first home instill and i am totally lost

[megancolleen]

So, it's my first time doing a home instillation, and I quickly learned that it's not as easy as the nurse made it seem. I've been in my bathroom "teaching myself" to do this (and by "teaching myself" I mean "crying in frustration and stifling the urge to throw the syringe against the wall.") I can't even get the syringe to fill up properly. I know now that I did not miss my calling as a nurse, that's for sure!

I don't know what's wrong with me, but I don't know if I can do this. :confused:

[pingpong]

You should call your uro's office and schedule another "lesson", then don't leave until you have it down pat. The first time is tricky, I know, but don't give up yet! You want the instills to make you feel better, not worse. And you want to make sure your technique is correct so you can avoid UTI's.

[megancolleen]

I gave up after FOUR HOURS of trying. I messed up four times and had to throw the solution away, which caused a dramatic decrease in my meds.

I was able to catheterize myself okay, but I just couldn't get the solution into my bladder. The cath kept either falling out or the whole thing would fall apart when I started pushing the syringe down.

Also, my bladder is MUCH more sore now than it was at the doctor's office. My only reward for all that trouble is pain. Ugh!

This has been a very frustrating day.

[megancolleen]

Thanks, pingpong, I probably should do that. I'm kind of upset that I was only given one lesson at my uro's office. I didn't even get to try to do it myself. They had me under the impression that one time was plenty, and it just wasn't.

[maryla]

The way They taught me at the Cleveland Clinic works great for me, I use the male lo-fric caths. which are longer than the womens, the longer the better for me. I mix my lidocaine and elmiron in a steril cup I picked up from my uro(make sure you wash it before and after you use it) I have a lg sringe that holds 60cc's which came with a plunger thinky, however I don't use it. I sit on the john and put my cath in, put the sringe on and lay on the floor, pour my lidocaine and elmiron solution into the swringe and hold up the sringe until everything runs in my bladder.


Just don't give up, it's well worth the initial frustration in the long run,

God Bless,

[GriffsMommy]

I'm sorry you had such a hard time. You should def go back to your dr's office and have them show you again and have you do it while you are there so you know you can do it. Stress is such a big cause of flares so it's not going to only make you worse if you are so stressed out about having problems with it all.

Even though so many of us do instills I honestly don't think that two of us do it the same way. I was given three small syringes to draw up each one of the meds. I use heparin, lidocaine and sodium bicarb. I draw up each med into it's syringe. I use the same one each time because the only thing it ever touches is the med vial. I then put the meds into a sterile cup. I put the lidocaine and heparin in first. If I'm not going to do the instill right then, I just leave the sodium bicarb in it's syringe until I'm ready to do the instill and then I had it to the sterile cup.

I then draw up the whole mixture into a bigger syringe. Probably 60 cc's but I honestly don't know since I'm downstairs and my stuff is upstairs in my bedroom.

After I have the meds set up I get myself set up. I use an 8fr 15 in pediatric feeding tube. I find this works best for me because they are so small they don't hurt my urethra as long as I use lidocaine first on my urethra and it is long enough to be able to drain my urine before I instill the meds.

I don't think most people do it this way but this is what I have found works for me. I use a large tupperware container that I put on my bed to help prop up my mirror and I also drain my urine into the container.

I get the mirror proped up and use it to be able to see my urethra while I sit on my bed with my pillows behind my back supporting me. I insert lidocaine into my urethra with a urojet that I got from my dr. I know that alot of people don't use these but I find it really helps to numb my urethra up so it doesn't get sore from the cath.

I give the lidocaine a minute to numb me up and then I get the big syringe with the meds in it and the cath. I make sure the mirror and tupperware container are close enough to me that I can see my urethra and I can have the other end of the cath in the container. I then very slowly insert the cath until urine starts to come out. I always pee before hand so there isn't much urine left but there is some. I know that a lot of people do it in the bathroom but I couldn't lay down all the way and see what I was doing and if I did it on the toliet I ended up dropping the mirror in and I obviously couldn't see what I was doing that way, lol.

