Instills at Home

[Ratchada]

I am going to bite the bullet and learn how to do instills myself next week. I am just curious. How often do those who do it at home do the instills? Weekly. daily, as needed ,etc,? I am afraid I will be wanting to do them all the time as I seem to have frequency and urgency all the time. I have not yet received guidelines from the doctor. Thanks for your help. Ratchada

[GriffsMommy]

This really is a question that you want to ask your dr because it varies so much from patient to patient and dr to dr. My dr has me doing them twice a week but I have the scripts written out to do three a week so I have the extra meds to do an extra one a week if I'm flaring.

I have seen some people do them daily, some do them multiple times a day and some do them as needed. Keep in mind you're going to need a script for the meds and things so that will probably have something to do with how often you can do them if you have insurance.

When you go to learn how to do the instills yourself then ask how often they suggest you do them and go from there.

Good luck, before you know it you'll be a pro at doing them yourself at home.

[SandyRN]

At first I did them 3x a week now I only do them when I have increased pain or when I flare. They've really been a great help to me and it's nice to be able to do them at home when I need them instead of running to the doctors office every time.

[bunnykinb]

Right now, I am getting instills every two weeks at the uro's office. I had also had one lesson of actually instilling myself last week. I will do this for whatever amount of time that I feel totally comfortable with doing home instills. I think I need the instills more frequently though. I was fine Tues. 3/11 through Sun 3/16. I came into work and have some burning again.

[soccermom32]

I love my instillations. I would do them every other day, but i do them about twice a week. It costs me $100 for 6 of them, so I can't afford to do too many.

[tigger_gal]

I just started them too, I can do them 2 times a week, but ask you doctor, it depends on what kind it is.

[bunnykinb]

The doctor's office called the supplier and the supplier said I have really good insurance. He will send me different sizes of the disposable caths with lubricant already included. I will need to see which size works for me and then he will request the catheters. I also need to ask the nurse about what is used to draw the heparin from the vials.

What do you use?

[sphinx]

I instill pretty much daily.....I definitely do it every work day, I often skip one of the weekend days and/or a day during the week that I am off. It depends on my schedule, what my plans are, etc. If I am going to be out and busy, I definitely do it, since it really helps decrease my frequency.

[L. Thomas]

The ingredients in your instill will make a difference. I can instill as often as I need...including more than onec a day. At first I needed to instill every day. Now I average 2 a week except during allergy season. During allergy season I have to instill at least every other day.

I wouldn't think you would have a problem becoming "addicted" to instills. If they take care of your problems you will be able to gauge how often you need one.

[bunnykinb]

What do you use to get the heparin, lidocaine etc out of the containers to mix?

[L. Thomas]

My total instill is 11cc
8cc lidocaine
2cc sodium bicarbonate
10,000 units heparin

I put all the ingredients in one syringe using negative pressure to fill the syringe.
I use a 30cc syringe and attach an 18 guage needle.

I pull the syringe back to 8cc. Then I push the air into the vial making sure to keep the needle in the liquid (not in the air part of the vial). The syringe will fill to the 8cc mark by itself (negative pressure).

Then I pull the plunger back 2 more cc and using negative pressure push the air in the syringe into the sodium bicarbonate vial (making sure to keep the needle in the liquid (not in the air part of the vial). The plunger will pull the 2cc out of the vial by itself (negative pressure). Then I pull the plunger back 1cc and push the air into the heparin vial and the heaprin will be drawn into the syringe.

I hope I have explained this so you can understand how I do it. Some recipes have a total volume much larger than 11cc. I am not sure how they do the mixing for those.

[bunnykinb]

I didn't notice how the heparin was drawn from its vial, but I can see where you would need a needle syringe. I noticed the nurse puts all meds in a speciman container which is about 1/3 filled with heparin, sodium bicarbonate and lidocaine. The only one that I know the amount is 40,000 cc of heparin. Then, the nurse attached a big catheter tip syringe and pour the mix from the container into the big catheter at the other end. Then, she put the top on and I guess that is where the air is pressured into the bladder?

