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.
heads up:
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”.
the preparation:
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.
rocket science:
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 ‘S’ 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 “I am just going to inject some local anaesthetic into your penis!†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 ‘melts’.
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, lead to gangrene of the penis.
Not a pretty sight.
I recently had surgery and required catheterization for three days until I was ablee to void myself normally.. Not once did the nurse use any betadine or iodine, no latex gloves, no Xylocaine or Lidocaine, just wham, lots of acute pain, then it was over. Thanks for the info, next time I will be more demanding.
i would demand to be sedated before consenting to this “legalized torture” this procedure causes me very severe anxiety problems where i simply cannot lie still and cooperate with having this done. the insertion of the catheter must hurt soooooooo much and this expectation of such pain would cause me to physically resist any attempt by the nurse to do the procedure. i am aware that patients are told the procedure is done with the patient awake and alert, and that sedation is not offered. i am also aware that sedation carries risks and i am willing to accept these risks and sign any release forms they need. in my case———no sedation equals no insertion.
Night shift, enough time to have a hot cuppa and a quick catch up on things posted that I’ve not had the chance to read, my unrelieved tea break (good chance someone will buzz, the tea will go cold, the computer go into sleep mode)
Our entire nursing staff males are outnumbered 16:1. How many shifts would you have them work in a row? There are occasions when they are the senior nurse on in the acute area, our female patients get no choice.
I thought nurses were professional, I know I am. Male or female patients, they are all treated with dignity.
Male catheterisation is not something we do for the practise, judging from those I’ve performed, the males have been most appreciative of the relief. The momentary embarassment was certainly fleeting.
Jay and Carl, you may not have had the opportunity to give birth, one of the most amazing things you could ever do, but along the way you lose all dignity you have all manner of people walking in and out of the labour ward whilst you have your female bits exposed to every man and his dog (if you’re lucky they’ve left you with half a gown on and your boobs aren’t hanging out as well as everything else)…. the thing is we get over it…. someones seen my bits hmmmm, if that’s the only thrill they get in their life then I’m truely sorry for them, they show far more in stick magazines.
I for one certainly do not go home at the end of my shift and dwell on my patients body parts, honestly just the thought would keep me up at night…. and the nightmares.
Now back to my night shift…..
There is definitely a double standard in protecting female privacy and dignity. Absolutely female patients enjoy a degree of consideration, sensitivity and flexibility not experienced by male patients. But that is true everywhere, not just hospitals. Male inmates and arrestees are searched by female officers and must shower in front of female staff, etc. High school boys endure group physicals in front of female nurses and doctors all the time, with little choice in any of those matters. Professional athletes must permit female reporreporters in their locker rooms – no “choice.” By the way, all of these things are never forced on females similiary situated. Society is careful to protect them from that.
First of all it may not be rocket science to catherterize a male patient, but from experience I can tell you if it is not done properly you can cause a stricture that the patient will live with the rest of his life. I speak from experience. I live with it daily, I got a bad UTI, a stricture, epididymitis, and prostatitis. I have had to have surgery to correct the stricture, a TURP for the prostatitis, and now have UTIs off and on. And as for gender preference that is a big crock of crap, if a man ask for a male to do the procedure they are laughed at and told to just forget that the woman nurse will do it. If a woman were treated this way by a male nurse he would be fired on the spot. You people dont know what goes on in the hospitals or you just dont want to know. Men suffer embarassment daily becasue they will not speak up for fear of making the nurse mad. I have news for all female nurses I think most of them are preverted when it comes to male patients.
The thing with gender choice is, sometimes it really isnt an option. None of my GP’s are female. My obstetrician was a male. I had a male midwife. I have 2 male nurses on my ward, its not possible to have a male on shift each time, and even if I had more, their individual right to shift flexibility would affect my ability to roster a male on shift at all times. I was a urology nurse and catheterised loads of males, generally I found that they dealt with the momentary embarrassment well, just as i did with my male GP/obstetrician/midwife. If they were in acute retention, i could have been Pamela Anderson and I doubt they would have noticed =)
Skillmix, gender mix, and then blatant bias all play a part. There is a general expectation out there that a nurse is female. A sudden arrival of a male nurse at the bedside can be disconcerting to a patient, just like female doctors were treated badly until relatively recently. As a middle-aged male, I’m often mistaken for a doctor until I introduce myself.
