Placement of a urinary bladder catheter comes with the territory for many hospitalized patients. Indwelling Foley catheters are often inserted through the urethra and into the bladder of men and women. An internal ballon is then expanded to prevent the catheter from falling out. These catheters have an appropriate role in the management of some hospitalized patients. Bladder outlet obstruction and urinary retention require internal bladder catheters to manage the problem. Sometimes the catheter is the cause of the problem. Here is an example of bilateral hydronephrosis from a Foley catheter.
Too often, hospitalized patients get indwelling urinary catheters ordered out of convenience, ignorance or because that's the way the doctor has always practiced. Patients or nurses may request them and doctors may order them for any number of reasons, some appropriate, some not. Far too often, these catheters get placed and forgotten. Many hospitals have implemented policies and procedures to reduce the incidence of prolonged catheter placement and the complications that are sure to follow. The best way to prevent a complication of an indwelling catheter is not to place one. Catheter related infections and hematuria due to catheter trauma are just two of the many bad outcomes.
Too often, hospitalized patients get indwelling urinary catheters ordered out of convenience, ignorance or because that's the way the doctor has always practiced. Patients or nurses may request them and doctors may order them for any number of reasons, some appropriate, some not. Far too often, these catheters get placed and forgotten. Many hospitals have implemented policies and procedures to reduce the incidence of prolonged catheter placement and the complications that are sure to follow. The best way to prevent a complication of an indwelling catheter is not to place one. Catheter related infections and hematuria due to catheter trauma are just two of the many bad outcomes.
What can hospitals do to limit complications from internal bladder catheters? Some hospitals think outside the box and use external catheters instead. For men, these external catheters are called condom catheters. Don't worry, I have verified these condom catheters are Catholic compliant. They are placed just like a condom. No more concerns about bladder infections. No more concerns about traumatic clots inside the bladder. No more concerns about dirty old men having unprotected sex in the hospital. Just place a condom catheter on them and be done with it. Or at least until they pull it off 32 times a day and ask the nurse for help putting it back on. I guess Uncle Eddie isn't so demented after all.
How do these condom catheters work? What about their length? What about their girth? Surely, one size does not fit all. So many questions, yet so few answers. I did what any hospitalist would do when they have free time on their hands. I commandeered the condom catheter directions for my review. Boy, was that a shocker. These things are definitely not one size fits all. Below are a couple of pictures from the folding insert, complete with directions, a 20 cm ruler (8 inches) and a girth sizing guide for the Coloplast Conveen® Optima external condom catheter. For best results, I suggest you follow their advice. I have provided a summary of their recommendations here as a public service announcement. If you ever find yourself hospitalized and need a urine capturing device, and a nurse calls you sport, I recommend you give them all zeros on your patient satisfaction scores.
Step 1 Prepare Skin: Make sure the skin is clean and dry, free from oils and moisturizers. A protectant wipe may be used. If necessary, trim pubic hair.
- WOW! I don't know how many nurses or men can ever get past step one. A clean and dry penis in a 90 year old nursing home patient? Oils and moisturizers? What kind of nursing how is THAT guy staying in. And trimming the pubic hair? I'm sure nurses didn't graduate from nursing school with pubic hair trimmer expert in their job description. Certainly, hospitals MUST be considering a pubic hair trim as an add on amenity worthy of extra revenue.
Step 2 Size: Use sizing guide to measure circumference and length to determine correct catheter. Four circumference sizes are available in STANDARD length and four circumferences sizes in SPORT length for short/retracted shafts.
- WOW! Call me crazy, but I'm certain becoming an expert in measuring penis girth was not an elective in nursing school. It's great that Coloplast has the girth and length measuring device available, but I think their good intentions may have unintended consequences. I can see it now, patient and nurse arguing over which girth size to pick. Don't even think about telling him he's a sport. You'll crush his manhood and force me to consult a psychiatrist for suicidal thoughts. Way to go Coloplast. Maybe these condom catheters aren't such a great idea. "Oh, to be 20 again..."
Step 3 Open it. Ok, easy enough.
Step 4 Apply the Catheter: Place the catheter on the head of the penis, keeping a 1/4 to 3/4 inch gap between the penis and the outlet tube. Hold the catheter in place with one hand, while gripping the double strip pull tab with the other. Then pull the double strip pull-tab, slowly un-rolling the catheter towards the base of the penis. Gently squeeze the catheter around the shaft of the penis for a few seconds to ensure adhesion.
- OH MY! There goes my length of stay and 30 day readmission rate. With service like this, my patients will never want to leave the hospital.
Step 5 Leg Bag: Connect the catheter to the urine bag.
Step 6 Removal: Catheter should be exchanged daily.
- Perform steps 1-5 daily to ensure great patient satisfaction scores! Expect longer lengths of stays and higher 30 day readmission rates as we trade excellence in one measured outcome for another.
I do have one suggestion for the folks over at Coloplast. I recommend you offer these condom catheters in an assortment of colors and designs. Think about it. How many crazy old men love their hunting. Camouflage condom catheters to the rescue. Since they haven't felt anything in the last 20 years, you might as well help them make it disappear. Favorite football team? The Chargers? The Jets? The Giants? The Packers? Come on. Offering an upgraded football catheter is a gold mine for you and your client hospital's amenity of services. Keep your marketing team active and we'll all get to WIN-WIN. Now, please enjoy this original Happy Hospitalist ecard, part of a collection of hundreds on Pinterest.
"Please stop flashing your penis at me. I'm not impressed. Except maybe like 1% of the time."
To view this card at The Happy Hospitalist Medical Humor store, turn off the "safe filter" on the left hand side" at the store landing page linked above.
Some of this post is for entertainment purposes only and likely contains humor only understood by those with a sense of humor. Read at your own risk.
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