Penis and vagina. Its sort of like Mac and Windows.
Catheterizing female patients can be exasperatingly tricky, its just all so complicated.
Penises on the other hand seem much more user friendly. Sleek and functional. Of course as a penis owner, I may be biased. But all is not as it seems….even they are not without their own perils and pitfalls.
Peni come in all shapes and sizes. I’ve seen little old men with members requiring a stepladder and safety harness to catheterize, I’ve seen dicks decorated with studs and rings and distracting tattoos, and I’ve seen strutting young dudes with Percys’ that look more like vaginas. This is just the way of the world.
But whatever you encounter, remember that your patient is probably feeling pretty uncomfortable with the thought of you stretching them into an anatomically erect position before ramming a garden hose down their dangly bit. Make sure you explain the procedure and provide reassurance, privacy and professionalism.
Note: There are some important signs to look for in an acute trauma patient before you attempt a catheterization. First, the doctor should have performed a PR exam to check for a high riding prostate. Second there must be no bleeding from the urethra. Both signs of a possible urethral rupture. Do not catheterize these patients. Seek assistance from a medical officer.
The normal male urethra leaves the bladder at the trigone. It then passes through the prostate, burrows its way down the length of the penis and emerges at the tip of the glans. But not always.
In the condition known as hypospadias, the urethral meatus can open anywhere along the ventral aspect of the shaft of the penis giving it the descriptive nickname of a “whistle dick”.
Once you have assembled your equipment as per your hospital policy you can position the patient laying comfortably on his back with legs slightly apart.
Perform a thorough hand wash and then don sterile gloves.
Most catheterization kits contain a second pair of sterile gloves to place over the first pair. You can then remove the outer pair once you have swabbed the site.
Swab the shaft of the penis. Take the penis in your non-dominant hand and gently retract the foreskin (around 1 in 6 males worldwide are circumcised). Swab the glans… and swab around the urethral meatus.
Discard used swabs into the bin you have placed close by.
Carefully remove your outer gloves. Pick up the fenestrated towel or drape. Rather than having the Willy poking through the hole in the towel, I prefer to fold it in half ( the towel, not the Willy ) forming a slot that can then be slid onto the penis from below. The penis then flops down onto the sterile field.
OK. Let us proceed.
Grasp the penis just below the glans with the thumb and first finger of your non-dominant hand. Lift it upwards, perpendicular (or should that be perpen-dick-ular? ) to the abdomen. This straightens out the urethra, which normally follows a sort of â€˜Sâ€™ trajectory in a flaccid penis.
Inform the patient that this next bit is going to feel a little weird. And cold.
Using the applicator syringe slowly squirt the entire contents of Xylocaine jelly ( around 10 mls) into the urethra.
Do not pick up the syringe and say â€œI am just going to inject some local anaesthetic into your penis!â€ Most males will think you are about to stick a giant needle into their privates and have a cardiac arrest.
Once the urethra has been filled with anaesthetic jelly, squeeze the urethra closed between your thumb and finger (to stop the gel oozing out) and make a little polite conversation.
Most nurses rush ahead ramming the catheter home before the anaesthetic has had a chance to work. This is painful, causing the patient to tense-up and increase resistance to the passage of the catheter. Local takes around 3 minutes to work properly, although that is a long time to be discussing the latest sports results with a bloke whilst holding his penis in your hand. So at least wait a bit.
Now, lift across the catheter in its tray, and lay it on the sterile field.
Pick up the catheter with your dominant hand while your other hand re-applies gentle traction, lifting the penis back to attention.
Insert the tip of the catheter into the urethral meatus and advance it cautiously down the urethra, feeding it from the tray so as not to contaminate it.
There are 2 potential roadblocks to a smooth catheterization. The first is the external sphincter and the second is the prostate. If resistance is felt, ask the patient to try and relax as if he were having a pee.
If there is still resistance, you can gently apply a little more traction to the penis and push a little harder….but thats about it. If the catheter will still not advance you should remove it, try again with a slightly larger size or notify the medical officer.
Once the catheter advances smoothly, continue to feed it in. All the way up to the hilt. You want to make sure that you are not about to blow the balloon up in your patients urethra (You will know if this happens because his fist will rapidly fill your entire visual field).
Inflate the balloon with 10mls of sterile water and connect the catheter to the drainage bag. Once the balloon is inflated, you can gently pull the catheter back until it stops.
Do not be alarmed if there is not an immediate flow of urine from the catheter. All that anaesthetic jelly tends to clog the end of the catheter and it may take a minute or so before it â€˜meltsâ€™.
Secure the catheter to the patient as per your hospital policy and clean up. Be sure you roll the foreskin back over the glans if you pulled it back during swabbing, to prevent a swelling and constriction known as paraphimosis which could, if left untreated,Â lead to gangrene of the penis.
Not a pretty sight.