Our society has made a great deal about preserving the choice, dignity and privacy of women, and only recently have we really started talking about the same for men. I’ve had some male patients visibly relax and finally explain their prostate problems to me, too embarrassed to share them with a female doctor or nurse.
Interestingly when I was in Germany, almost 50% of the nurses I met there were male, and the whole dynamic was different. It all stemmed from a policy of national service, either 12 months in the Army, or 18 months in other service, mainly hospital work. Many then went on to become RNs.
By the way, Ian, great work yet again! Can’t get enough of your invaluable tutorials, your humour and your realism.
Thanks for your reply. What I don’t understand is this — scheduling is not like rocket science. Granted, if you don’t have any of one particular gender available at all, you have to go with what you’ve got. But if you do have a mix, even if there are more females than males — why isn’t it just standard operating procedure to make sure that the schedule has at least one or two members of each gender on duty to deal with this issue? Is it that schedules are more designed around the convenience of the staff or institution than around the interests of the patients? Please explain.
Sometimes Minutemoon it just comes down to numbers. Given male nurses make up about 10% of the nursing population in Australia, it just isn’t possible at times to offer an alternative. However, I agree when it is possible, then yes, it’s a worthy courtesy.
(I’ve also been on duty when only male nurses were on. Imagine the surprise on the face of the elderly lady who asked for a female nurse! We all filed in to her cubicle and said: “This is the entire nursing staff on tonight…who would you like?”)
I note that in neither your male nor female directions do you even suggest that the nurse ask the patient if he or she would prefer a nurse of the same gender for this especially invasive procedure. One of the responses after your description of the female procedure does address that issue. As a male nurse, he says he asks if the female would prefer a female nurse. Should female nurses also ask men if they prefer a male nurse? Or is that not politically correct these days? Or is it just assumed that male patients just have to accept female nurses for this procedure whether they want it or not. What’s assumed and not assumed about how patients feel about the gender of the nurse doing this, and what’s assumed or not assumed about whether patients should be asked their preference or whether they have any rights to preference at all? Of course, let’s be honest. Female patients will always have the choice. Males may not. Is that saying something about lack of respect for the dignity of male patients who for some strange reason would enjoy the same modesty and privacy rights afforded to female patients?
EEJ: Foley catheters are measured in “French” gauge which goes up in size as the number goes up.
The rationale for using a bigger catheter if you can’t get it in the first time is that a bigger catheter is stiffer and thus less likely to bend and flip around inside the urethra.
I am a also a T12 trauma patient and have been catheterizing for over 11 years with no problems.
Hi … my boyfriend recently had a fall that caused a compression fracture of his T12, there was some cord damage, however it is early to decide what is permenant and what is still swelling and trauma. He is unable to void on his own and has to cath himself … my question is this … how long can he continue to cath or be cathed? Can this be done indefinately?
I do not know how many times I have found blokes who have been catheterized and someone forgot to put the foreskin back in its normal position.
Just recently one unfortunate bloke had not had this courtesy performed. Rather unsuccesfully two separately circumcised males were not able to help this gent and had to call on the help of some female colleagues.
I’m a bit concerned…..
You state something to the effect of “if you meet resistance, TRY A LARGER SIZE” ??
I’m not medical personnel, but simple math would tell most people that if Tab A won’t fit into Tab B, a larger tab will only make things worse….
Okay, so I realize that with things measured in “gauges” (like shotgun shells or body piercings), the larger the number, the smaller the object; it just didn’t come across that way when I read it.
Ouch!
In the medical field, a larger size= smaller. a 14 g something is larger than a 22 g something..
Hi Ian, I find that if you place the (lignocaine gel) syringe on the end of the catheter, post insertion of the catheter, and retract the plunger 2- 3ml, a bit of urine and gel will be collected in the syringe. By this point you connect the bag and inflate the balloon in quick succession, super nurse way!! You will have a happy male patient!!!
Oh wait, I’m reading backwards – THERE is the female version! : D
Being a woman, I resent being compared to a Windows computer!
Then again, I’ve always had a thing for Macs.
I can’t WAIT to hear your version of female catheterization! : D