condom catheters

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Give me your best tips for getting condom caths to stay put. I work in home health and have a patient that had a foley, but kept pulling it out. The physician said ok to try a condom cath, but after putting it on this morning, the caregiver called to say it already came off.

I made sure the member was dry (difficult because he urinates frequently), and used skin prep before applying the catheter. He has advanced Parkinson's plus dementia and is very active in his bed, so this is going to be a challenge---but I really want to try because he hates the foley so much. When the caregiver told him I was removing the foley this morning, he looked at me and said "God bless you!"

Specializes in Community Health/School Nursing.
The critical thinking needed to start with the physician that ordered the condom cath.

Then the nursie that only wants to follow the doctor's order.

In this case.. I am advocating for the PATIENT that does not want anything placed in or on his member.

There are many other options to prevent a "mess".

Care to expound on "Thanks for playing"?

:-) Please expound!

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In fact, it would seem from the OP that no one is advocating for the patient in this situation.

Nope.. they are not. Task oriented,keep that condom cath on at all costs.. forget about the patient attached to the cath!

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:-) Please expound!

Thanks! Know I am going in the right direction when I am accused of being a drama queen.

Have you ever had your poppa hospitalized and in misery from a foley or condom cath? It is an exquisitely sensitive area for men. You need to learn that.

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Specializes in Gerontology RN-BC and FNP MSN student.

Yea I agree with beenthere, my experience was with a quad who actually wanted his cath to stay on. :)

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Specializes in Community Health/School Nursing.
Thanks! Know I am going in the right direction when I am accused of being a drama queen.

Have you ever had your poppa hospitalized and in misery from a foley or condom cath? It is an exquisitely sensitive area for men. You need to learn that.

Actually, I was being the drama queen. That was in reference to wanting to know what the OP meant by "thanks for playing". I guess it's hard to "read intent" online. I have been married for 25 years. I'm very familiar with the male anatomy. I also took care of my dying father in law who had prostate cancer. He had a foley for months and we decided to take it out and let him have peace and rest without the pain. I get it. Nothing I need to learn. Again, it wasn't towards you.....it was meant to represent MY interest in knowing what the OP meant.

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Specializes in Oncology.
I took great enjoyment in informing him, in front of his visitors, that he required a child-sized catheter and that I had to walk over to the pediatrics wing to find one.

We're not a children's hospital, but we have a pediatrics unit that takes kids that need hospitalization but are not unstable by any means, thus, they rarely do things like foleys. One night I got floated there. They had an end of life 8 year old that had just been made comfort care that day. I had to help his nurse put in a tiny 10 french foley. Just heart breaking. Anyway, this reminded me of that.

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Specializes in Hospice.

I've used them a lot over 42 years and don't think they're useless or ridiculous. I had best results with the ones held by double sided tape. Start by grasping the member so that any loose skin is also (gently) stretched away from the base, apply plenty of skin prep, wrap a single layer of double sided tape as close to the base as possible, using bandage scissors to trim the tape so that the edges approximate as well as you can manage, then roll the condom over the tape. Try to avoid getting pubis hair caught - trim it if you need to. Most drainage bags have clips you can use to attach the tubing to bedclothes or jammies. Clip it so that there's slack so that the patient can move around without tugging on the condom.

Same principles apply if you use a brand that uses an external "strap" to hold the condom in place: skin prep, keep as much loose skin as possible away from the base, secure as close to the base as possible, flag or clip tubing to avoid tugging.

Accept the the fact that they will fall off regardless of product or technique. This is a good thing - constant moisture held against the skin and heated up by a layer of latex is NOT a good thing.

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It's really hit or miss. I'm a new cna but I've learned that I need to take my time doing it...not that it always helps. We found with one of our elderly male patients that it goes on fine, you pull the foreskin back and stick it on, but every time he urinated the head of his member would pull back inside his foreskin popping the cath off and rendering just putting it on at all useless.

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Specializes in Hospice.
It's really hit or miss. I'm a new cna but I've learned that I need to take my time doing it...not that it always helps. We found with one of our elderly male patients that it goes on fine, you pull the foreskin back and stick it on, but every time he urinated the head of his member would pull back inside his foreskin popping the cath off and rendering just putting it on at all useless.

Which is why you don't pull the foreskin back. You want all that loose skin actually inside the condom so that the condom doesn't shift around as the skin moves back and forth. Obviously good, thorough peri before and between condom applications is even more important than usual.

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As has been pointed out previously, a confused patient who pulls his indwelling foley out is not likely to leave a condom catheter alone either.

You can try a skin prep which helps it to "stick" to the skin of the member somewhat, however, you DO NOT want to promote any shearing or tearing injuries to that skin.

Why does this fellow require a catheter? Why is the team focusing on a POC that is irritating, agitating, and annoying the patient?

He's in his own home (condo) and has a private home health aide 24/7. The reason for the foley was because he's incontinent (urinates a LOT), has advanced parkinsons and dementia, and is essentially bedbound. He can be out of bed using a hoyer, but is so active that leaving him in a chair is a huge fall risk and isn't really safe.

I'm just trying to find the best solution to keep him comfortable, and also reduce the risk of skin breakdown from the urine.

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Specializes in NICU, PICU, Transport, L&D, Hospice.
He's in his own home (condo) and has a private home health aide 24/7. The reason for the foley was because he's incontinent (urinates a LOT), has advanced parkinsons and dementia, and is essentially bedbound. He can be out of bed using a hoyer, but is so active that leaving him in a chair is a huge fall risk and isn't really safe.

I'm just trying to find the best solution to keep him comfortable, and also reduce the risk of skin breakdown from the urine.

Doesn't your patient get to have a "say" in his POC? It seems to many of us that he is "telling" you over and over again to leave his junk alone!

If he is in his own home with 24/7 HHA that is even more reason that he should not have to endure the catheterization of his bladder.

He is confused and does not like it and he will continue to remove whatever you attempt to attach to him to contain the urine unless you restrain him either phamacologically or physically.

Advocate for him, not just his skin.

Imagine being in his situation, not wanting that stuff done to you and being powerless to stop folks like yourself from doing it anyway. Not much dignity there...IMHO.

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I'm trying to advocate for him, and at the same time make sure his skin is given the best chance at staying intact. His aide is good, but I worry about the constant wetness on his skin. I saw him yesterday and she told me even with changing him several times during the night, he was still completely soaked through to his sheets.

I've talked to his care manager who coordinates the aide (hh was brought in when he was first dc home from hospital a couple of weeks ago) and she's working with the aide to use the best briefs they can find, protective cream for his buttocks, and changing the briefs as often as possible.

I'm open to suggestions on this---not my usual patient, but I want to do what's best for him. Right now that means the foley is out, no condom cath and instructing the aide on pressure sore prevention, etc.

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