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Navina Classic - Frequently Asked Questions (FAQ's)

Catheter FAQ's

Usage

Q: How often should I perform TAI?

A: At the start it is common to irrigate once every day for the first 10-14 days. Later on the frequency may possibly be reduced to once every other day or every third day. The frequency should be decided in consultation with a healthcare professional. 

Q: Can I stop using stool modifying medicine when I start using Navina?

TAI is usually part of a bowel management program. It is possible that you may be able to reduce the amount of laxative they are using eventually but you may have to continue using some to ensure that the stools have the right consistency to ensure easy evacuation. It is best to continue with your current laxative regimen until you are getting regular results from TAI. Consult a healthcare professional before changing your personal regimen. 

Q: How long does the procedure take?

A: It is very individual but the aim is that the bowel management routine will take less than one hour. For some people the results are fast and emptying of the bowel is complete. For others it will be more time consuming and the bowel empties intermittently. 

 

Medical Issues

Q: Is the risk of bowel perforation higher the longer I irrigate?

A: No, the evidence shows that the risk of bowel perforation does not increase the longer you use TAI. 

Q: What if bleeding should occur?

A: A small amount of bleeding or smearing of blood on the catheter may occur and should not alarm you. More severe or sustained rectal bleeding with or without pain suggests a possible bowel perforation, which should be treated as a medical emergency and requires immediate medical attention. 

Q: What should I do if I feel pain?

A: If cramps, discomfort or pain occur while instilling the water, pause instillation for a few moments and continue more slowly once the discomfort has subsided, ensure that the water is warm enough, at body temperature. If pain is severe or persistent stop the irrigation immediately. It could be perforation of the bowel which should be treated as a medical emergency. 

Q: What if I feel sweating, palpitations or dizziness during irrigation?

A: If you have a spinal cord injury this may be a sign of autonomic dysreflexia. Instill the water slowly and limit the time on the toilet depending on tolerance. If symptoms are bothersome, ensure that you are not alone when irrigating until symptoms at each TAI are reduced or minimized. If you are at risk of autonomic dysreflexia, you should have medication easily at hand. If autonomic dysreflexia occurs, stop the irrigation immediately. Further assessment and possibly other treatments are required before continuing with TAI. 

 

Instillation

ADULTS: 

Q: How much water should I instill?

A: healthcare professional will advise you how much water should be used. For adults it is common to start around 500 ml. A maximum of 200 ml may be added for activating the catheter´s hydrophilic surface and to expel air from the System. 

CHILDREN:

Q: How much water should I instill?

A healthcare professional will advise you how much water should be used. For children it is common to calculate 20 ml/kg body weight. A maximum of 200 ml may be added for activating the catheter´s hydrophilic surface and to expel air from the System. 

Q: Can I add salt to the water?

A: Navina Classic System can be used with a saline solution but the product needs to be rinsed thoroughly with clean water directly after use. 

Q: Is the water temperature important?

Always use lukewarm water (36-38 °C). Water that is too cold can be unpleasant and you may experience cramps. Water that is too hot may irritate the delicate lining of the rectum and colon. 

Q: Can I use gel on the catheter?

A: No, the catheter is hydrophilic and will become slippery when immersed in water. There is no need to add gel. 

Q: What water quality should I use?

A: Only use clean tap or bottled water.  

Q: How fast should I pump to instill the water?

A healthcare professional will advise you what water flow rate they should use. The water should be instilled at a rate fast enough to provide stimulation to the bowel wall but not too fast as it can cause abdominal cramps, pain or strong reflex contractions. Pumping every 5-10 seconds will give a flow rate of approximately 300-500 ml/minute. 

Q: What balloon size is recommended?

A: A healthcare professional will advise you of the appropriate balloon size. It should be just big enough to hold the catheter in place and seal the anal opening to minimize leakage during irrigation. Maximum 5 pumps for the regular catheter and maximum 2 pumps for the small catheter. 

Q: Can the size of the balloon be adjusted?

A: The balloon can be deflated by pressing the button. 

Q: What if no water is flowing when I am using the dark blue pump?

A: Make sure that the water container is filled with water and that the lid is completely closed. Make sure that the tubes are connected tightly and that they are not blocked or kinked. 

Q: What if the water flow is too low?

A: Make sure the water flow switch is opened on the Navina Classic control unit. Make sure that: The lid of the water container is completely closed.  The tubes are connected at the right place.  The tubes are connected tightly so the air does not leak. Make sure the tubes are not blocked or kinked.  You are not impacted and that your rectum is empty.  Try placing the water container higher. The pressure in the System might have reached the maximum and the safety valve may be opened. Deflate the catheter and try to empty the bowel. If you do not feel completely empty, make sure you are not constipated and that your rectum is empty and repeat the irrigation procedure. 

