Catheters and Infections

Is there a big risk of developing a UTI from catheters/ urethral play ? Seems like something that would happen, how common is it ?

Extremely common, even in health care. People will say that they've never gotten one. I say YET.

I have to catheterise myself 2 -3 hourly every day for medical purposes . No matter how careful I am cleaning myself beforehand I still get at least one infection every 4 - 6 weeks . If a urine infection spreads from the bladder to the kidneys it's really not pleasant . Known as urinary sepsis it's extremely painful , makes you very sick and requires hospitalisation . It can kill you if it gets into the blood stream . After experiencing infection so often it's put me off uretheral play . It's a stupid thing to do in my opinion , but if people wish to do it then I hope you are aware of the risks .

Nikki

I get a cystoscopy every 12 weeks, since my urologist removed a malignant tumor from my bladder last Jan. After each scoping he gives me one antibiotic tablet to take. I just got a case of cystitis from my last scoping in spite of the antibiotic. That required a week's dose of antibiotic to clear up. Not a fun time. So, even with the scrubbing of the glans and a sterile cystoscope, infections can and do happen. He also sometimes fills the bladder with sterile saline and watches me void it out. I really do like like these procedures.

Eventually, if he finds no new tumors, he will scope me every 6 months, for life.

Yikes. I was starting to become interested, but maybe I should just stick with safer alternatives

Extremely common, even in health care. People will say that they've never gotten one. I say YET.

The response to this question is actually similar to the question about masturbation.

95% tell the truth, the other 5% LIE. For a person to do urethral insertions on a weekly or more frequent basis over many years is lying if they say they never had an infection.

People who have done it frequently will have had an infection at some time, although it may have been only a slight one that was quickly eradicated.

I guess I am of a slightly different opinion. I agree that playing in, near or around a urethra can cause health issue, however with that being said, .....................

We are taught in nursing school that placing a cath is a sterile procedure, and yes it can be. In real like most of us try to keep things as sterile as possible. But probably a good 90 percent of the time we place a cath that according to procedure isn't really still sterile. Not saying we drop the cath on the ground and then place it. Something as simple as getting closer than a foot above your sterile field according to procedure renders the entire thing no longer sterile. Do you think when that happens we stop, clean up, go get more supplies and start over? Ummm no.

If I have a patient that is really compromised then most of us will do everything in our power to keep the procedure sterile. But if we are doing a straight cath for labs or something and we pass the sterile line, we just keep going. To my knowledge I have never given anyone an infection, again, to my knowledge.

Now, if you are fluid bonded with someone it is my opinion that sterility isn't an absolute must, or if you have to self cath yourself all the time in order to urinate. First of all it is 100 percent impossible to self cath yourself and keep sterile according to procedure. Clean technique is about the best you can hope for in that case. Again, when you are fluid bonded a clean technique is also all that is needed. If you clean the urethra and keep the cath in your washed hand or gloved hand and are not letting it hit the bed you will be fine. If you put the cath in the right hole the first time, then again you should be fine.

Please remember, if you do something enough times eventually something is going to happen, that's the law of provability. You just have to play smart, not stupid.

Mashie

What opinion do you have Mashie about "playing" with a metallic urethra vibrator like this one

... http://www.amazon.com/Masters-Series-Vibrating-Urethal-Sound/dp/B0020N31Y2 ...

are they infections risks if the toy is clean, used only by the two lovers(couple), using sterile lube, and sliding in never deep enough to reach prostate or female bladder "closing". Never sliding in the bladder.

Clean or sanitary isn't sterile. In the healthy male, everything beyond the first half inch or so is naturally sterile. By inserting, it's probable you're pushing bacteria upstream no matter what you do. In the female, the distances are much smaller, which is why women are more prone to UTIs than men.

Mashie, while placing a catheter should be a sterile procedure, the moment the procedure ends, so does sterility. The catheter moves, the labia or penis moves, the catheter contacts non-sterile surfaces. That's why indwelling catheters are changed regularly.

Placing a cath CAN be a sterile procedure, but it doesn't always have to be a sterile procedure.