[L. Thomas]

Then, the nurse attached a big catheter tip syringe and pour the mix from the container into the big catheter at the other end. Then, she put the top on and I guess that is where the air is pressured into the bladder?

After I mix the ingredients in the syringe I use a 8fr (15")pediatric feeding tube as a catheter. After I drain the bladder I attach the syringe to the end of the catheter to instill into the bladder. That would be the same as pouring the ingredients into a syringe. It is not necessary to have the air in the syringe to instill the cocktail. The cocktail is instilled as you push the syringe plunger.

[Taramc]

I'm doing mine 3x/week now. 10cc Marcaine, 5cc Heparin, 1 Elmiron capsule emptied into them. The biggest and most important thing for me when it came to the instills, was getting my hands on size 8 fr 6" Intermittent Cathethers. They're the pediatric size. All others caused too much urethral irritation. Also I use LIDOCAINE GEL instead of regular surgical lube. It makes a HUGE DIFFERENCE!

[bunnykinb]

I receive samples of 12 fr and 14 fr lo-fric hydro...something catheters. I think the 14 is still going to be a problem for me. I will check out the website on the supplier for smaller caths.

What is an intermittant cath?

[Taramc]

Those are the ones 6-inches long, as opposed to the 'feeding tubes.' They have a rubber end that attaches to a syringe I use that has a tapered end.

I do mine a little differently: I pull the liquids out with a small needle syringe and squirt them into a pee cup. Then I mix an Elmiron into the cup and pull the whole thing up into a syringe that attaches to an intermittant cath.

Here I took pics of everything once. It's all here:

http://i70.photobucket.com/albums/i88/traffictype/IMGP2253.jpg

My way is probably a little more dangerous for infection, so I boil everything first, every time.

[bunnykinb]

Well, I didn't use the hydrophilic cath right at all. The supplier said the cath should be in the silver packet to get the water solution on the cath to make it easier to put in; I even had shown the nurse and she didn't know either. She caths herself too.

The supplier said if I get too small a catheter that it can leak out. Has anyone had this problem?

Also, how far in does your cath go into the urethra? With the red rubber cath, it went in about 2 1/2-3 inches, but with the supplier cath 12fr hydrophilic, the nurse had to put it in more, about 5-6 inches.

Thanks.

[sphinx]

Well, I didn't use the hydrophilic cath right at all. The supplier said the cath should be in the silver packet to get the water solution on the cath to make it easier to put in; I even had shown the nurse and she didn't know either. She caths herself too.

The supplier said if I get too small a catheter that it can leak out. Has anyone had this problem?

Also, how far in does your cath go into the urethra? With the red rubber cath, it went in about 2 1/2-3 inches, but with the supplier cath 12fr hydrophilic, the nurse had to put it in more, about 5-6 inches.

Thanks.

I have tried samples of the lo-fric too. I loved them! Too expensive for me to use all the time, though. I used just the basic kind, they were 10fr, you just left it in the package, put a small amount of tap water in and it had a little sticky tab you could hang it on the edge of the sink. You let it set for a certain amount of time, which was ok cuz it took about that amount of time to get all ready. Then you just remove the cath from the package and insert it. Very neat and easy.

As for how far to insert the catheter-insert til you get pee coming out. Then maybe nudge it a tiny tad farther.

[bunnykinb]

The supplier did say leave the cath in the water solution for 20 seconds. There were not any instructions. I don't have any problems finding the urethra and putting the cath in. Once the cath is in, I feel like a pretzel in order to try and put the meds in. The nurse said it seemed a little difficult without two people.

[bunnykinb]

How long did it take anyone to learn to do instills themselves?

Thanks

[L. Thomas]

website on the supplier for smaller caths.


You might want to check about pediatric feeding tubes too. I use a pediatric feeding tube. I am not sure what the samllest size catheter is but I use a 8fr 15" long pediatric feeding tube. There are pediatric feeding tubes that are smaller. It takes forever to instill smaller ones and I couldn't tell the difference in how the smaller catheters felt when I instilled.

