Texas catheter HELP!

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Hi everyone, I'm still Mike your 60 year old CNA again looking for help from the learned ones. I have a home health client who we'd like to get started on a Texas catheter. Big guy, 6'2" and 210 lbs. VERY immobile. I need to get him off the between-the-legs "Big Bertha" urinal so I can reposition him. I can't get his skin breakdown healed cause he's on his back 14 hours a night and then sits all day. I did get the thing on him one night, but it's like trying to stuff a night crawler into a toothpaste tube. I finally got the 'condom' like end onto his member but where do you grab to roll the thing on. He's a good sport but one episode like that was enough. Of course, I never thought about trimming his pubic hair till I had that sticky adhesive all over him. You angels gave me lots of help with his TED hose so please don't fail me now! Sorry this got so long. Big blabbermouth!

Mike

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Specializes in OB, M/S, HH, Medical Imaging RN.

Without sounding too graphic here.....I used to take care of a quad for 4 years who wore a Texas Catheter. You roll it on the head of the member, then grab the head with one hand and roll it the rest of the way up with the other hand. Put the adhesive strip on rather tight. You should be able to get a pinkie under there but not easily. My patient would frequently have an erection while I was applying the condom. He never knew it and I'd have to tell him "let me just cover you up while we wait for things to settle d-o-w-n." He would turn red and then we'd both have a good laugh. You have to wait for the erection to go back down before applying the adhesive or you will have one big wet mess when it comes off. Bless his heart, he passed 4 years ago and I still miss him everyday although I know he's in a much better place and happy now after 16 years of being a quad.

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(((((((((((((((((((hugs to you))))))))))))))))))for trying to take such good care of your patient.

You definitely get a gold star from me...........and those are not easy to come by.

Wish that there were more of you around, and I seriously mean that.

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Haven't used them in years, but I remember the struggle it was to apply them and keep them in place. I'm sure others will be able to help with this.

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Specializes in school nursing, ortho, trauma.

the ones i used to use didn't have an adhesive - had a fastener that is hard to describe - almost reminded me of one of those ties used to close the big contractor trash bags...(best likeness i can come up with...) and despite my doubts with it - it was pretty darn reliable... i want to say that hollister makes them but i am most likely wrong...

Dutchgirlrn is rithg with the technique - it's one ya have to do a few times to master. Good luck!

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Couldnt you get a foley catheter for him? I am aware of infection issues with this but it seems to me that he could be kept cleaner if he is not wet which will lead to fewer skin breakdowns. You would be more easily able to keep his skin clean. Male pts are usually very easy to catheterize. And you can turn him much more easily this way. just a thought. Good luck and I do agree that we need more caretakers just like you!

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Couldnt you get a foley catheter for him? I am aware of infection issues with this but it seems to me that he could be kept cleaner if he is not wet which will lead to fewer skin breakdowns. You would be more easily able to keep his skin clean. Male pts are usually very easy to catheterize. And you can turn him much more easily this way. just a thought. Good luck and I do agree that we need more caretakers just like you!

Hi..Thanks for the suggestion, but in FL CNAs are not allowed to use Foleys. The one time I got Tex on him, he like it and was dry the next AM. Like someone said earlier, practice makes pen......er....perfect.

Mike

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You know if this pt is homebound he probably qualifies for a home health nurse to make at least a weekly visit. That nurse could place and monitor the foley catheter. I have never had a good experience (for any length of time) with a texas cath. Usually there is just not enough of the pt to get a good hold of to effectively get the darn thing up, around and fastened. Good luck to you!

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Specializes in Family.

I took care of a quad not too long ago and we'd use foam tape to keep it on him, worked very well. Of course, he usually was semi at attention so to speak so putting it on wasn't difficult. Good luck!

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Hi again..

I said "Foley".......he said "DIE!" Monday night is the big event...not my demise but the Texas 2 liter hat. Check the obits for my name and thanks again for all your help!

Mike

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I almost do the same thing as Dutchgirl. First get permission to trim the hair near the base of the member or he is going to hate you when you try to take that off. I always hold the tip of the texas catheter (with my left thumb and forefinger) on the outside near the reservoir tip although it really isnt called that and place it to the member. Dont unroll yet! Now position the head of the member in that tip, gently grasp the member with your thumb and forefinger through the outside of the catheter. Now with your right hand just unroll.

Probably as a CNA it isnt your duty to warn him of the consequences and we dont know how bad the skin breakdown is. But if he will not stay off of his bottom and is incontinent I honestly dont know how that breakdown is going to heal. It doesnt matter if you use the best treatment in the world, keep him completely dry, etc, the most important way to heal a pressure sore is to relieve pressure.

If the breakdown is mainly coming from incontinence or if it is irritation perhaps go through your channels and get an order or permission to apply a barrier cream--you can get it over the counter, just something to prevent against moisture. Again I dont know the situation so really a nurse needs to look at it and give some options, we would look like a fool applying EPC cream to a stage 4 decub :roll

As with the other posters great job! Nice to know there is another caring CNA out there!

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Whew! It's Monday night and the Tex cath is in place. I think it should make it through the night, otherwise tromorrow at 8AM I'll have a nice surprise. He voids nearly 2 liters every night being a tube feeder. We did a little tonsorial action in the pubic area this morning so he's pretty well free of hair. I feel foolish asking this, but the various condom heads I've seen are marked with measurements like 28mm or 31mm. What are we measuring? Length of the condom, diameter of the member, circumference of the member, what? I think the ct's daughter bought some marked 28mm and there is no way I can get his soft 'head' in the tip. We didn't cover this in CNA school and the nurses at my agency weren't as much help as you angels. You wonder how I made it to age 60, and after 27 years as a manager in the car business at that! Thanks in advance for any more help you can give me.

Mike

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