Foley Catheter Insertion in the Uncircumcised Male

Mario has been worried for the past hours, he seems to have some difficulty urinating. In fact, he is contemplating a checkup at the hospital right now. He’s already really worried, knows it’s the right thing to do and by doing so, he knows his condition will be properly managed by health professionals. However, there is one problem here, he isn’t circumcised yet. Aside from feeling embarrassed, he’s afraid health professionals might find it difficult inserting a urinary catheter once ordered. What will he decide? To go to the hospital and risk shaming himself? Or just stay at home and try some alternative interventions? Questions keep swarming his mind as he rubs his lower abdomen and sits at the corner of the bed.

Inserting a foley catheter in an uncircumcised male

maxresdefaultAs observed, when boys reach a certain age (or even after birth), they undergo something painful. Unlike the pains a female feels during her period, this “painful experience” is a one-time event only. Boys are born with a hood of skin (foreskin) which covers the head (glans) of the penis. In circumcision, the foreskin is surgically removed, exposing the end of the penis.

For some who haven’t undergone the procedure, they may feel a bit embarrassed and might hesitate participating in the insertion of a urinary catheter. However, it must be explained to them that it is nothing to be ashamed of and that though uncircumcised, inserting a catheter is still possible and almost the same with inserting a urinary catheter in a circumcised male except for one thing. Here’s how the procedure is performed.

  • Place the patient in the supine position with legs extended and flat on the bed.
  • Prepare the catheterization tray and catheter and drape the patient appropriately using the sterile drapes provided. Place a sterile drape under the patient’s buttocks and the fenestrated (drape with hole) drape over the penis.
  • Apply water-soluble lubricant to the catheter tip.
  • With your non-dominant hand, grasp the penis just below the glans and hold upright.
  • If the patient is uncircumcised, retract the foreskin. Replace the foreskin at the end of the procedure. Do not force the foreskin back, especially in infants.
  • With your dominant hand, cleanse the glans using chlorhexidine soaked cotton balls. Use each cotton ball for a single circular motion.
  • Place the drainage basin containing the catheter on or next to the thighs.
  • With you non-dominant hand, gently straighten and stretch the penis. Lift it to an angle of 60-90 degrees. At this time you may use the urojet to anesthetize the urinary canal, which will minimize the discomfort.
  • With your dominant hand, insert the lubricated tip of the catheter into the urinary meatus.
  • Continue to advance the catheter completely to the bifurcation i.e. until only the inflation and drainage ports are exposed and urine flows (this is to ensure proper placement of the catheter in the bladder and prevent urethral injuries and hematuria that result when the foley catheter balloon is inflated in the urethra).
  • Note: If resistance is met during advancement of the catheter: Pause for 10-20 seconds. Instruct the patient to breathe deeply and evenly. Apply gentle pressure as the patient exhales
  • If you still meet resistance, stop the procedure and repeat above steps.
  • Attach the syringe with the sterile water and inflate the balloon. (It is recommended to inflate the 5cc balloon with 7-10cc of sterile water, and to inflate the 30cc balloon with 35cc of sterile water.) Improperly inflated balloons may result to drainage and leakage difficulties.
  • Gently pull back on the catheter until the balloon engages the bladder neck.
  • Attach the urinary drainage bag and position it below the bladder level. Secure the catheter to the thigh. Avoid applying tension to the catheter.
  • Remove drapes and cover patient. Ensure drainage bag is attached to bed frame. Remove your gloves and wash hands.

Note: Never inflate a balloon before establishing that the catheter is in the bladder and not just in the urethra. If the patient reports discomfort, withdraw the fluid from the balloon and advance the catheter a little further, then re-inflate the balloon.

Without proper guidance and knowledge, some people may feel discouraged when it comes to consulting their condition to health professionals. This is where health teaching comes in, common folks must be made aware that not just because their condition is unlike the others, they aren’t entitled to undergo other procedures that will benefit their overall well-being, that they have nothing to be ashamed of. It should be known that facing their fears and going to the hospital for help is way better than staying at home, trying to bear the pain and let it worsen over time.

 

Sources:

Liane Clores, RN MAN

Currently an Intensive Care Unit nurse, pursuing a degree in Master of Arts in Nursing Major in Nursing Service Administration. Has been a contributor of Student Nurses Quarterly, Vox Populi, The Hillside Echo and the Voice of Nightingale publications. Other experience include: Medical-Surgical, Pediatric, Obstetric, Emergency and Recovery Room Nursing.

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