As a nurse I know that once the cath is placed it's no longer sterile. And here in my state indwelling catheters are no longer changed regularly. The medical community has determined that changing them actually causes a greater risk for infection then not changing them. That changed about 3-4 years ago. And according to the medical data, less frequent changes of indwelling caths has cut down on the infection rate about 50 to 60 percent. So now we only change the if there is a problem. 4 years ago I did all 30 of my continuing education credits that we are required by law to do to keep our nursing license on the changes in indwelling catheters and care of them.

Mashie

Just shows how things are different Worldwide.

This last stay they introduced the change of a foley cath every 2 or 3 days maximum. Mostly my urologist or his SHO did the change . Whilst the SJS was raring it's ugly head these changes were often coupled with a cystoscopy . This was due to the internal blisters , which unfortunately I'm still experiencing .

Before the new policy of change , mine was changed on a weekly basis .

As for self catheterising which I'm doing at the minute because I'm at home I was taught to just be as clean as I possibly can . It's impossible to self cath in a toilet ( public) which isn't exactly clean or sterile . I do have sterile individual wiped to use and obviously I wash my hands before and after , but that's as sterile as it can be.

And as Mashie stated

And here in my state indwelling catheters are no longer changed regularly. The medical community has determined that changing them actually causes a greater risk for infection then not changing them. That changed about 3-4 years ago. And according to the medical data, less frequent changes of indwelling caths has cut down on the infection rate about 50 to 60 percent. So now we only change the if there is a problem.

Mashie

I agree with the fact they don't need changing so often . I'm forever battling infection and am home but still requiring home nurse visits 3 X a day to administer Ivs due to kidney/bladder infection .

I'm sure I had less when my foley was not changed so often.

Nikki

Repetitam

What opinion do you have Mashie about "playing" with a metallic urethra vibrator like this one

... http://www.amazon.com/Masters-Series-Vibrating-Urethal-Sound/dp/B0020N31Y2 ...

are they infections risks if the toy is clean, used only by the two lovers(couple), using sterile lube, and sliding in never deep enough to reach prostate or female bladder "closing". Never sliding in the bladder.

thank you for your reply.

Yes Dr. fireman there is always a risk of developing a UTI with any procedure that introduces a foreign object into the body. So whether its a catheter or a urethral sound there is always a significant risk of introducing infection and developing a UTI.

As Niknoks and Mashie has stated

I have to catheterise myself 2 -3 hourly every day for medical purposes . No matter how careful I am cleaning myself beforehand I still get at least one infection every 4 - 6 weeks . If a urine infection spreads from the bladder to the kidneys it's really not pleasant . Known as urinary sepsis it's extremely painful , makes you very sick and requires hospitalisation . It can kill you if it gets into the blood stream . After experiencing infection so often it's put me off uretheral play . It's a stupid thing to do in my opinion , but if people wish to do it then I hope you are aware of the risks .

Nikki

We are taught in nursing school that placing a cath is a sterile procedure, and yes it can be. In real like most of us try to keep things as sterile as possible. But probably a good 90 percent of the time we place a cath that according to procedure isn't really still sterile. Not saying we drop the cath on the ground and then place it. Something as simple as getting closer than a foot above your sterile field according to procedure renders the entire thing no longer sterile. Do you think when that happens we stop, clean up, go get more supplies and start over? Ummm no.

If I have a patient that is really compromised then most of us will do everything in our power to keep the procedure sterile. But if we are doing a straight cath for labs or something and we pass the sterile line, we just keep going. To my knowledge I have never given anyone an infection, again, to my knowledge.

Once a catheter is placed, the daily incidence of bacteriuria is 3-10%. Between 10% and 30% of patients who undergo short-term catheterization (ie, 2-4 days) develop bacteriuria and are asymptomatic ( producing or showing no symptoms). Between 90% and 100% of patients who undergo long-term catheterization develop bacteriuria. About 80% of nosocomial ( hospital aquired) UTIs are related to urethral catheterization; only 5-10% are related to genitourinary manipulation.The most important risk factor for developing a catheter-associated UTI (CAUTI) is prolonged use of the urinary catheter.

In the UK we use Instillagel, it contains a local anaesthetic to prevent pain and antiseptics to reduce the risk of infection getting in, while lubricating to make the process smooth. Personally I do think this helps to reduce the risk of infection when a catheter is introduced.

