UNIT II Promoting Healthy Physiologic Responses

Skill 12-5 Applying an External Condom Catheter

When voluntary control of urination is not possible for male patients, an alternative to an
indwelling catheter is the external condom catheter. This soft, pliable sheath made of silicone
material is applied externally to the penis. Most devices are self-adhesive. The condom catheter is
connected to drainage tubing and a collection bag. The collection bag may be a leg bag. The risk for
urinary tract infection with a condom catheter is lower than the risk associated with an indwelling
urinary catheter. Nursing care of a patient with a condom catheter includes vigilant skin care to
prevent excoriation. This includes removing the condom catheter daily, washing the penis with soap
and water and drying carefully, and inspecting the skin for irritation. In hot and humid weather,
more frequent changing may be required. Always follow the manufacturer’s instructions for applying
the condom catheter because there are several variations. In all cases, take care to fasten the
condom securely enough to prevent leakage, yet not so tightly as to constrict the blood vessels in
the area. In addition, the tip of the tubing should be kept 1 to 2 inches (2.5 to 5 cm) beyond the tip
of the penis to prevent irritation to the sensitive glans area.

Maintaining free urinary drainage is another nursing priority. Institute measures to prevent
the tubing from becoming kinked and urine from backing up in the tubing. Urine can lead to
excoriation of the glans, so position the tubing that collects the urine from the condom so that it
draws urine away from the penis. Always use a measuring or sizing guide supplied by the
manufacturer to ensure the correct size of sheath is applied. Skin barriers, such as 3M or Skin Prep
can be applied to the penis to protect penile skin from irritation and changes in integrity.

Skill 12-5 Applying an External Condom Catheter

EQUIPMENT  Condom sheath in
appropriate size
 Skin protectant, such as 3M
or Skin Prep
 Bath blanket
 Reusable leg bag with
tubing or urinary drainage
setup
 Basin of warm water and
soap
 Disposable gloves
 Additional PPE, as indicated
 Washcloth and towel
 Scissors
ASSESSMENT Assess the patient’s knowledge of
the need for catheterization. Ask
the patient about any allergies,
especially to latex or tape. Assess
the size of the patient’s penis to
ensure that the appropriate-sized
condom catheter is used. Inspect
the skin in the groin and scrotal
area, noting any areas of redness,
 irritation, or breakdown.
NURSING DIAGNOSIS Determine the related factors for
the nursing diagnosis based on the
patient’s current status. Possible
nursing diagnoses may include:
 Impaired Urinary
Elimination
 Risk for Impaired Skin
Integrity
 Functional Urinary
Incontinence
OUTCOME IDENTIFICATION AND PLANNING The expected outcome to achieve
when applying a condom catheter is
that the patient’s urinary
elimination will be maintained, with
a urine output of at least 30
mL/hour, and the bladder is not
distended. Other outcomes may
include the following: the patient’s
skin remains clean, dry, and intact,
without evidence of irritation or
breakdown.
IMPLEMENTATION
ACTION RATIONALE
1. Bring necessary equipment to the bedside. Bringing everything to the bedside
conserves time and energy.
Arranging items nearby is
convenient, saves time, and avoids
unnecessary stretching and twisting
of muscles on the part of the nurse.
2. Perform hand hygiene and put on PPE, if Hand hygiene and PPE prevent the
indicated. spread of microorganisms.
PPE is required based on
transmission precautions.

3. Identify the patient. Identifying the patient ensures the

right patient receives the
intervention and helps prevent
errors.

4. Close curtains around bed and close the door to the This ensures the patient’s privacy.
room, if possible. Discuss the procedure with patient. This discussion promotes
Ask the patient if he has any allergies, especially to reassurance and provides
latex. knowledge about the procedure.
Dialogue encourages patient

