Applying a Condom Catheter

Subject: Fundamentals of Nursing

Overview

Applying a Condom Catheter

It is applying a thin condom sheath to penis for drainage of urine without inserting a catheter into urethra. There is no tube placed inside the penis. Instead, a condom-like device is placed over the penis. A tube leads from this device to a drainage bag. The condom catheter must be changed every day.

Purposes

  • To drain urine in case of an incontinent patient.
  • To permit patient's normal physical activity without fear of embarrassment caused by incontinence.

Indication

Incontinent men who still have complete and spontaneous bladder emptying.

Articles

  • Rubber condom sheath.
  • Strip of elastic tape and skin preparation (e.g. betadine).
  • Urinary collection bag with drainage tubing.
  • Basin with warm water and soap.
  • Towel and wash cloths.
  • Disposable gloves.
  • Razor (optional).

Procedure

S.N. Nursing Action Rationale
1 Identify the patient and assess the status of patient e.g. last voiding, level of awareness, physical limitation and pathological condition e.g. prostate enlargement, etc. Proper assessment helps to identifying patient's ability to cooperate during procedure.
2 Review the physician's order and nursing care plan. Helps to identify the reason for catherization.
3 Explain procedure to patient. Reduces anxiety and promotes cooperation.
4 Screen the patient. Provides privacy and maintains patient's self-esteem.
5 Wash hands. Reduces transmission of infection.
6 Prepare all required equipment. Keeping all articles ready for use helps in saving time.
7 Place mackintosh and draw sheet under the hip and put kidney tray in convenient area. Prevents soiling of linen.
8 Assist patient to supine position, place bath blanket over upper torso. Fold sheets to show that lower extremities are covered. Only genitalia should be exposed. Promotes patient's comfort and visualize perineal area.
9 Use disposable gloves. Reduce chance of infection.
10 Assess condition of penis for skin irritation, excoriation, swelling or discoloration. Provides baseline data to compare changes in condition of skin after condom application.
11 Measure the circumference of the penis. Ensures catheter is appropriately sized.
12 Provide perineal care and dry thoroughly; clip hair at the base of penis if required. Removes irritating secretions. Hair adheres to condom and pulls during adhesive tape removal causing discomfort.
13 Prepare urinary collection bag and tubing or prepare leg bag for connection to condom if necessary. Clamp off drainage exist parts. Secure collection bag to bed frame. Bring drainage tubing up through side rail on to bed. Provides easy access to drainage system after condom is in place.
14 Apply skin preparation to penis and allow drying for 30 to 60 seconds.  
15 With non-dominant hand, grasp penis along shaft and with dominant hand roll condom sheath onto penis. Ensures easy application of condom.
16 Encircle penile shaft with a strip of elastic adhesive. Strip should touch only condom sheath. The strip should be applied one inch from the proximal end of penis and do not completely encircle or tighten the penis. Condom must be secured so that it fits smoothly and will stay on. 
17

Connect drainage tubing to end of condom  catherter. Be sure that condom is not twisted.

Allows urine to be collected and measured.
18 Coil the excess tubing on bed and secure to bottom sheet. Prevents looping of tubing and promotes free drainage of urine.
19 Place the patient in safe and comfortable position. Promotes client's comfort.
20 Remove gloves. Dispose of contaminated supplies and wash hands. Prevents spread of infection.
21

Regular inspect skin on penile shaft for signs of breakdown/irritation.

 Indicates whether the condom or urine is causing irritation.
22 Record and report, time of condom application condition of skin and voiding pattern. Provides dat to determine change in elimination status.

Special Considerations

  • Remove the condom once a day to clean the area and assess the skin for signs of impaired skin integrity. This will promote hygiene and reduce the possibility of skin breakdown.
  • Do not reattach the condom catheter if it falls off. It will not stick any better in second try. Apply a new catheter and strip.
  • Client may have latex allergy and may require latex free condoms.
  • Sometimes urine can leak around the catheter. This may be caused by: Catheter that is blocked or that has a kink in it.
    • Catheter that is too small.
    • Bladder spasm.
    • Constipation.
    • The wrong balloon size.
    • Urinary tract infections.

Care of Patient with an Indwelling Catheter

In caring for a patient with an indwelling catheter, the main goal is to prevent infection of the urinary tract.

Purposes

  • To prevent urinary obstruction.
  • To prevent ascending infection.
  • To make free flow of urine.
  • To make comfort to the patient.

