Assisting with Elimination
Applying a Condom Catheter
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- » Providing Catheter Care
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Safety
- Use Standard Precautions when handling body fluids.
- Verify that the patient does not have a latex allergy before applying a catheter made of latex.
- Do not shave the pubic area, because doing so may increase the risk of skin irritation.
- Secure the condom firmly, so that it is snug and stays on but is not tight enough to constrict blood flow. Applying gentle pressure on the device ensures adherence of the adhesive to the skin of the penile shaft.
- If you are using a condom catheter with an outer securing strip, use the spiral wrap technique to allow the elastic adhesive to expand, so that blood flow to the penis is not compromised.
- Be alert for signs of penile ulceration, erythema, swelling, or discoloration. If any such sign appears, do the following:
- Remove the condom, and notify the health care provider.
- Do not reapply the condom catheter until the penis and surrounding tissue are free of irritation.
- Reassess the patient’s current condom size. See the manufacturer’s size chart.
- Ensure that the condom is not twisted and that urine flow is unobstructed after applying the device.
- Keep the urinary drainage bag below the level of the patient’s bladder. Empty the drainage bag when it is halfway full, to avoid unnecessary tension on the catheter.
Equipment
(Roll cursor over items to see labels)
Basin of warm water
Condom catheter kit
- condom sheath
- securing device
- skin preparation solution
Stat lock and prep pads
Condom catheter
Leg bag with straps and tubing
Waterproof pad
Bath blanket
Towels and washcloth(s)
Clean gloves
Hair guard, or paper towel
Scissors
Soap
PrintableDelegation
Before a condom catheter is applied, the nurse must assess the skin of a patient’s penile shaft and determine whether the patient has a latex allergy. The skill of applying a condom catheter can be delegated to nursing assistive personnel (NAP). Be sure to inform NAP of the following:
- Follow the manufacturer’s instructions for applying the condom catheter and securing the device.
- Monitor the patient’s I&O, and record it, if applicable.
- Immediately report any redness, swelling, skin irritation, or breakdown of the tissue of the glans penis or penile shaft.
Preparation
- Assess the patient’s urinary pattern, ability to empty the bladder effectively, and degree of urinary continence.
- Assess the skin of the penis for rashes, erythema, and/or open areas. This assessment may be deferred until just before the catheter is applied.
- Assess the patient’s mental status, his knowledge of the purpose of using a condom-type catheter, and his ability to apply the device. It may be appropriate to include family members in the assessment.
- Verify the patient’s size and the type of condom catheter on the plan of care, or use the manufacturer’s measuring guide to measure the length and diameter of the penis when in a flaccid state.
Follow-up
- Observe the type of urinary drainage.
- Inspect the penis with the condom catheter in place within 15 to 30 minutes of applying it. Assess the penis for any swelling or discoloration, and ask the patient if he has any discomfort.
- Inspect the skin of the penile shaft for signs of breakdown or irritation at least daily, when performing hygiene, and before reapplying a condom catheter.
Documentation
- Record the application of a condom catheter; the condition of the penis, skin, and scrotum; urinary output; and the patient’s voiding pattern.
- Report any penile erythema, rashes, and/or skin breakdown.
Review Questions
1. When preparing to apply a condom catheter, the nurse would do what first?
Close the door and draw the bedside curtain
Obtain the patient’s written informed consent- Clamp the drainage tubing
- Offer the patient a urinal
CORRECT. This answer is correct, because the patient’s privacy must be protected throughout this intervention.
INCORRECT. Although it is appropriate for the nurse to explain the procedure to the patient, formally obtaining informed consent is not necessary.
INCORRECT. Although the drainage tubing will be clamped later, it is not the nurse’s first priority at this stage.
INCORRECT. A condom catheter is indicated primarily for patients with incontinence, not for those who have enough voluntary bladder control to void into a urinal on request.
2. Which instruction might the nurse give to nursing assistive personnel (NAP) about applying a condom catheter on a patient?
- “Check for breaks in the skin before applying the catheter.”
- “Determine whether the patient is still having problems with incontinence before you put the catheter on him.”
- “Read the manufacturer’s instructions for applying the adhesive to secure the condom.”
- “Be sure to get a snug fit between the tip of the penis and the end of the condom catheter.”
INCORRECT. Assessing the skin of the penis before applying the condom catheter is a nursing responsibility and cannot be delegated to NAP.
INCORRECT. Determining the patient’s level of incontinence is a nursing responsibility and cannot be delegated to NAP.
CORRECT. This is the best statement, since it provides NAP with direction that pertains to applying the condom catheter.
INCORRECT. This is not an appropriate instruction, since 2.5 to 5 cm (1 to 2 inches) of space must remain at the top of the catheter. The condom sheath, however, should fit snugly on the penile shaft.
3. Which instruction would the nurse give to nursing assistive personnel (NAP) to ensure the patient’s comfort when a condom catheter is applied?
- Wash the penis before applying the catheter.
- Clip the drainage bag to the bed.
- Wear gloves when applying the condom catheter.
- Use a hair guard before applying the condom catheter.
INCORRECT. Performing perineal hygiene is important for infection prevention but does not ensure the patient’s comfort.
INCORRECT. Excess drainage tubing is clipped to the bottom sheet. Keeping the drainage bag on the bed will not ensure the patient’s comfort; the bag must be kept below the level of the patient’s bladder.
INCORRECT. Wearing gloves when applying a condom catheter is important for infection prevention but does not ensure the patient’s comfort.
CORRECT. To ensure the patient’s comfort, the nurse would instruct NAP to use a hair guard before applying the condom catheter.
4. Why would the nurse ensure that a patient’s condom catheter is not twisted?
- To prevent the catheter from coming off
- To make sure the catheter is the correct size
- To ensure an adequate hourly urine output from the kidneys
- To prevent an allergic response
CORRECT. A twisted condom obstructs urine flow, causing urine pooling, skin irritation, and weakening and deterioration of the adhesive. These factors can cause the catheter to come off.
INCORRECT. A twisted catheter indicates improper application or positioning, not a poor fit.
INCORRECT. A twisted catheter has no effect on urine output; the kidneys will keep producing urine even if the condom catheter cannot contain it.
INCORRECT. Some patients are allergic to condom catheters made of latex (most are now made of silicon), but such an allergy is unrelated to the positioning of the catheter.
5. What would the nurse do for a patient who is complaining of penile pain 15 minutes after having a condom catheter applied?
- Offer an antiinflammatory medication.
- Drop the level of the urine drainage bag.
- Remove the catheter.
- Ensure that the catheter is not twisted.
INCORRECT. Providing medication is not appropriate because it addresses the symptom—pain—rather than determining its cause.
INCORRECT. A urine drainage bag that has been placed too high will not collect urine adequately, but it will not cause pain.
CORRECT. If a patient complains of pain 15 minutes after a condom catheter is applied, the nurse should remove the catheter and assess the patient to determine the cause of the pain.
INCORRECT. Ensuring that the catheter is not twisted is not sufficient, because checking the catheter’s positioning does not pinpoint the source of the pain.
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