CATHETERIZING CUCUMBERS

After a small victory with designing a low cost sock aid, some of the PMR doctors asked me to help design some adaptive equipment to increase independence in bowel and bladder management for their tetraplegia patients. Right. “What have I gotten myself into?” was the first thought that ran through my head. I like a good challenge, especially one that promises increased independence for my patients. I was ready to tackle the project.

First step was to find out how the cultural boundaries would affect my ability to research the way bowel and bladder management was treated here. This can be a taboo topic, and in a culture as modest as India’s, I wasn’t sure how far I’d get before offending. I summoned up the courage to blatantly ask one of the PMR doctors exactly what I wanted to know. He calmly answered my question and assured me that cultural boundaries would not get in my way. In fact, he arranged to have me watch a few SICCs so that I would know exactly how it is done.

Second step was to learn what and how they teach SICC (Self Intermittent Clean Catheterization) and DS (Digital Stimulation) here at CMC Rehab. This is where the observation part happened. After learning how it is done here, I started researching how both procedures are done in other areas to compare and contrast. The main problem I was to help solve was to provide some way for tetraplegic patient (C5-C6) with little to no hand function to be able to stabilize and insert a catheter independently. At first I started thinking along the lines of a low cost, easy to make tenodesis splint.  A tenodesis splint, for those who don’t know, can help increase thumb to finger grasp strength after the wrist is bent back. (A patient with a spinal cord injury at the C6 level will generally have the ability to bend the wrist back.) A tenodesis splint would give a tetraplegic patient increased grip strength on the catheter tube for insertion. I was ready to design, or adapt an existing design. Then I kept researching.

I found information that led me to believe no adaptive equipment would be necessary for SICC. I’m not sure if this disappointed me or not. I had been pretty gung-ho about designing things. The design process is fun to run through when you have complex problems. Then it hit me… process. We didn’t need to redesign a product. We needed to redesign a process. Here at rehab the OTs are responsible for walking the patient through SICC simulation (with a catheter and small piece of Styrofoam) and then letting nursing know that they are ready to start the real thing. The problem with the Styrofoam is that a patient can hold it ay any angle they wish to get the catheter in… real life doesn’t afford this luxury. The problem with the process was that it was being taught with finger function as a necessity.

So I went out and bought a banana. After reaming out the center with some wire I found, I handed it and a catheter to my Patient Zero. I taught him to use the palms of his hands for both stabilization and insertion. It kind of worked. As it turns out, a banana that is too ripe will not catheterize very well. So I bought what I thought was a cucumber. It turned out to be some odd variety of gourd, but it looked very much like a cucumber and worked very well for simulating a new technique. It catheterized rather well which led to increased confidence and independence for the real deal. Winning!

Lesson One: sometimes the least expensive option is to reinvent the process not the product.

Lesson Two: overripe bananas truly are only for one thing: making banana bread.