I hold onto the cath with one hand to make sure it doesn't come out, as long as I have it in far enough this shouldn't be a problem with the long cath but I still want to make sure. I grab the syringe which is within reach and attach it to the end of the cath. My syringe and caths fit together perfectly. Then all I have to do is push the meds into the cath and into my bladder. With the set up that I have I just have to remember to remove the cath while the syringe is still attached or all of the meds start coming back out the cath and I waste half of my meds.

This has been what has worked best for me and I can do it in only a couple of minutes now. I know it's so hard when everybody gets different supplies from their dr's but hopefully this might help a little.

If there is any information I can give you to make this easier for you, let me know. I felt so accomplished after the first time that I did it myself. It is so strange the things that make us happy when we feel horrible so much of the time. Good luck!

[sphinx]

Definitely get another lesson...make sure that you actually do it yourself in the office with their assistance.......that way they can give you pointers right then and there.

Here's how I do mine....

I just use Heparin and Lidocaine. I use a 20cc syringe, and first draw up 10cc of lidocaine. To do this I start by injecting 10cc of air, then withdraw the 10cc.

Then I have 2 vials of Heparin, each is 1cc each. I use the same syringe to draw each up. I use all the fluid from each bottle so I don't worry about cross contamination. (but I always use the lidocaine first). I skae the mixture *gently* in the syringe. Then, because the tip of the 20cc syringe is not compatible with the end of the catheter, I attach a separate "catheter adapter" to the syringe. It is blue, screws on, and fits in the catheter end nice and snug. I always leave 1-2cc air at the top of the syringe to "push" the remaining solution in when I do the instill.

I sit on a folded towel on the front edge of the toilet seat. I have a plastic container to drain the urine in (not talented in to get it into the toilet, lol). I put the container on the floor, and place a mirror on top of it. I lean over the mirror and locate my urethra. I make sure I am clean down there. I use a 10 french 6 inch female catheter. I lubricate it and insert just the tip first...I feel the tip is in there, then remove the mirror quickly and push the remainder of the cath in while I lift the container to drain the urine in to. When it's done dripping, I cough and shift around a little to make sure I am empty. Then while holding the cath steady with one hand, I grab the syringe with the other hand and insert it into the end of the cath. I push the plunger and immediately remove it before it can come back out into the tubing.

I usually do this after I shower. I wash my hands before I prepare the solution, and again before I insert the catheter. I make sure I place everything in arm's reach. Before you know it, it will be second nature.

But like I said, be sure you can do it at the office with help, before you go home. Even if they have to help a lot, just having the feel of it helps a lot.

Good luck-you'll be great!

[sickofmybladder]

I would also ask for another lesson - my doctor's office made me do mine at my lesson to make sure - but here's some tips:

It sounds like they didn't show you negative pressure - to draw the meds out you need to first have that much air in your syringe - this is pushed back into the med - and then that much med comes out (make sense?) So if you need 10cc of lidocaine - you should first draw the plunger of your syringe down to 10cc's - put the needle in the bottle - push up and then pull back out.

GriffsMommy is right - we all seem to do different things - I do 3 batches at once so I can save on the sodium bicarb (mine has to be thrown out once it's been used) and keep 2 in the fridge - I can't seem to calculate correctly using the 20cc syringe - so I draw the meds out with a 10cc syringe (always lidocaine first also because that is reusable) and then put the meds in the 20cc syringe one at a time (without the needle on the 20cc syringe) - I put the needle on - cap it - and put in fridge. (My doctor told me that they are good for 1 week). Somehow I think the sterile cup would be better - I'm going to look into that...........the contents of the syringe go into a 60cc catheter syringe.
I also do mine after showers - I sit on my bathroom floor with my back against the tub on a clean towel and place the mirror where I can see everything (I can't do over the toilet either) - lube the catheter well - and take it nice and easy - if you find your having trouble inserting - breathe in - don't know why but it works - once the catheter is in (trust me - it will be further than you think) - I slowly push the meds in - (once I went to fast - and it fell out) then remove the catheter before the syringe (otherwise all of the med will cath right back out of your bladder) -

[ICNDonna]

If you're filling a syringe with a needle into a sealed container, what you need to do before you stick the needle into the sealed container, is to pull the plunger on the syringe to the desired dosage. Then stick the needle into the sealed container and push the plunger down --- then be sure the tip of the needle is in the liquid and pull it back again to the dosage. I'm not sure if I explained that very well, but when you are drawing liquid into a syringe from a closed container, you have to get some air in it to displace the liquid you'll be drawing.

