Foley Catheters and Erections

[inspir8tion]

On occasion in the OR, when catheterizing a male patient, the pt becomes erect. My nurse manager says we cannot put a foley into an erection. All the surgeons and other nurses I work with say to continue with the catheterization and that the erection facilitates the process.

I am trying to find evidence supporting either one of these statements or both.

Any ideas?

[kathgail]

As what I've known in our lecture, since I'm still a junior nursing student, it is better to insert the catheter to an unerected. If erection, we place cold packs on it.

[mvanz9999, RN]

Question from peanut gallery: Is insertion painful for the patient?

Sorry for the O/T post.

[inspir8tion]

The patient is under anesthesia, so don't know if it is painful.

Can anyone point me to some literature on the subject (for or against)?

[brewerpaul]

Geez-- just the thought of a Foley would make me lose mine ;-)

[heather2084, BSN]

We don't put foleys in until the pt is out...saves work on us and a LOT on the pt.

[inspir8tion]

In the operating room, we do not put foleys in patients until they are under anesthesia.

[brewerpaul]

inspir8tion said:

In the operating room, we do not put foleys in patients until they are under anesthesia.

At 56 y/o, with a touch of BPH, I find that comforting...

[Corey Narry, MSN, RN, NP]

From a clinical medicine video (available only to online members) and an article in the New England Journal of Medicine, "Male Urethral Catheterization", Volume 354:e22, Number 21, May 25, 2006:

Absolute contraindications for male urethral catheterization:

A confirmed or suspected urethral injury such as a patient with pelvic injury or fracture. Physical findings include blood at the meatus, gross hematuria, perineal hematoma, and a "high-riding" prostate gland.

Relative contraindications for male urethral catheterization: urethral stricture, recent urethral or bladder surgery, and a combative or uncooperative patient.

None of the above states that penile tumescence is a contraindication. This physiologic response does not cause narrowing of the urethral passage. Remember how we have to hold it straight and perpendicular to body's plane to straighten the natural S-shaped curvature of the urethra as it begins from the meatus to the bladder sphincter and eases the catheter's insertion. The same concept applies with penile tumescence, this physiologic response straightens the urethral passage and can actually help in facilitating insertion of the catheter. Since the patient is already anesthetized, that is even better as the patient feels no discomfort.

[Spidey's mom, ADN, BSN, RN]

mvanz9999 said:

Question from peanut gallery: Is insertion painful for the patient?

Sorry for the O/T post.

In the ER, I use lidocaine jelly for insertion.

In the OR, they wait until the patient is under anesthesia.

I've never had to insert a foley into an erection - and I've inserted a lot. My DH says just the idea would keep him from having any reaction except maybe shrinking testicles.

Steph

[inspir8tion]

Thank you for the great response! I really appreciate it.

pinoyNP said:

From a clinical medicine video (available only to online members) and an article in the New England Journal of Medicine, "Male Urethral Catheterization", Volume 354:e22, Number 21, May 25, 2006:

Absolute contraindications for male urethral catheterization:

A confirmed or suspected urethral injury such as a patient with pelvic injury or fracture. Physical findings include blood at the meatus, gross hematuria, perineal hematoma, and a "high-riding" prostate gland.

Relative contraindications for male urethral catheterization: urethral stricture, recent urethral or bladder surgery, and a combative or uncooperative patient.

None of the above states that penile tumescence is a contraindication. This physiologic response does not cause narrowing of the urethral passage. Remember how we have to hold it straight and perpendicular to body's plane to straighten the natural S-shaped curvature of the urethra as it begins from the meatus to the bladder sphincter and eases the catheter's insertion. The same concept applies with penile tumescence, this physiologic response straightens the urethral passage and can actually help in facilitating insertion of the catheter. Since the patient is already anesthetized, that is even better as the patient feels no discomfort.

[fuzzball7]

I would get an erection.