We long-term urinary catheter wearers need two types of drainage bags. One is for sleeping and/or wearing around the house when you don’t have anyone REALLY close coming by for a visit. that is the bedside drainage bag. It has a long, thick, heavy-duty plastic tube leading down to a quite-large bag with handles on it. The other type of bag is the leg bag. That’s the one you wear when you need to go out into polite society, or you have guests coming to the house. It’s got a much more flexible as soft tube so it can move around easily beneath your pants. It also has a much smaller capacity.
One of the first things I had to do when I got home after having my suprapubic catheter installed was find good, comfortable and safe methods for dealing with my leg bag. The problem was that I had this tube coming out of my belly with only a stitch to hold it in place, since it was a pig-tail type of catheter and not the Foley type that has a balloon to hold it in place. This actually presented me with two problems. The first was that the only things holding my cath in place were the curved shape of the part of the catheter that was inside my body (which can easily be pulled out without a whole lot of pulling), and the aforementioned stitch through my skin. So I was paranoid of getting it caught in something or otherwise pulled out.
I was sent home with a sticker stuck to my leg that had two velcro straps on top of it that were supposed to hold the catheter up. this worked OK with my bedside drainage bag because the top of the tube had a large round plastic knob that looked like it was designed to stick a needle into for whatever nefarious purposes one might have for doing that. But with the velcro fastened under that knob, if wasn’t going to pull down my leg at all. My problem was with the leg bag.
Now most catheter securement devices, like the sticker on my leg – The Grip-Lok Foley Catheter Securement Device* – assume (as the name even implies for this particular brand) that you will have a Foley catheter, which has two outlets at the end. If you wrap the velcro strap around just one of them, it stays up really well because it acts like a hook around the strap. But the pigtail catheter like I had only has one outlet. So if I stood up, the hose stretched out and pulled the end of the catheter down through the velcro strap. Trying to take a walk outside was pretty scary.
* Call Zefon Sales at 1-800-282-0073 in the US and +1 (904) 284-1647 internationally.
So what I did was wrap a bunch of narrow tape around the leg bag tubing, just below the outlet (see picture at the top left of the page). This worked to help the tube from pulling down when I walked. But it didn’t take long before it started working its way under the velcro and starting to pull down on my catheter. So eventually I just grabbed my roll of thick fiber tape and started wrapping until I had a huge wad of tape that was NOT going to pull through the velcro strap. Then I wrapped some softer medical tape around that, since the fiber tape was a bit uncomfortable on my skin, being as it is, designed for taping boxes shut:). But that really worked well and was the first big improvement I made to improve my life post-catheter.
See the picture at the top of the page for a diagram of this. The bow-tie shaped thing is the Grip-Lok Foley Catheter Securement Device.
Good Ideas and Bad Ideas
Take a look at the three drawings above. The first two will work well to prevent your leg bag from pulling down on the catheter, either causing pain at the insertion site, or possibly pulling it out! The first picture uses the “V” shape of a Foley catheter to catch on the securement device. The second picture shows a wad of tape providing the catch. The third picture, however, is all kinds of wrong (again, if you are able to walk). The first problem is that the velcro on the securement device is above the “V” where the two outlets of the Foley split. You could pull the catheter up and down pretty easily through the velcro strap. Not good. The second problem is the securement device itself. It is made of stretchy material that you wrap tightly around your leg and close with the velcro strip on the end. As I mentioned in my article, Tips For Holding Your Catheter In Place, these will slide down your leg after taking two or three steps. You can try wrapping it tighter around your leg, but you can only do that so much before it starts to cut off your circulation. So all-in-all, if you are ambulatory, avoid using this type of securement device (unless you simply cannot have any adhesive on your skin for some reason, which would prevent you wearing something like the GRIP-Lok or Venetec StatLock, which is another kind of sticky-on-y type of device.
Tension – not too much, but also not too little
Here is a little lesson I learned the other night. You need SOME tension pulling away from your insertion site if you are wearing a suprapubic catheter. So you need a balance. Pull down/away too much and you risk pain and/or pulling your cath out. But leave too much slack between the insertion site and the securement device, and the part of the catheter inside your bladder can fall away from the bladder wall and sink down toward the opening of the urethra. Not only can this cause pain “down there” where the tip makes contact, but it can cause the balloon (if using a Foley cath), which is helping to seal the point-of-entry, to move away from the insertion site, which could cause urine to leak out of the site. I haven’t had the urine-leaking-out problem, but I HAVE had the other one.
I decided to use my old technique of using the wad of tape (see picture in the middle above) method with my leg bag the other night, because my GRIP-Lok was starting to unstick a bit. It was only about 15 minutes before I was feeling pain in my wee-wee because there wasn’t enough tension to hold the balloon against my bladder wall. As soon as I could, I reset to using the method in the picture on the left above, allowing less slack above the GRIP-Lok. Also – and here I must specify that although my urologist recommended this for me, it is not recommended by many specialists, so call your doctor first – I gently pulled the catheter out and away from my insertion site until it stopped coming. This allowed me to pull the balloon back up into place.
So if you are wearing a leg bag and have a suprapubic catheter, make sure you have enough tension to hold the balloon in place (assuming it’s a Foley), but not enough to tug at the insertion site.