Flushing... the real deal

We had our follow up clinic yesterday, 2 weeks after the MACE.

The clinic started off kinda of weird, when the resident came in to see us and seemed to be surprised that we had been discharged from the hospital and had surgery. Um, yes that is why we are here...

I probably should have told him to turn around, read the chart and then come in and start again...

But once our actual doctor came in (with the resident) we got all checked out. Everything is healing well. There had been some discharge that I wasn't sure if it was an infection, but they said it was all healed nicely.

We will follow up again in 3 months.

Then it was time to take the foley catheter out, and show the nurse that we can do it ourselves.

I have the advantage as a nurse (and catheterizing 4x a day for the last 4 1/2 years) so I wasn't that worried about it.

I gave Nick my phone and he took pictures the whole time.

I have about 100 pictures from his perspective.
But I was able to take out the catheter, put another back in, flush it and we were done.
It didn't bother Nick at all

Tuesday night when we got home, it was time.

No more tubes were left in.

I got all of my supplies together.

The foley catheter, 60cc syringe for the initial flush, lubricant and the tube flush. 

The tape was recommended to use instead of blowing up the balloon in the catheter to keep it in place.

They said that they had one patient where for some reason the catheter twisted back into the small intestine, and when they blew up the balloon it caused pain.

The first night we taped it in. I didn't realize how much Nick moves around on the potty until we needed him to stay still. And the catheter came out. Nick wasn't very happy that his lap started flooding with fluid, but it didn't hurt him. And it was a lesson learned.

I've been using the foley balloon (why else use a foley and not a straight catheter?) and Nick hasn't been having any pain, and it hasn't fallen out.

So to add to my list above, a little 3cc syringe to blow up the balloon. After the catheter is in, blow up the balloon, and remove the syringe. When it is time to take the catheter out, attach the syringe, deflate the balloon and take the catheter out.

Another thing that they recommended was to push the glycerin in first. That will irritate the bowel to work the fluid in. So I mix 10mL of glycerin with 10 mL of normal saline, draw that up in the syringe and push that through. 

Nick really wants to do that job.

It was recommended to go slowly when increasing the volume of the flushes. So we just increased slowly over 2 weeks until we get to 350mL (+10mL glycerin) on Friday. I make the normal saline myself (using tap water) and then it goes in over 15 minutes.
Nick got some cramping at the beginning, but it seems to have settled. I slow it down if he gets cramping, but don't go too fast.
It has been so much more convenient for me, and has gotten Nick interested. It is also faster.
He sits on the potty for about 45 minutes, which is much better than the 60-75 minutes we were at before.

Nick has been a bit hesitant when I put the catheter in his belly button. The lubricant is cold and it feels funny. But it doesn't hurt and he will let me do it.
In the morning I put the catheter in (no flushing) and at night the catheter goes in and we flush. We put it in twice a day to prevent the hole from closing (like pierced ears).

Everything is going so well so far.

Recovery - flushing

Once we got home, it was time to actually get started to get everything to work! The whole reason we did this MACE to begin with. Constipation, independence.

I was worried about constipation. Nick didn't poop after his operation, and not before he left the hospital. 24 hours after we had been discharged and still nothing. That was 4 days.

I had flushed it twice, little 20mL flushes and nothing.

So I was messaging back and forth with his Nurse Practitioner. She said just give it some time, 20 mL is nothing, but we could start to increase it and add glycerin (an irritant to get the bowel moving).

So I stopped worrying and kept working on our daily flushes.

I had been told to go slow. So it was 20 mL for the first 2 days, then 40 mL for the next 2. They said to mix the glycerin (10mL) with 10 mL of normal saline and put that through first, and then the rest of the mix.The goal is to be at our optimum fluid volume (360 mL) by 2 weeks. Putting in the glycerin first means that the bowel is irritated and working before the rest of the fluid is put in.

I have also been going slow with pushing the fluid as well. I've been doing it all by hand through a large syringe, and just pushing slooooow. I did 60 mL yesterday, and it took about 10 minutes. With larger volumes we have a bag and tubing to hang as well.

They sent us home with supplies. A 60mL syringe with a catheter tip (which means it has a pointy plastic tip to fit into the catheter end). Normal saline to use for flush-fluid. Alcohol wipes, extra foley catheter and the bag and connector for larger flushes, also a small syringe (6mL) for removing the air from the foley ball.

Nick has been having some cramping with the flushes. Not so much when we are doing the flushing, but afterwards when it starts to work. I'm not sure what to do about that. I've tried slowing the flushing and warming it up to decrease the cramping. But it also means that it is working. So we've been breathing and distracting.
When we first started Nick also got nausea at the same time, but I think that is passing. We have a bucket by the toilet just in case.

Right now the foley is staying in, so all we are doing is flushing it. After clinic next week they will take out the foley, so that when we do the flushes we will put the catheter in and flush. We also have a fluid bag to fill for the larger volume (probably I'll use the bag after tonight).

Nick hasn't minded the foley hanging from his belly. It remains capped and hangs with some tape.