[Taramc]

took me about half an hour to find the right hole. Took me about 8 months to realize I'm supposed to drain my pee first.

[sphinx]

How long did it take anyone to learn to do instills themselves?

Thanks


It really didn't take me long......I had only the one lesson in the office and I could have gone back, but had no troubles. Learning to find my urethra was the thing that got me at first, getting in the best position to see it. After I did it one time, I haven't had any trouble at all. Since that first time, it's mainly just been fine-tuning my routine. I've got it down pat now, the whole thing only takes a couple minutes including preparing the meds, cathing, instilling and cleaning up.

[bunnykinb]

The catheter supplier said the smaller the cath, the more chance of leakage. Is that true?

I have found the urethra just fine, and can drain the bladder. But, once I try to put the syringe onto the cath and then more the mix in, that is when the cath pops out. Do you think it may be because I moved a bit?

Thanks a bunch.

[L. Thomas]

The catheter supplier said the smaller the cath, the more chance of leakage. Is that true?

But, once I try to put the syringe onto the cath and then more the mix in,
Thanks a bunch.

I am not sure what you are trying to do. Are you trying to instill the contents of the syringe and then add more to the syringe to instill? (because the instill cocktail fills more than the syringe will hold?)

You must remove the catheter from the bladder before disconnecting the catheter. If you disconnect the catheter before you remove it the instill will flow back down the catheter.

The same thing will happen if you empty the syringe and remove the plunger.

I use a 8fr 15" and I have had urine leakage around the catheter a couple of times. Each time the bladder had overfilled and the pressure was so great I leaked around the catheter while draining the bladder. But the instill didn’t leak out.

[sphinx]

The catheter supplier said the smaller the cath, the more chance of leakage. Is that true?

I have found the urethra just fine, and can drain the bladder. But, once I try to put the syringe onto the cath and then more the mix in, that is when the cath pops out. Do you think it may be because I moved a bit?

Thanks a bunch.

are you saying that you have the catheter in your urethra, then when you try to attach the syringe to it that the catheter slides out of the urethra? If so, my suggestion is to get all your supplies prepped and ready and within easy reach. When I insert my cath, I make sure it is in far enough by inserting far enough to drain urine, then a bit more. I hold it still with my left hand making sure it is steady(brace the heel of my hand against my thigh holding the cath with my fingers), reach for my already prepared syringe with my right hand, then use both hands to connect the 2 (the cath is only 6 inches, so not a whole lot of tubing is sticking out). I make sure the cath end and the syringe are tightly together, then push in the liquid and right away pull the catheter out before disconnecting the syringe.

If that isn't what you are saying, then I'm not sure what to say!:)

[bunnykinb]

Hmm, I put the cath in and drain the urine. Then the big plastic catheter tip syringe is put onto the other end of the catheter. I then put the mix of heparin, lidocaine and sodium bicarbonate into the syringe. The plunger part of the syringe is pushed into the syringe. At that point, the mix starts coming out of the catheter end that is supposed to be in the urethra.

So, I must not have the catheter in too well?

Thanks.

[L. Thomas]

I am trying to picture what is happening when you put the coctail into the syringe. It sounds like you are filling the syringe with the syringe already attached to the catheter. Try filling the syringe without it being attached to the catheter. Then attach it to the catheter after the plunger is in place.

[sphinx]

I agree with L.Thomas.....it sounds as if while trying to get the mixture into the syringe the cath is slipping far enough out of the urethra so that the mixture is not going in as it should. Definitely try filling the syringe ahead of time. My syringe is ready to go first, and to keep it clean I just sort of keep it loosely inside the packaging it came in.

Try it with the syringe filled first.....see how that works. I can see how your way might seem difficult with not having enough hands, am I right? Or maybe that's just me! (I have to simplify everything, lol!)

