. Intermittent catheterization, especially in a patient with dementia would be traumatizing as well as again causing potential for infection. This is usually reserved for those who are unable to void and then it is usually done about six times a day.
Some of the difficulties in having a catheter is that it is not consistently comfortable for most, and there can be "spasms," and the person with the catheter can feel the catheter's presence. My personal experience is that so many patients with dementia with indwelling catheters actually pull them out, inflated balloon and all. Truly. Then that leads to someone having to somehow restrain the person's ability to do this and I have seen restraining gloves put on a person and that is not good practice.
There are also external catheters. A condom-like sheath is placed on the penis. There is a tube leading from the bottom of the sheath, it leads to a leg bag. The bag collection bag is strapped to the person's calf. This device comes with it's own problem issues of the sheath falling off, leakage and no tolerance by the patient as well as staff remembering to empty the small collection bag multiple times a day. These devices, for most, are not highly successsful.
The best approach would be for staff to assist your father to the bathroom to void every two hours and provide him with men's disposable incontinence briefs or if it is just leakage and not a total void, there are incontinence pads made for the male anatomy that fit inside briefs. The voiding every two hours should be put in writing into the patient care plan and monitored by the supervising nurse.
This is a challenge and I so hope that this problem can be met with special briefs, (some are designed to look just like regular briefs), and assisting him to the bathroom more frequently.
Best wishes coming your way,
Hi Anja, I can't speak to the medical side of a person having a permanent catheter, but there was a lady named Florence who resided at my mom's memory care who had one of these. She seemed to do fine with it medically, the hard part was that she never remembered she HAD a catheter. She was pretty advanced in her dementia, immobile, wheelchair-bound, but she could still talk, and she would constantly ask everyone around her to help her get to the bathroom because she "had to go."
The first time she asked me to help her get to the bathroom, I asked one of the aides to assist her, and they whispered, "She has a catheter, she doesn't need to go to the bathroom." So from then on, I'd have to tell Florence, "You have a catheter" or ignore her, which was hard. She'd actually get mad because I'd focus on my mom and not on answering her question. To be clear, I'd always answer her, but then she'd repeat herself again and again.
So, just something to think about in addition to the medical side.
I would not subject anyone to that as it is painful and the risk of
infection is very high if you keep it in a long time.
Anja5, the original poster, has not stopped back in. However, I would hope that people posting their reactions here would note that catheterization would never be done by responsible medical personnel unless absolutely medically necessary, absolutely NOT for convenience of staff.
Persons catheterized (like my dad was) chose catheterization over death. For my dad the cascading effect of urine filling his bladder, then backing up into his kidneys and then shutting down his heart was not his desired fate. At that point in his life, he had a choice of whether to put up with catheterization, or die from sepsis or a heart attack. He chose life. Catheterization is not necessarily painful -- there may be discomfort because of the reason for catheterization, say, if there is a large stone blocking the ureter, or if there is an extremely enlarged prostate, both were the case with my dad.
I do hope Anja5's loved one is getting the attention they deserve and that this is not just an incontinence issue -- Anja5 stated he was only a "bit incontinent," and in this case any and all other ways (wearing adult underwear, trying on the toilet every two hours) should be tried first. No way should catheterization ever be considered for convenience of staff. That is just wrong.
My reason for posting is to clear up the misconceptions.