With regards to any type of play with catheter and sounds , sterility and asepsis is extremely important , from cleaning the area to ensuring that the sound or catheter remains sterile on insertion. So Dr Fireman please ensure the person inserting these has an excellent aseptic technique if you dont want to develop a UTI , cystitis or renal infection.

Finally although only about 20% of UTIs occur in men, these infections can cause more serious problems than they do in women. Men with UTIs are far more likely to be hospitalized than women.

Yes Niknoks, we don't routinely change catheters either in my clinical area. As Mashie has stated the research has indicated that they only need to be changed if a problem develops and we dont have a very high incidence of catheter associated UTI:

And here in my state indwelling catheters are no longer changed regularly. The medical community has determined that changing them actually causes a greater risk for infection then not changing them. That changed about 3-4 years ago. And according to the medical data, less frequent changes of indwelling caths has cut down on the infection rate about 50 to 60 percent. So now we only change the if there is a problem.

With your SJS I think that added to the risk of infection, blockage and catheter becoming coated with the bacteria and caused the decision to be made about changing every 2 or 3 days.

We follow the same policy with regards to Central lines and Arterial lines, When I started in 1994 , we routinely changed them every 7 days regardless.

As others have said its very common, here if they don't have a 22fr Foley in me, then I self cath 6 times per day, and its a steady battle to stay away from infections.

RN1993, up until a few years ago, and again in my state, I can't speak for other states and I have no idea if this is a state thing or a US thing, so I will say in my state of Ohio we used to only allow or keep IV's in a site for 3 days. Then it was changed to 7 days, and now in the hospital I was in a few weeks ago they said their new policy is to keep them in as long as they were patent and had no other issues, and or the medication they were running in wasn't harsh on the veins. Which in my opinion makes perfect sense. I love needles in my butt, not in my veins and the less I have to be poked or poke someone else the better, lol.

Mashie

They have the three day rule here on cannulas . That's been the case since sometime last year when I was a patient. Otherwise they were kept until they started hurting or tissued.

I have a long line in each arm which they insist on changing every 7 days .

I too hate my veins keep getting poked . They always protest . It's getting harder to get a line in and it stay working well for the week .

I keep getting asked if I want a port , but I'm not quite convinced yet it's the best thing for me .

Nikki

In India , They change cath every 3-4 days.

As for IVs , I am happy I now have a port for my chemotherapy injections.

We still employ the 72 hr rule with regards to IV Cannulas/venflons as Niknoks has said:

They have the three day rule here on cannulas .

We however can keep keep them in for a maximum of 120 hr (5 day) after which they have to be resited regardless if there are any signs of infection (Phlebitis) , like pain, redness (Erythema), warmth or Tissuing ( extravasation) like swelling or leaking from the cannula site. This is taken very seriously in my clinical environment and the site has to be checked and documented before any administration of medication or fluids ( we employ an IV chart for this purpose).

Mashie I don't think any hospital in the UK employs that rule at present with regards to a peripheral cannula. I must perform a bit on research on that . As you have indicated some antibiotics can be very detrimental on the veins peripherally.

RN, yes, it's not just ATB's that can be detrimental but there are other meds too. Not a lot, but there are some. When I went in for my emergency appy they gave me phenergan through my IV which burned like a mother and damaged the vein. When I went into that same hospital a few weeks ago they had to use that illumination wand to find my veins because I was so dehydrated. The nurse looked at that vein in my hand where the phenergan had been administered 4 years ago and asked me what happened to it. I told her about the phenergan and she said, "Oh yes, that is exactly why we are no longer allowed to administer phenergan through an IV line anymore, ever. So that is one of the meds that isn't an ATB, but is also very damaging to a vein.

Mashie

Mashie, I've been in the ER 4 times with dehydration and hypokalemia, from non-stop BM's. I got slurred speech, was staggering and nauseated. They'd hang a bag of KCL right away and soon, the staggering and slurred speech went away. I'd also get a "mini-bag" containing the Phenergan, so it was not the same as having it by IV Push. Then, they put more Phenergan in my other IV (either saline, D5W, lactated Ringers), so it ran in slowly. My 4th trip for this also included cardiac arrhythmias as a result of bad potassium loss. They admitted me that time for one night to observe my heart and give me IV's all night. I didn't know that Phenergan was rough on the veins. I didn't take anymore Phenergan, cause I had tons of Zofran at home, since I sold it.