[bunnykinb]

The way I described, is the way the nurse is teaching me. If the mix is put into the large catheter tip syringe, wouldn't it start coming out?

[L. Thomas]

I'm not sure. I don't fill the syringe that way. I use a needle to draw the meds from the vials into a syringe. I'll try it your way with an instill and see.

[lab queen]

It's been about a year since I had to do instills (yeah!) but if I'm remembering correctly this is what I did:

1. Using a syring draw up the heparin, lidocaine and sodium bicarbonate, draw each one up separately and place in a sterile cup.

2. Put the water in the lo-fric catheter package.

3. Clean the urethral area with iodine.

4. Take the plunger out of the catheter-tip syringe. In fact I threw the plunger away.

5. Insert the catheter until urine comes out (I sat on my bathroom floor and just put an old towel down to drain the urine onto).

6. Pour the medication mixture into the syringe, holding it a little above your body. Gravity lets the medication flow into the bladder.

7. Pinch the catheter, with the syringe still held up, and remove the catheter.

8. That's it. Wash any syringes that you re-use.

I might have forgotten some details but that's pretty much what I did.

[L. Thomas]

It's been about a year since I had to do instills (yeah!) but if I'm remembering correctly this is what I did:

I might have forgotten some details but that's pretty much what I did.

Sounds like this would work.
Louann

[bunnykinb]

Did you fill the catheter tip syringe with the meds first, and then attach it to the other end of the catheter? I go in this Wednesday again for lessons.

For the lo-fric cath, did you have a water solution that the catheter goes into?

Thanks.

[lab queen]

I'm sorry it took me so long to reply. I haven't been online lately.

I attached the empty catheter-tip syringe (without the plunger) to the catheter after in was in.

I just used tap water for the lo-fric catheters. I think they're great! If you call the company they'll send you a holder and a stand-up mirror free. I really liked the holder since they are so slippery after they are wet.

[L. Thomas]

catheter tip syringe
Thanks.

Is a catheter tip syringe the same as a leur lock syringe? I use a lure lock syringe and the catheter attaches directly to it. Are you using a needle to draw the meds from a vial?

I may be way off base but if your total volume can be held in one syringe, you can draw all of your meds into 1 syringe using the negative pressure method of filling a syringe (with needle attached). The leur lock will attach directly to the catheter.

So there are basically 5 steps.

Drain the bladder with the catheter.
Fill the syringe
Attach the catheter to the lure lock syringe
Instill cocktail into the bladder by pushing the plunger on the syringe.
Remove the catheter and disconnect the syringe from the catheter.

I eventually learned to instill while I sat on a toilet. After reading post I think this is the most simple way and I know it is the most convenient Doing an instill this way you can easily carry a cocktail with you anywhere.

[sphinx]

A catheter tip syringe is not the same as a leur lock. The leur lock has the connector you screw the needle on to. The catheter tip syringe has a cone, of funnel shape instead, it is all one piece, you can't attach a needle to it.

[lab queen]

Oops. I meant to say I attached the empty syringe to the catheter before inserting the catheter.

Someone was having trouble with the catheter coming out when they pushed the plunger on the syringe so I shared my method of letting gravity put the meds in the bladder.

[sphinx]

Oops. I meant to say I attached the empty syringe to the catheter before inserting the catheter.

Someone was having trouble with the catheter coming out when they pushed the plunger on the syringe so I shared my method of letting gravity put the meds in the bladder.


If you attached the syringe first, how did you drain your bladder? Just curious. Cuz usually the cath drains the urine then you push the instillate in.

[bunnykinb]

I was the one having the catheter come out after the bladder was drained. I only have the catheter tip syringe and not the sure lock. I draw up each med one at a time with a needle syringe and put it into a specimen cup; sterile of course. Then, partially lying down, the catheter tip syringe is attached to the catheter and then the meds in the cup are poured into the catheter tip syringe, and held up a bit. It is at this time that my catheter slips out, and of course, wasting meds. If the meds went in right, then I am supposed to put the plunger on and press down filling the bladder with air.