I am a PALS, but also a Family Nurse Practitioner, and...I have to do intermittent self-catheterization. So I have a few observations:
1. An 18 or 20 French catheter is VERY small for an adult indwelling cath. I have used 20fr on 7 year old kids, NOT adults. I was taught to use a 12 or 14 fr. on adults Why? Because the holes in the cath are larger, and you can pass tissue (clots) much more easily. The fact that irrigation results in fluid around the cath seems to support this statement.
Going to a 12fr, with routine 4x daily irrigations w water would be my first move.
2. Having clots that plug up the holes in the cath leads to bladder infections, which means more clots...thus the vicious circle. You should have a urine culture & sensitivity for bacteria, then be treated with the appropriate antibiotic.
3. If your cath is getting plugged up, your urine is not passing freely, and it can back up to the ureters & kidneys & damage/infect them. This can be VERY serious. Dialysis and ALS do not equal a good quality of life!.
4. Once urine is flowing w a bigger cath, drink at least 2 quarts of water daily. You can't let the urine get concentrated.
5. Watch your blood pressure. Higher than normal BP could mean kidney problems.
I have used an indwelling cath for up to 45 days in a row, with no problems. Simply put, you are not getting adequate medical/nursing care.
If I am being too blunt, I apologize. As a PALS and a (male) RN & Nurse Practitioner, it angers me that they are allowing you to suffer when it it not necessary.
PM me if you want to discuss this opinion.