AD is a result of the nervous system going berserk because there is some kind of noxious stimuli causing distress in one's body below the level of the injury. So due to paralysis and impaired sensation, the person cannot identify the source of the noxious stimuli. It's sorta like if you or I sat on a tack but couldn't move to get off of it, the pain would increase and increase and put you into quite alot of distress to say the least. But a para or quad can't necessarily tell you what is bothering them, or if they can, often cannot do anything about it for a variety of reasons (such as in Wheeler's case, uhhh, he can't move at all). Common reasons for AD are a too full bladder (kinked catheter if indwelling, not cathed frequently enough if intermittent), full bowel (imagine if you ever really, really had to go but not be near a bathroom (or the woods if you're a bear), that's what its like), a urinary track infection (pain from the UTI alone or the resulting gunk stops up the catheter or slows the drainage, or both), skin pinched (e.g. sheet or pants bungled up underneath one), or, some other injury like breaking a bone in the foot or leg, a burn, etc etc... the list goes on and on. If the cause cannot be identified, a stroke can result, so it is NOT a matter to take lightly. If AD is really bad, the bad boy of fixing AD in a hurry is nitroglycerin. It lowers BP in a hurry, precipitously, but that can give the opposite problem of too low BP, which can cause fainting and other bad stuff. So nitro is a last resort if you cannot get the problem figured out.
Keeping in mind that Wheeler is extremely stoic - he asked me for nitro today. He was having a horrible horrible pounding headache, and I couldn't identify anything obvious that was bothering him other than really awful looking urine. So I gave him the nitro and his BP went down. We were 90% sure it was his bladder giving him problems, so I needed to irrigate him, switch out the SP cath and put on a new bag. The key to all of this is the new bag, its the last step. There's no sense in irrigating if you're going to be an old bag back on, the germs will crawl back up it. If you put in a new cath without a bag, it will run all over the floor, so that's not an option. But of course, I didn't have a new bed bag to put on. ARGH. I knew we were low, in fact, I knew we were on the last one, and I kept meaning to buy more, but I just never got to it. Actually, that's not true. I drove all the way to Raleigh, to the only place that carries them in stock, but they closed at 7 pm and I arrived at 7:20. What drug store closes at 7 pm?? So anyway, we didn't have a new bag.
I waited a bit to make sure he wasn't going to pass out, nor that his BP would pop back up, then I hustled Offspring into the car and off we went to get a bag. Got the bag, came back and irrigated, changed the supra, hooked up a new bag. This is alot more complicated than it sounds. Here it is, in approximate order, although its not completely this process every time.
First, the irrigation tray - container, plunger, must supply distilled water + boil the water to purify it before instilling into bladder. One should not irrigate routinely, but when the urine looks like it did, one should irrigate with sterile, distilled water that you remember to buy at the store and to boil and allow to cool down beforehand.
Insertion kit, including drapes, synringe with sterile water, sterile gloves, surgical jelly, antiseptic swabs. First you have to suck the water out of the balloon with a syringe (that you remembered to save from the last time you did this because the new one in the kit is for inflating the balloon; I can't tell you how many times I got part way through and realized I didn't have a non-sterile syringe to deflate the balloon). Drape the belly, swab to sterilize, put on sterile gloves, put up catheter, coat with jelly. After this point, DO NOT TOUCH ANYTHING you don't intend to go directly into his body (e.g. don't scratch your nose, skin has nasty germs on it).
This is the indwelling catheter (same used for foley as suprapubic), it goes into a hole in his belly below the belly button but above the pubic bone. This goes directly into this bladder then you have to inflate that balloon to ensure it doesn't fall back out of the hole. If you don't put the catheter in within 20-30 seconds of taking the old one out, the hole on the outside of the boday closes up for good and you need surgery again to put it in again. Nothing like a little pressure eh? The syringe above is used to inflate the balloon, which is inflated in this picture. It goes in deflated and you push water through the thingy with the white tip.
Connectors between tubing and bags/catheter tip, mostly for leg bags, but sometimes for bed bags if the catheter and bed bag brand don't match.
Insert the catheter tubing into this strap that goes around top of thigh to anchor catheter to body:
This is then bag into which urine drains when in bed:
And just FYI, this is a leg bag, for wearing with clothing in wheelchair:
Extension tubing that goes from catheter to leg bag or catheter to the bed bag if the bed bag doesn't come with tubing (it usually does):
Straps that anchor leg bag to shins (you need two, one by knee, one by ankle):
As I've mentioned here many times: don't break your neck.
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