When I did home instillations, I used a catheter that was about a foot long and had a place on the end of the catheter where I could put the large syringe holding the instill mixture. I then pushed the plunger on the syringe, holding the catheter with one hand. I always pulled the catheter out before removing the syringe so the solution wouldn't pour right back out through the catheter.

And by all means ask for another lesson.

Huuugs,
Donna

[megancolleen]

Thank you everyone for the great information! I really appreciate it.

Donna, that makes perfect sense, and is really helpful--I actually had no idea how to use a syringe properly.

I think I'm pretty close to getting it, but I've decided to go in for another lesson. I'm going to bring my fiance with me and have him in the room so he can learn too and help me at home.

[tigger_gal]

I sent you a pm

[L. Thomas]

Keep you chin up. Practice makes prefect..or is it perfect practice makes perfect. Let me know if I can help. You've got my support.

[dngwic2]

What a smart girl you are. Your fiance should know how to cath you. My husband was with me at my lesson. He even joked with the nurse that he was going to check under the hood! I have never asked for his help. A matter of pride I guess cause I could have used a little help at first. Even so, he should know how. I would rather have him do it than a stranger if I cannot do it myself. My lesson lasted about a minute and a half and since it is a 6 hour drive to my current uro I had to persist to get it down. I can't do it on the toilet, have to straddle the side of the tub with mirror in front of me. I have been doing instills 3 times a day for over a year. I hope it goes well for you.

[GriffsMommy]

It sounds like you have gotten some other great advice. I think it's a great idea to have your fiance go with you for your next lesson. I have always done it on my own but my husband has told me more than once that he will do it for me if I need him too. He has watched me do it so he does know where my urethra is so I think if I set everything up for him he could do it now. I didn't even remember to tell you about the negative pressure that Donna is talking about. She is right, you do have to put the same amount of air into the vial that you're going to be drawing out or it won't work. Once you do it the first time without any help you will feel so accomplished and before you know it, you'll be doing it with no problems like it's second nature!

[CathyKi]

My husband has been an incredible help to me. With my arthritis it is difficult loading the syringe so he does it for me. He has found it is easier to pull up the lidocane into the syringe before attaching the needle. All the marcaine and heperain pretty much fill that 60cc up. Then the catheter really doesn't fit well onto the delivery syringe. I would like to know more about adapters. The first time I laid on a pillow case (easy to bleach) an inserted the catheter. It was hard for me to find the pee hole. When I lay back it is easier to see so he has agreed to put it in and pretty much do everything. He was a medic in Vietnam and a chemist now so this is all right up his alley.
The only problem we have is leaking around the end of the catheter where it hooks onto the syringe. It is more relaxing to do it at home and doing it around evening gives the medicine a longer chance to work whilst I sleep.
Sodium Bicarb really bothered me. My doctor got me off the ambien with Valium. I took it instead of the ambien to sleep and now I am cutting them in half so I can taper off of those. The Valium has really really helped my frequency. :bunny:

[sphinx]

Cathy, I have arthritis too, so I feel ya! If you are doing everything using a 60cc syringe I can see where it would be hard-I am a nurse and have found that the bigger the syringe, the harder it is to draw up meds. (Luckily I work in a setting now that doesn't have much use for syringes other than the occasional antibiotic or flu shot! But I have RA and inject myself 3 times a week......with very small syringes and needles....so my hands get a lot of practice handling these things)......

About the adapters.....what kind of 60cc syringes do you use? They come in 2 types, one with a "catheter tip" and one with a "luer lock tip". The luer lock has a tip that the needles screws onto. The catheter tip does not have a way to screw a needle on. It is a syringe where the end is the right size and shape to fit right onto the end of a catheter.