All this rat race stopped when I started every 3 day enemas to deal with the many BM's. I haven't been back to the ER since I started doing that.

You should ask them for Tigan, Zofran, or maybe Compazine for nausea. I get extrapyramidal side effects with Compazine. Zofran works great, if you can afford it.

What is the best lidocaine lube for a catheter, and where do you buy it?

Course

The one they use in the UK which is a numbing gel and lube combined is called Instilligel. Not sure if you can buy it though or have to have a prescription.

Not sure if they have the same thing your way .

Maybe Mashie or Switchable Susie can help with that

Nikki

I have already found that.....hope someone can help

What is the best lidocaine lube for a catheter, and where do you buy it?

Course

IF YOU NEED LIDOCAINE LUBE FOR A CATHETER, YOU DON'T KNOW WHAT YOU ARE DOING AND YOU RISK SIGNIFICANT INJURY.

DON'T DO IT.

Catheter insertions done properly are not painful and the catheter goes in smoothly with ordinary surgical lubricant. Of course, real hospital patients may be apprehensive about it, and that may cause problems.

Besides, if you are playing when you are numb, you are missing all the wonderful sensations people want when they play with catheters.

Not a medical expert it shouldn't happen but it might. there's always a risk.

With anything, including drinking water there is a risk. But if you know what you are doing, know your anatomy, and are familiar with the equipment the risk is so very small. Seriously small.

Mashie

With anything, including drinking water there is a risk. But if you know what you are doing, know your anatomy, and are familiar with the equipment the risk is so very small. Seriously small.

Mashie

that's good to know, but just to be on the safe side i would let a medical professional do it or teach before me doing it myself.

but that's just me, it's up to you what and how you want it done Dr fireman

Course as stated by Susie there are risk associated with the use of lidocaine mainly trauma as you are unaware due to the loss of sensation from the local anaesthetic and as such you can cause yourself significant injury. In the Uk its just standard practice to use Instilligel (providing you are not allergic to lidocaine) when inserting any catheter in a hospital setting, I have never use any other lube .

I know that patients who intermittently cath , use catheters are either Hydrophilic-coated ( have a layer of a pre-lubricated coating that is bound to the catheter surface. The pre-lubricated coating absorbs and binds water to the hydrophilic catheter, resulting in a thick, smooth and slippery surface. The coating layer remains intact upon introduction into the urethra and ensures lubrication of the urethra in its entire length.) or have a sterile lubricating gel for use.

Dr J

not a medical expert it shouldn't happen but it might. there's always a risk.

As with every activity in life whether medical related or not there is risk . Every medical personnel tries to minimize the risk in clinical practice, as does the lay person .

Yes Mashie I know that antibiotics are not the only medication that may cause inflamation of a vien . We have quite an extensive list that includes the following :

Commonly used IV medications

Vancomycin

Aciclovir, Gancicolvir

Gentamicin

Phenytoin

Amphotericin

Cefotaxime

Mycophenolate Mofetil

Vasocompressive agents ( we generally dont run these peripherally , but can be given as an IV bolus in emergency )

Dobutamine

Dopamine

Epinephrine (adrenaline)

Norepinephrine (noradrenaline)

Vasopressin

Concentrated electrolyte solutions ( again not routine given peripherally especially the KCL)

Calcium chloride

Calcium gluconate 10%

Potassium chloride 7.45%

Sodium bicarbonate 4.2% & 8.4%

Sodium chloride 10%

Cytotoxic agents

Busulphan

Actinomycin-D

Daunorubicin

Doxorubicin

Epirubicin

Idarubicin

Mitomycin

Paclitaxel

Treosulfan

Vinblastine

Vincristine

Vinorelbine

Hyperosmolar agents

Total parenteral nutrition ( We never give this peripherally )

>10% dextrose

Mannitol 15%

Other

Radiographic contrast media

Promethazine (phenergan)

Diazepam

Digoxin

This is not an exhaustive list.

Potassium burns like hell.