Cleaning urinary catheters

[jerek]

Hi,

I have a story and then some questions. First the story:

I am in my last semester of nursing school, and I work as a nurse aide in a large teaching hospital. A few days ago, I was working with a ICU patient who had been burned. He was doing well--off the ventilator, fairly alert, etc. Still, he wasn't able to use his hands yet. I was instructed to do his bath by one of the nurses. I met with the patient first to make sure he was ok with it, etc. His wife said that she could help roll him over if i needed it, which is good because the other nurses aren't fond of helping with that kind of stuff.

I started the bath and things were going according to routine until I happened to look at his catheter--he still had a blanket over his lap at this point. I saw lots of crusty discharge, so much that his pubic hair was stuck to his member and scrotum. It had been a while since someone cleaned him up. I didn't know what to do--I didn't want his wife to see it. After a few moments of panic, I said "It's been a while since someone cleaned around your catheter." I went ahead and cleaned the area up--his wife just kind of made a face. She wasn't upset, thank God.

Here are my questions: how can you tell if your patient is circumcised? Since I work in ICUs, the patients can't usually tell me. I guess I could ask their wives, but is that appropriate? I can't count how many times uncircumcised male patients have developed edema because their foreskin wasn't pulled back.

Also, since perineal care is not usually a priority here, is it appropriate for me to want to do it well? I mean it sort of violates some sort of unspoken rule in the hospital's culture.

My third question is going to make me sound crazy. How common is it for male patients to respond to being touched in the perineal area? I don't mean arousal, but sometimes their member will move or change sizes even if they are sedated. It can take a fair amount of handling to retract foreskin. Am I doing something wrong?

Lastly, when cleaning up female patients, it isn't uncommon for the contents of a bowel movement to get inside their lady partsl canal. I'm pretty sure leaving it there will cause an infection, but how detailed should I be in cleaning that area?

I apologize for the length of this. I just don't want to seem like a pervert, but I want to do a good job. Thanks

[Elvish, BSN, DNP, RN, NP]

Moving to Dialysis/Renal/Urology in hopes that you get a few more answers than you were getting in the previous forum. :)

[anurseadvocate]

I can only address the following ---Also, since perineal care is not usually a priority here, is it appropriate for me to want to do it well? I mean it sort of violates some sort of unspoken rule in the hospital's culture.

THis is the same, to me, as not turning patients to prevent pressure ulcers which happens so often in ICU, when, in fact, the patient could be turned q2h. Also, when yo usay 'unspoken rule' I am, on one hand, shocked, yet on the other, just makes me realize more and more of the problems within ... Maybe you should ask the manager of ICU about perineal care and she what he/she says. Any nurse who falls into this unspoken culture as you state ---well, shame and shame on that person. Why would this be not done.. isn't this part of giving a bath esp if the patient can't do for themself? Maybe the nurses from the old days are different but we never would omit perineal care when giving a bath.. perhaps some nurses feel it is beneath them... unbelievable, but really not.

[NRSKarenRN, BSN, RN]

thank you for paying attention to an often missed care activity in hospitals, snf and homecare. it's one area i focus on after lung check, vs and cursory skin check. pet peeve is finding someone lying with cruddy catheter, lying in stool, tons of bellybutton lint....along with disgusting toe crud 'cause no one removed socks!

when i see that much crusty sediment, whip out that basin, warm soapy water lathered on washcloth that i allow to sit on area for about 5 minutes to soften sediment, makes for easier removal. some of my aides swore that squirt shaving cream on washcloth lathered then applied worked best to remove gunky drainage, rinsed well with separate washcloth. for women, wiping front to back with toilet paper then same type warm soapy wash, clean rinse works.

newborns: care of the uncircumcised member has info for adults ....

care of the uncircumcised member

tabbner's nursing care: theory and practice - google books result

some males are more sensitive to touch than others. neurological injury, and some types sedation + meds can cause erection spontaneously just moving client in bed yet alone during personal care.

phimosis and paraphimosis: emedicine emergency medicine

priapasm :the male health center - erection problem

priapism: emedicine emergency medicine

acting like this is just routine care, gather all needed supplies prior starting care, ensure privacy with pulled curtains, covering genital area with towel/bath blanket (if you can find one!) as you remove top sheet, light banter with eye contact seems to minimize patient embarrassment.

good luck in your career.