I personally use a 20cc syringe. My instillation "recipe" is 10cc of 2% lidocaine and 2 cc heparin. So I have no need of a larger syringe. 20cc syringes only come with a luer lock tip, not a cath tip. Because I find 60cc syringes difficult to work with (like I said before, the bigger they are, the harder I find them to be in terms of drawing up meds, etc).....I'd rather not switch to a different syringe. So I buy this adapter online. They screw onto the end of the syringe. They are luer locks so should fit on any size syringe with a luer lock tip. Anyway, I draw my meds up with a needle, then attach the adapter and then hook it to the funnel end of the cath after I insert it and drain the bladder.

It is a perfect fit for the type of cath I use. I use a bard mentor (I think?) 6 inch female cath 10 french. It fits well and does not leak. However, I got a sample of a different cath and it didn't fit well at all, totally leaked all over. So that's a consideration too.


My husband has been an incredible help to me. With my arthritis it is difficult loading the syringe so he does it for me. He has found it is easier to pull up the lidocane into the syringe before attaching the needle. All the marcaine and heperain pretty much fill that 60cc up. Then the catheter really doesn't fit well onto the delivery syringe. I would like to know more about adapters. The first time I laid on a pillow case (easy to bleach) an inserted the catheter. It was hard for me to find the pee hole. When I lay back it is easier to see so he has agreed to put it in and pretty much do everything. He was a medic in Vietnam and a chemist now so this is all right up his alley.
The only problem we have is leaking around the end of the catheter where it hooks onto the syringe. It is more relaxing to do it at home and doing it around evening gives the medicine a longer chance to work whilst I sleep.
Sodium Bicarb really bothered me. My doctor got me off the ambien with Valium. I took it instead of the ambien to sleep and now I am cutting them in half so I can taper off of those. The Valium has really really helped my frequency. :bunny:

[L. Thomas]

Then the catheter really doesn't fit well onto the delivery syringe. I would like to know more about adapters. The only problem we have is leaking around the end of the catheter where it hooks onto the syringe. :bunny:


I am not sure about the total volume of you instill. I use a 30cc lure lock syringe and a 8fr 15" pediatric feeding tube as a catheter. It fits without any leakage. I am sure there are lure lock syringes that have a larger capacity. I would check with a durable goods supplier.

I have tried to explain the procedure I use in the link in my signature. I sit on the toilet with my legs spread wider than normal and the urine drains into the toilet. Then I instill. After you have done instills for a while you will find which is most comfortable for you. I like the way I do them because I can take a premixed instill with me anywhere.

[sphinx]

I am not sure about the total volume of you instill. I use a 30cc lure lock syringe and a 8fr 15" pediatric feeding tube as a catheter. It fits without any leakage. I am sure there are lure lock syringes that have a larger capacity. I would check with a durable goods supplier.


60cc syringes come in both cath tips and with luer lock tips. You can get either.

[soccermom32]

I buy 6 instillations at a time. My doc gives all the supplies to me in a big shopping bag. I come home, and seperate what I need into 6 big ziploc bags for 6 instillation. The meds sit upright in a tupperware. That way, when I'm ready, I grab 1 ready bag and my meds.

Here is how I do mine, typically at night after bath:

1. Put air into the needles the the others said, push it into the bottle of med and draw up what I need. I make my cocktail and then put it in the big syringe. It also helps to draw up a little air into the big syringe BEFORE filling your meds with it. When you turn it upside down, you'll see the meds and some air at the top.

2. I take a bath, make sure I'm clean.

3. I sit on a towel on the floor with a mirror. I sterlize my urethra with a solution they gave me and insert lidocaine. I let it sit for a minute and then get the mirror close to insert the cathedar sitting up. Once I'm in, I pretty much move away the mirror and move up the container to catch the urine. Wants the urine drains, I turn up the end, insert syringe and shoot it in. I remove immidately with the syringe still connected to the cath.

I've done 5 so far at home and I'm getting pretty quick at it. You will too. Ask for another lesson if you are unsure by all means!!!


:toilet: