Slightly nervous about starting female cath...

[Thedreamer]

A little background. I am a gay male. Though I was a little adventurous back in high school I just never got around to actually being with a woman. And low and behold, I figured out I was homosexual in college. That being said, we practiced this week for clinical on how to start straight catheters. Mind you, I take pride in being top in my class and performing very well on my skills.

All that being said. I am terrified of actually starting a cath on a female patient. Not because I am scared of the female form or any such rubbish but because I have never actually SEEN a real life female organ down under :rotfl: and dont know how I will react.

I have worked as an EMT and picked up people half dead off the street. Ive held a mans skull together with just my hands in the ER. Ive helped in the OR in a rotation once. I can handle gory, bloody, smelly situations. Yet THIS of all things is what is terrifying me.

Does anyone have any advice they can bestow on me? I know I have to get over this phobia somehow because it is impractical and irrational. Am I just being worried because I am nervous about the situation? It had never occured to me that this would be something I would worry about until my proff made it clear that we will be getting female patients this term, as last term my instructor didnt allow males to have female patients.

My mom called it just being nervous cause its uncharted territory for me.

[KellNY, RN]

Don't sweat it, hun. Most straight men haven't really seen it up close, if ya know what I mean.

Try to think of it as what it is--a nonsexual (to you) part of the anatomy of over 50% of the population.

Now, I'm not pro-Media (not anti either), but just to help reduce the shock factor, any way you'd be able to get your hands on a *very* graphic text or else a sleazy mag? And I only mention this because in all the texts I've encountered, an actual photo of a lady parts is hard to come by, unless it's got a tiny head bulging out of it. Otherwise they tend to use those pencil or two color sketches, neither of which is entirely helpful in this situation. Whereas, if you get one of the "dirtier" mags, you'll get real up close and personal. No meatus, granted, but in your face privy parts/hood, labia majora, labia minora, and perineum nonetheless.

One word of advice, from someone who has guided students through placement (and this goes quadruple for Pts who have not had an epidural, spinal or some other anesthetic)--Please, please please! Take a moment to identify your landmarks. Most common mistakes are threading it into the lady partsl-no huge deal, but you'll have to get a new kit if you're doing it right, OR trying to push it into the privy parts/clitoral hood. *OUCH*

The meatus (which may look like a little dimple/crevice or small hole if positining is great and there is no swelling) will be approx midway between the privy parts (looks like a large bump-think tip of a female's pinky finger, covered by a "hood" which looks like...well, a hood) and the lady parts itself.

Really use that non-dominant hand to spread the labia apart so that you reduce risk of contamination and are better able to visualize your landmarks. And by all means-try to witness a cath real time, in person before attempting to insert one yourself. Just tell the nurse "I'd like to see it done once before I give it a go" and explain without going into detail that you have limited experience with that anatomy.

If it helps, you have an okay chance that a female Pt won't want a student let alone a male student starting a cath on her (I know I wouldn't--sorry men, sorry students!).

[Daytonite, BSN, RN]

Well, kiddo, I guess I'd have to give you the same advice I'd give any young woman who had never seen male genitals before.

Act like you've done it a million times before and that you know what you are doing. You'll be fine. You can faint and have a heart attack over any shock you suffer later outside the view and earshot of the patient.

In your case, because you are a man, not because you are gay, you should always make sure there is another female nurse or female healthcare worker in the presence of the patient with you. This is for your own protection. I'm sure you'll do just fine. Like any other procedure there are nuances to it that you will need to learn. That will come with practice and experience. I think your mom is right, you're just nervous. You need to get the first one or two of these out of the way and I think your concerns about it will change to perfecting your techniques more than worrying about any embarrassment you might feel.

[Thedreamer]

Day, dear god thank you. You always say things that knock sense into me or make me laugh out loud about my own inhibitions. And that advice about another FEMALE nurse being in the room is a GEM.

I know on thursday I am going to get a female patient cath, I just know it. My instructor kinda made it sound like she was going to choose a PT that needed it and assign me to them. So im going to do exactly as you said. Im going to look like i've done this a thousand times before, do my best, and after I leave the room my bones can turn to jelly!

God I love this resource. I tell all my classmates about you guys and how wonderful and informative you all are. :kiss

[AirforceRN, RN]

I think this is something that all male students have gone through. I'm fourth year and still get a little nervous doing it...a couple hints I have been told, they work for me...

1)Bring two foleys with you, if you hit the wrong spot you already are prepared. Leave the first one in temporarily so you know where NOT to go.

2) BRING A FEMALE WITH YOU, the protection for yourself is the primary reason, a second pair of hands and a non verbal helping point in the right direction is a good reason too.

3) Ask the patient to cough if you can't see the meatus. I've been told this and it has worked for me...just kind of pokes out for a second.

4) Sometimes you really have to spread things open. I was having trouble at first because I wasn't exposing things enough. Don't hurt the patient (obviously) but don't be scared to really open up the labia to get a better view.

I'm sure the female nurses will have better hints, but these helped for me. Don't worry, its not as easy as male caths but after a few you get the hang of it. I've never been so happy to see urine come out of a tube than my first successfull female cath...strange isn't it?

[Thedreamer]

I've never been so happy to see urine come out of a tube than my first successfull female cath...strange isn't it?

I hear thats how it goes in the student world, and sometimes in the RN/LPN world hehe. The only proffession in the world that gets excited over urine going into a tube

[KellNY, RN]

Also-if Pt can get into froggy position--heels together as close to the butt as possible with knees relaxed to the side, it helps spread the labia.

And when you spread the labia manually, spread lower rather than higher....cuz, um, ouch (it tugs on the clitoral hood).

Oh, and when you get urine, keep inserting for an inch or two (for an indwelling/foley). Reasoning is you could still be at the neck of the bladder or in the urethra, and when you go to inflate the balloon-at best you'll meet resistance and know something is up, at worst you could cause serious urethral trauma.

We had a pt to whom this had happened on Labor and Delivery...she ended up incontinent of bladder--with her foley still in place! We d/c'ed that one and placed a larger foley, and that slipped right out with the balloon filled. After numerous cystoscopies, she ended up being incontinent, sent home with the largest foley i've ever seen (don't remember the french) and partial home care needs.

She was "cured" after about 3 weeks, but that's a long time to be either using a foley and/or wetting yourself when your only admission dx was "Pregnancy at term for delivery"-no prior bladder issues. Lucky no one was sued.

[Thedreamer]

No pressure! :stone

[skislalom]

Another reason to bring another nurse with you, to hold the flashlight...unless you are in a facility with good directional lighting over the bed (like OB)...flashlights can really help you "see" what you are doing.

Good luck

[Soup Turtle]

I'm terrified about this too, and I AM a female!

[Thedreamer]

Turtle :redpinkhe Now Im both excited and nervous. I feel more confident I can do this with the advice everyone has given me. But now I am scared of hurting the labia. I need to practice on monday after school on the dummy to figure out how to do this best :)

Thanks guys!

[BWSPN]

I recently was able to do a straight cath for the first time. The advice posted is wonderful. We were taught after cleansing down the middle don't take your eyes off the meatus! It doesn't hurt to breath either! The hardest part for me was standing there holding the labia apart while 955cc of urine slowly (it seemed slow anyway) drained from the tube.