Precautionary Measures

Everyday care of catheter and drainage bag is important to reduce the risk of infection. Such precautions include:

Prevention of Ascending Infection

  • Wash hands before and after caring for a patient with an indwelling catheter.
  • Must use sterile technique to change and care bag and tube.
  • Give or help the patient with perineal hygiene twice a day and after each defecation.
  • Clean the perineal area thoroughly, especially around the metus, daily and after each bowel movement.
  • The best way to prevent infection, encourage patient to drink a lot of fluid everyday up to three litters. Drinking a lot produces a lot of urine which keeps the bladder flushed out and stops sediment from sticking in the catheter.
  • Maintain closed drainage system and do not open the drainage system at connection points to obtain specimen or to measure urine. Any break in the system can lead to the introduction of micro-organisms. Do not open the drainage system to obtain urine specimens or to measure urine.
  • Never leave the urinary bag lying on the floor.
  • If the drainage tube becomes disconnected do not touch the ends of the catheter or tubing. Wipe the ends with antiseptic solution before reconnecting it.
  • Properly position and secure to minimize the risk of infection.
  • Promptly report any signs or symptoms of infection. These include a burning sensation and irritation at the meatus, cloudy urine, strong odor to the urine, an elevated temperature and chills.
  • Teach the patient the importance of personal hygiene.

Maintaining Drainage

  • Take close note of the urine's volume and characteristics.
  • Be careful not to clamp or kink the tube for too long.
  • Remind the patient not to ever lie on the tubing and to inspect it to make sure it is straight.
  • Utilize the following steps to stop pee from pooling and reflexing into the bladder.
  • Maintain the drainage bag below the bladder's level. If necessary, the catheter must be clamped.
  • Don't let the drainage bag get full.
  • Before the client exercises or walks, empty the entire contents of the pee tube into the bag.
  • Drainage bag needs to be clamped while moving around or making beds.
  • At least once every eight hours, empty the drainage bag.
  • Only use clean hands to disconnect the drainage bag from the catheter.
  • You need to replace the tube and bag if silt builds up in the drainage bag or tubing or if there is a leak.
  • You need to replace the tube and bag if silt builds up in the drainage bag or tubing or if there is a leak.
  • When a blood clot or other debris poses a threat to obstruct the catheter, frequent irrigation may be prescribed.
  • Only replace catheters when necessary. Based on the clinical signs of catheter encrustations, leakage, bleeding, and catheter-associated UTIs, the patient's unique time between catheter changes should be determined.

Performing Catheter Care

Definition

It is cleansing the urethral meatus, the skin surrounding the catheter insertion site and perineum for patients with retention catheter who are bed ridden.

Articles

  • Catheter care set
  • Clean tray containing
    • Warm water and shop
    • Antiseptic lotion
    • Normal saline
    • Sterile gloves
    • Kidney tray
    • Mackintosh and draw sheets
    • Adhesive tape and scissors
    • Prescribed medicine
  • Screen

Procedure

S.N. Nursing Action Rationale
1 Review orders. Ensures correct patient and procedure.
2 Identify the client and explain the procedure. Elicits client's cooperation.
3 Screen the client. Maintains privacy.
4 Assess status of patient. Reduces anxiety and promotes cooperation.
5 Wash hands. Reduces transmission of infection.
6 Prepare all required equipment. Keeping all articles ready for use helps in saving time.
7

Position the patient.

Female: Dorsal recumbent position with legs flexed.

Male: Supine position.

 Ensures easy access to perineal area.
8

Place waterproof pad/mackintosh and draw sheet under the patient.

 Protects bed linen from soiling.
9

Drape sheet over patient exposing only  perineal area.

 Prevents unnecessary exposure of body parts.
10 Don clean gloves. Prevents from cross infection.
11 Remove tapes to free catheter tubing. It provides easy access to clean the area.
12

Expose the urethral meatus (with non- dominant hand).

Female: Gently retract labia to fully expose urethral meatus and catheter insertion site. Maintain position of hand throughout procedure.

Male: Retract foreskin hold penis at shaft just below glans, maintaining position of hand throughout procedure.

 Provides full visualization of urethral meatus.
13 Assess urethral meatus and surrounding tissue for inflammation, swelling and discharge. Note amount, color, odour and consistency of patient if burning or discharge. Ask discomfort is felt. Determines presence of local infection and hygiene status.
14

Cleanse perineal area.

Female: Use clean cloth, soap and water and clean towards anus. Cleanse catheter first and then meatus, labia minora and majora. Be sure cleansing each side and dry area well.

Retract labia and wipe using sterile cotton swabs dipped in antiseptic solution from center to periphery in straight strokes from front to back, using one cotton ball for each stroke.

Male: grasp shaft of penis and retract foreskin. Cleanse tip of penis at urethral meatus first. Using circular motion cleanse from meatus outward and down the shaft. Repeat with clean until penis is clean. Remove clean gloves and wear sterile gloves.

Clean the catheter from meatus outwards for approximately 3-5 using antiseptic cm solution from center to periphery in circular tokes.

Repeat step using cotton swab with sterile water/normal saline.

Cleansing reduces number of microorganisms.

Antiseptic may act as irritant to skin.
15 Apply antiseptic ointment if prescribed. Reduces further growth of microorganisms.
16 Place patient in safe and comfortable position. Promotes comfort.
17 Remove gloves, dispose of contaminated supplies and wash hands. Prevents spread of infection.
18 Record and report condition of perineal tissue, the time procedure was performed, patient's response and abnormalities noted. Provides data and communicates information to others.

 

Removing Indwelling Catheter

Purposes:

  • To promote the normal bladder function.
  • To prevent trauma to the urethra.
  • To prevent infection.

Articles Required:

A tray containing

  • kidney tray
  • disposal syringe
  • gauze pad/piece
  • disposal gloves

Screen

Bucket/dust bin

Procedure

S.N. Nursing Action Rationale
1 Review orders. Ensures correct patient and procedure.
2 Identify the client and explain the procedure. Elicits client's cooperation.
3 Explain the procedure to the patient and assess status of the patient. Reduces anxiety and promotes cooperation.
4 Maintain privacy. Promotes the client's dignity.
5 Wash hands. Reduces transmission of infection.
6 Prepare all required equipment. Keeping all articles ready for use helps in saving time.
7 Keep the patient in supine position. Ensures comfort.
8 Place makintosh under client's thigh. Prevents bed from becoming soiled.
9 Wash hands before procedure, and wear gloves. Reduces transmission of microorganisms.
10 Empty urine in tubing into urobag. Empty the bag of urine if needed. Prevents leakage from catheter on to the client when the catheter is removed.
11 Remove tape that may be holding the catheter to the leg. Allows easy removal of catheter.
12 Deflate the balloon before attempting to remove the catheter by inserting a syringe into the balloon valve and aspirating the fluid used to inflate it. Always verify the size of the balloon, which is printed either on the catheter or documented in the chart, so that we know how much fluid to remove before proceeding. Removal of fluid from balloon prevents damage to urethra while removing the catheter.
13 Ask the patient to take several deep breaths to relax while gently remove the catheter. Once the ballon is emptied, Remove catheter gently and slowly. Deep breath helps the muscles to relax.
14 Note any sediment, mucous or blood that may be on the catheter. If needed, culture the tip of catheter by cutting it off with sterile scissors and place in sterile container. Helps to identify the growth of bacteria.
15 Dispose the catheter appropriately. Prevents from contamination.
16 Clean the perineal area after removing catheter. Provides comfort.
17 Cover client and position comfortably. Provides comfort and privacy.
18 Ensure that patients fluid intake in generous, and record the patients intake as well as time and amount of output for at least 24 hour. If patient does not void within 8 hours of removal of catheter, notify the physician promptly. Determines that patient has returned to usual voiding pattern.
19 Record and report any unusual sign and symptoms such discomfort, burning as sensation when voiding and bleeding. Provides data to determine change in elimination status.

 

Risks/hazards of Indwelling Catheter

  • when the catheter is introduced, there is harm to the urethra.
  • Incorrect catheter insertion might result in damage to the rectum or bladder.
  • While inserting the catheter, the balloon could rupture.
  • Once inflated, the balloon does not float after being placed. Insert a second Foley's catheter if the balloon still does not puffed up after being inserted into the bladder.
  • The flow of urine to the bag ceases. Verify that the catheter and bag are in the proper positions and that the catheter tube is not obstructing the flow of urine.
  • The flow of urine is stopped. Change the catheter or the bag, or both.
  • The bladder could become infected as a result of the Foley's catheter.
  • One of the most typical types of infections is an infection of the urinary tract brought on by the use of a catheter.
  • Placing a catheter may cause bladder spasms. This sudden, strong urge to urinate might be uncomfortable.
  • scar tissue from frequent catheter use causes the urethra to narrow.
  • Another issue with indwelling catheters is leakage surrounding the catheter. When a spasm takes place, urine frequently leaks around the catheter's outside (although these usually only develop after years of using a catheter).

Possible Complications of the Catheterization

Complications of catheterization include:

  • Allergy or sensitivity to latex
  • Hematuria
  • Kidney damage (usually only with long-term, indwelling catheter use)
  • Urinary tract or kidney infections
  • Septicemia
  • Stricture formation
  • Bladder stones
Things to remember

© 2021 Saralmind. All Rights Reserved.