5. Adjust bed to comfortable working height, usually
elbow height of the caregiver (VISN 8 Patient Safety
Center, 2009). Stand on the patient’s right side if you
are right-handed, or on patient’s left side if you are
left-handed.
6. Prepare urinary drainage setup or reusable leg bag
for attachment to condom sheath.
7. Position patient on his back with thighs slightly apart.
Drape patient so that only the area around the penis
is exposed. Slide waterproof pad under patient.
8. Put on disposable gloves. Trim any long pubic hair
that is in contact with penis.
9. Clean the genital area with washcloth, skin cleanser,
and warm water. If patient is uncircumcised, retract
foreskin and clean glans of penis. Replace foreskin.
Clean the tip of the penis first, moving the washcloth
in a circular motion from the meatus outward. Wash
the shaft of the penis using downward strokes
toward the pubic area. Rinse and dry. Remove gloves.
Perform hand hygiene again.
10. Apply skin protectant to penis and allow to dry
11. Roll condom sheath outward onto itself. Grasp penis
firmly with nondominant hand. Apply condom sheath
by rolling it onto penis with dominant hand (Figure
1). Leave 1 to 2 inches (2.5 to 5 cm) of space between
tip of penis and end of condom sheath.
participation and allows for
individualized nursing care. Some
condom catheters are made of
latex.
Having the bed at the proper height
prevents back and muscle strain.
Positioning on one side allows for
ease of use of dominant hand for
catheter application.
Provides for an organized approach
to the task.
Positioning allows access to site.
Draping prevents unnecessary
exposure and promotes warmth.
The waterproof pad will protect bed
linens from moisture.
Gloves prevent contact with blood
and body fluids. Trimming pubic hair
prevents pulling of hair by adhesive
without the risk of infection
associated with shaving.
Washing removes urine, secretions,
and microorganisms. The penis
must be clean and dry to minimize
skin irritation. If the foreskin is left
retracted, it may cause venous
congestion in the glans of the penis,
leading to edema.
Skin protectant minimizes the risk of
skin irritation from adhesive and
moisture and increases adhesive’s
ability to adhere to skin.
Rolling the condom sheath outward
allows for easier application. The
space prevents irritation to tip of
penis and allows free
drainage of urine.
 12. Apply pressure to sheath at the base of penis for 10 Application of pressure ensures
to 15 seconds. good adherence of adhesive with
skin.
13. Connect condom sheath to drainage setup (Figure 2). The collection device keeps the
Avoid kinking or twisting drainage tubing. patient dry. Kinked tubing
encourages backflow of urine.

14. Remove gloves. Secure drainage tubing to the Proper attachment prevents tension
patient’s inner thigh with Velcro leg strap or tape.on the sheath and potential
Leave some slack in tubing for leg movement. inadvertent removal.
15. Assist the patient to a comfortable position. Cover Positioning and covering provide
the patient with bed linens. Place the bed in the warmth and promote comfort. Bed
lowest position. in the lowest position promotes
patient safety.
16. Secure drainage bag below the level of the bladder. This facilitates drainage of urine and
Check that drainage tubing is not kinked and that prevents the backflow of urine.
movement of side rails does not interfere with the
drainage bag.
17. Remove equipment. Remove gloves and additional Proper disposal of equipment
PPE, if used. Perform hand hygiene. prevents transmission of
microorganisms. Removing PPE
properly reduces the risk for
infection transmission and
contamination of other items. Hand
hygiene prevents the spread of
microorganisms.
EVALUATION The expected outcome is met when
 the condom catheter is applied
without adverse effect; the patient’s
urinary elimination is maintained,
with a urine output of at least 30
mL/hour; and the patient’s skin
remains clean, dry, and intact,
without evidence of irritation or
breakdown.
DOCUMENTATION
Guidelines Document the application of the
condom catheter and the condition
of the patient’s skin. Record urine
output on the intake and output
record.
Sample Documentation 7/12/12 1910 Patient incontinent of
urine; states: “It just comes too fast.
I can’t get to the
bathroom in time.” Perineal skin
slightly reddened. Discussed
rationale for use of condom
catheter. Patient and wife agreeable
to trying condom catheter.
Medium-sized condom catheter
applied; 200 mL of clear urine
returned. Leg bag in place for
daytime use. Patient verbalized
understanding of need to call for
assistance to empty drainage bag.
—B. Clapp, RN
UNEXPECTED SITUATIONS AND ASSOCIATED INTERVENTIONS  Condom catheter leaks with
every voiding: Check size of
condom catheter. If it is too big
or too small, it may leak. Check
space between tip of penis and
end of condom sheath. If this
space is too small, the urine has
no place to go and will leak out.
 Condom catheter will not stay
on patient: Ensure that condom
catheter is correct size and that
penis is thoroughly dried before
applying condom catheter.
Remind patient that condom
catheter is in place, so that
patient does not tug at tubing. If
the patient has a retracted
penis, a condom catheter may
not be the best choice; there are
pouches made for patients with
a retracted penis.
 When assessing patient’s penis,
you find a break in skin integrity:
Do not reapply condom
catheter. Allow skin to be open
to air as much as possible. If
institution has a wound, ostomy,
and continence nurse, a consult
would be appropriate.