condom catheters

[84RN]

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!"

[84RN]

Yes, he definitely has a say in his poc, which is why I asked for the order to remove the foley in the first place. Now it's obvious he doesn't want the condom cath, so readjusting the plan accordingly.

I AM advocating for him, thanks for the benefit of the doubt.

[toomuchbaloney]

From my perspective the question then is not how to keep the catheter that he objects to in place. The question then is how to keep the incontinent patient from developing skin breakdown.

Can you impact the amount of urine at night? How is he getting fluids and in what quantity at what time? Simple things like adjusting the evening fluid intake or the timing of antidiuretics can make a noticeable difference.

Can you use an extra pad in his night time brief to help with the amount of urine?

I am glad that you are not fixated on having some sort of a urinary catheter in this case as it seems impractical as all get out and is clearly troublesome for the patient.

[84RN]

That's what the focus of my visit tomorrow will be.

Will be doing all we can do keep him dry and watching skin closely. He really does have a very good aide, wish all my patients were as fortunate. This poor man has been through so much. A few weeks ago we got the referral to start him for "foley care", nurse went out and found him with 103 fever, pus coming out of his member, pressure sores. Instead of starting him, sent him immediately to hospital, adult protective services got involved, and during his hospitalization they found another agency to manage his care (his only relative lives very far away).

Now, he's immaculately clean, pressure sores all healed, and very well taken care of, thankfully.

[smartin13]

Working in an acute neuro department and with the recent focus on removing foley's I have extensive experience with condom catheters, and most of the time they stay on and don't leek. Ensure you have the correct size so that it is snug, use your skin prep prior to placing the condom and then again around the edges, we then place an attends or breif on the patient to help secure it in place and catch anything that may leek. Perhaps it is just the brand my facility uses but 98% of the time they stay on our patients including the confused ones.

[SwansonRN]

I think skin prep and using the correct sized condom are the keys to success. If the condom is easy to put on, it's too big. In my experience just about every male is a small/extra small when they're in my unit. Sorry dudes!

[VampyrSlayer, CNA]

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.

Hmmm I was taught to pull the foreskin back but next time they ask me to put one on I'll try that! We very rarely use it on him. He's comfort measures so the only reason we do it is because he pees...a lot. And usually soaks the pad and we have to do a complete bed change which is very difficult and unpleasant for him. He has his lucid moments but for the majority of the time is not "with it". His skin is so thin he is always getting little skin tears (especially around the sites of bandages for other skin tears). We do reposition him but moving him around to do frequent bed changes is very unpleasant for him.

[loriangel14, RN]

We use them on our floor and they work great. Never had much of a problem with them coming off. ours come with 2 sided tape. You put the tape on the member, peel off the paper on the second side and then roll the condom over the tape. i had one patient in the community that used double sided carpet tape to make it stay on.

[firstinfamily, RN]

Why didn't a nun's cap be provided for the women. This is like an upside down hat that goes on the commode and can measure urine output very accurately. No graduate needed!!

[firstinfamily, RN]

Double sided tape??? Is this possibly another use for duct tape??? It never ends!!!

[Loo17]

I actually have found that a slightly larger condom cath stays on better than one that is too small. Skin prep to the member, do not pull back the foreskin if applicable, make sure the skin prep is dry as well as making sure the member is extended as much as possible-like if it is an innie, unroll the condom cath as much as possible then kind of hold it for a couple of seconds so it adheres. If you don't unroll it enough it wont stick. I also use the cath secure on the patients upper thigh so it doesn't pull. If the patient has a lot of hair it might not adhere well and may hurt if the hairs are pulled.

[Double-Helix, BSN, RN]

1 gram = 1mL of fluid. Strict I&O can quite easily be calculated for an incontinent person by weighing the soiled brief and subtracting that value from the weight of a dry brief. Unless the patient is hemodynamically unstable, needing to keep track of output is not an indication for a catheter. In the case of a patient who continually removes the condom catheter, or it doesn't fit, weighing briefs will actually give you a more accurate overall I&O because you won't be losing unmeasurable urine in the patient's clothes and bed linen.

I&O does not seem to be the goal for this patient. Comfort is. If the catheters (external or internal) are causing him discomfort, he needs a new plan of care. Briefs and frequent toileting with thorough skin care would promote dignity, comfort, and protect skin integrity.

[duskyjewel]

I've never worked anywhere that had a scale for weighing briefs. I'm sure that's common in peds, but with adults?

Or maybe I just haven't worked in the right places.....