Q: What if debris from the catheter flow back in the tube?

A: If there´s an experience that debris from the catheter is flowing back in the tube, clean the tube by pumping water through it. New tubes can also be ordered separately if needed. 

Q: What if there is leakage of water around the catheter?

A: Ensure that the catheter is properly located. Check water temperature. Increase balloon inflation up to the personal maximum setting. Instill water more slowly. 

Q: What if the catheter gets expelled before I have deflated the balloon? 

A: Minimize inflation to avoid triggering reflexes. Instill the water more slowly. Contact a healthcare professional who will assess and treat any rectal impaction that may be causing the rectal expulsion. 

Q: Can the instillation be stopped?

A: Instantly stop the instillation at any time by closing the water flow button with the blue switch. 

 

Balloon

Q: Navina catheter regular: Why shall the balloon be inflated with maximum 5 pumps?

A: The maximum size of balloon inflation was selected after consultation with healthcare professional experts, to meet the anatomical needs and prevent over-inflation of the balloon and the risk of balloon burst. Navina catheter small:  Why shall the balloon be inflated with maximum 2 pumps?  The maximum size of balloon inflation was selected after consultation with healthcare professional experts, to meet the anatomical needs, safety in children, prevent over-inflation of the balloon and the risk of balloon burst. 

Q: Can the balloon burst and, if so, is it dangerous?
 
A: Yes, there is a risk of the balloon bursting and this is why the maximum number of pumps are defined/catheter size. If the balloon bursts despite following the recommendations by your healthcare professional, this may certainly be discomforting although generally not dangerous. There are however a few reported cases of patients that have had bowel perforations due to balloon burst. It should be noted that the risk for bowel perforation is 1 out of 500,000 irrigations or 0.0002%.¹ 
1. Christensen P, Krogh K, Perrouin-Verbe B, et al. Global audit on bowel perforations related to transanal irrigation. Tech Coloproctol. Feb 2016;20(2):109-115. 

Evacuation

Q: What if the bowel does not empty?

A: Try to lean forward, cough or perform abdominal massage. If water and the bowel content still do not come out, you may be severely constipated and a manual clean-out of the rectum might be necessary. You might also be dehydrated, so remember to drink a lot of water and repeat the TAI procedure the day after. If you have been successfully using TAI for a while it might be that the colon is clear and this could be a first indication that the TAI frequency could be reduced. 

Disassembly

Q: Can the catheters be reused?

A: No, the rectal catheter is for single-use only. Dispose of it after use in the normal household waste. If reused, Wellspect HealthCare cannot guarantee the functionality nor the safety of the product. Reuse may lead to infection. 

Q: How should the Navina System be stored?

A: After the components are cleaned and dried, store your Navina System in the Navina case and keep it out of direct sunlight. Also ensure that the tubes are not kinked and that the System is kept away from sharp objects. Keep away from children. 

 

Cone FAQ's

Usage

Q: How often should I perform TAI?

A: At the start it is common to irrigate once every day for the first 10-14 days. Later on the frequency may possibly be reduced to once every other day or every third day. The frequency should be decided in consultation with a healthcare professional. 

Q: Can I stop using stool modifying medicine when I start using Navina?

A: TAI is usually part of a bowel management program. It is possible that you may be able to reduce the amount of laxative you are using eventually but you may have to continue using some to ensure that the stools have the right consistency to ensure easy evacuation. It is best to continue with your current laxative regimen until you are getting regular results from TAI. Consult a healthcare professional before changing your personal regimen.

Q: How long does the procedure take?

A: It is very individual but the aim is that the bowel management routine will take less than one hour. For some people the results are fast and emptying of the bowel is complete. For others it will be more time consuming and the bowel empties intermittently. 

 

Medical Issues

Q: Is the risk of bowel perforation higher the longer I irrigate?

A: No, the evidence shows that the risk of bowel perforation does not increase the longer you use TAI.

Q: What if bleeding should occur?

A: A small amount of bleeding or smearing of blood on the cone may occur and should not alarm you. More severe or sustained rectal bleeding with or without pain suggests a possible bowel perforation, which should be treated as a medical emergency and requires immediate medical attention.

Q: What should I do if I feel pain?

