Genitourinary: Condom catheters (for nursing assistant training)

A condom catheter, also known as external urinary catheter or urinary sheath, consists of a flexible sheath that fits over the penis, much like a condom, and is connected to tubing that lets urine flow to a drainage bag. This provides a safe and non-invasive way to commonly manage urinary incontinence or involuntary loss of urine in biological males. 

Condom catheters should be changed on a daily basis. Now, before we talk about how to apply or remove a condom catheter, here are some general considerations. First, ask the nurse to tell you what catheter size to use. That’s important because if it’s too small, it may compress or traumatize the urethra, restricting the flow of urine or blood. And if it’s too large, it could leak or slip off. Clip the hair at the base of the penis or put on a hair guard before applying the catheter to prevent hairs from getting in the catheter. You also need to check the type of the condom catheter used. Some of them are held in place by a self-adhesive coating on their inside, while  others need an external strap of elastic tape. Remember to close the room’s door and bedside curtain and respect the client’s privacy. Before beginning the procedure, unclip the tubing from the bedsheet from the bed linens or the client’s leg, if there is any. Once you are finished replacing the condom catheter, secure the tubing again and make sure that it doesn’t have any kinks and that the condom is not twisted because that will obstruct urine flow. You also need to ensure that the drainage bag is placed below the level of the bladder to prevent the urine from flowing back into the bladder. 

Okay, so, you’re removing a condom catheter, and reapplying a new one. First, cover the over-bed table with paper towels. Then fill the wash basin with water and check that the temperature is comfortably warm. Place the basin together with soap, towels, and washcloths on the over-bed table. Ensure that the wheels on the bed are locked and raise the bed to a comfortable working height. Lower the side railings on the working side of the bed. Next, put your gloves on, slide a waterproof bed pad under the client’s buttocks to protect the bed linens, and cover the client with the bath blanket, exposing only the genital area. Ask them to spread their legs and bend their knees, if they can. If not, help them to do so, as much as possible. Next, to remove the condom catheter, pull the tape off - if there is any - and gently roll the condom down the penile shaft. Disconnect the tubing from the condom sheath, cap the tube, and discard the whole system. Then, wash the penis thoroughly with warm water and soap and dry it with a towel to prevent skin breakdown. Now, remove your gloves, practice hand hygiene, and put on clean gloves. 

When replacing a condom catheter, first, hold the penis tightly along its shaft with your non-dominant hand. Then, smoothly roll the condom sheath onto the penis using your dominant hand. Remember to allow a distance of 2.5-5 cm, or 1-2 inches, between the tip of the glans penis and the end of the condom catheter. Next, to secure the condom, if it’s self-adhesive, simply apply gentle pressure on the penile shaft for approximately 10-15 seconds. If not, apply an elastic tape strip in a spiral rather than a circular manner. This allows the tape to expand, preventing it from compromising blood flow to the penis. If they have a foreskin, return it to its normal position. Connect the end of the catheter to the drainage tubing.