A: If cramps, discomfort or pain occur while instilling the water, pause instillation for a few moments and continue more slowly once the discomfort has subsided, ensure that the water is warm enough, at body temperature. If pain is severe or persistent stop the irrigation immediately. It could be perforation of the bowel which should be treated as a medical emergency.

Q: What if I feel sweating, palpitations or dizziness during irrigation?

A: If you have a spinal cord injury this may be a sign of autonomic dysreflexia. Instill the water slowly and limit the time on the toilet depending on tolerance. If symptoms are bothersome, ensure that you are not alone when irrigating until symptoms at each TAI are reduced or minimized. If you are at risk of autonomic dysreflexia, you should have medication easily at hand. If autonomic dysreflexia occurs, stop the irrigation immediately. Further assessment and possibly other treatments are required before continuing with TAI.

 

Instillation

ADULTS:

Q: How much water should I instill? 

A: A healthcare professional will advise you how much water should be used. For adults it is common to start around 500 ml. A maximum of 200 ml may be added for activating the cone´s hydrophilic surface and to expel air from the system. 

CHILDREN:

Q: How much water should I instill?

A: A healthcare professional will advise you how much water should be used. For children it is common to calculate 20 ml/kg body weight. A maximum of 200 ml may be added for activating the cone´s hydrophilic surface and to expel air from the system. 

Q: Can I add salt to the water?

A: Navina Classic system can be used with a saline solution but the product needs to be rinsed thoroughly with clean water directly after use.

Q: Is the water temperature important?

A: Always use lukewarm water (36-38 °C). Water that is too cold can be unpleasant and you may experience cramps. Water that is too hot may irritate the delicate lining of the rectum and colon. 

Q: Can I use gel on the cone?

A: No, the cone is hydrophilic and will become slippery when immersed in water. There is no need to add gel. 

Q: What water quality should I use?

A: Only use clean tap or bottled water.  

Q: How fast should I pump instill the water?

A: A healthcare professional will advise you what water flow rate you should use. The water should be instilled at a rate fast enough to provide stimulation to the bowel wall but not too fast as it can cause abdominal cramps, pain or strong reflex contractions. Pumping every 5-10 seconds will give a flow rate of approximately 300-500 ml/minute. 

Q: What if no water is flowing when I am using the dark blue pump?

A: Make sure that the water container is filled with water and that the lid is completely closed. Make sure that the tubes are connected tightly and that they are not blocked or kinked. 

Q: What if the water flow is too low?

A: Make sure the water flow switch is opened on the Navina Classic control unit. Make sure that:

  • The lid of the water container is completely closed. 
  • The tubes are connected at the right place. 
  • The tubes are connected tightly so the air does not leak. Make sure the tubes are not blocked or kinked. 
  • You are not impacted and that your rectum is empty.  Try placing the water container higher. The pressure in the system might have reached the maximum and the safety valve may be opened. Remove the cone and try to empty the bowel. If you do not feel completely empty, make sure you are not constipated and that your rectum is empty and repeat the irrigation procedure. 

Q: What if debris from the cone flow back in the tube?

A: If there´s an experience that debris from the cone is flowing back in the tube, clean the tube by pumping water through it. New tubes can also be ordered separately if needed. 

Q: What if there is leakage of water around the cone?

A: Some leakage may be expected when using a cone, as it may be difficult to get a complete seal. Minor adjustment of the position may help. Instill water more slowly. If the leakage is extensive, contact your healthcare professional for help. 

Q: Can the instillation be stopped?

A: Instantly stop the instillation at any time by closing the water flow button with the blue switch. 

 

Evacuation

Q: What if the bowel does not empty?

A: Try to lean forward, cough or perform abdominal massage. If water and the bowel content still do not come out, you may be severely constipated and a manual clean-out of the rectum might be necessary. You might also be dehydrated, so remember to drink a lot of water and repeat the TAI procedure the day after. If you have been successfully using TAI for a while it might be that the colon is clear and this could be a first indication that the TAI frequency could be reduced.   

Disassembly

Q: Can the cones be reused?

A: No, the cone is for single-use only. Dispose of it after use in the normal household waste. If reused, Wellspect HealthCare cannot guarantee the functionality nor the safety of the product. Reuse may lead to infection.   

Q: How should the Navina system be stored?

A: After the components are cleaned and dried, store your Navina system in the Navina case and keep it out of direct sunlight. Also ensure that the tubes are not kinked and that the system is kept away from sharp objects. Keep away from children.   

Q: Can I wipe the Navina Classic control unit with alcohol?

A: No, only use mild soap and water.