Enough To Make Your Eyes Water

Oooh! That Smarts!

During Friday’s shift, one of my paramedic colleagues on another response car called me on the bat phone, “would you mind coming round and re-catheterising my patient? It appears that his catheter has come out.” “Not a problem.” This is another ECP ‘skill’ to assist with avoiding hospital admissions. We only re-catheterise men; no first time catheterisations. Although I jokingly describe this as “playing with old men’s willys” the relief for a patient with a blocked catheter who’s reached bursting point is equivalent to a patient in severe pain who’s given morphine.

For more information on male catheterisation see here.

This picture shows a typical male catheter. The small , tapered end inserts into the head of the penis and is passed along the urethra up into the bladder. There are two small openings near the tip which allow the urine to pass into the catheter.

We apply an anesthetic gel first by the way.

The end with the green cap is used for inflating the balloon inside the bladder with sterile water (see next picture). The other large opening, next to it, is where the urine drains out. This is attached to a catheter bag in which the urine is collected.

Arriving at the address I found Stan sitting in a chair. Now there’s no way I’m going to replace his catheter with him sitting up, so it was a slow shuffle into the bedroom. I began to get concerned when he exposed blood stained underwear. Once he’d got comfortable and we were all set to begin I saw that he had blood around the head of his penis but, more to the point, where was the previous catheter!?

“It’s come out.”

“Yes, but where is it?” A little fishing around down his trouser legs soon produced the elusive catheter. It had come out (been pulled out more likely). The bladder balloon was still inflated! – Oooo! Ouch! My word! It’s enough to make your eyes water! Imagine having a ball that size dragged down your penis. No wonder there was bleeding.

Here’s the catheter with the balloon inflated. This sits inside the bladder and should prevent the whole thing being withdrawn. That scrappy looking coin next to the balloon is in fact a ten pence piece, which gives you an idea of the size of the balloon.

I tried to refer him to the urology department but they passed the buck saying that I should re-catheterise him and refer him to A&E; which is what I did. The re-catheterisatioin was easy and did not appear to cause Stan any further discomfort, although I was very weary about doing it bearing in mind the possible trauma to his urethra

++++++++

Later on in the shift I assisted a crew with a patient who was supposedly fitting but was postictal on arrival. For reasons that are too long and complex to cover here, we (including his wife) all agreed that he should attend A&E, if only for observation, as there was a high probability he would fit again. As he slowly recovered he became more aggressive and unco-operative. His wife told us that he’d behaved like this once before when he’d had a stay on ITU. At that time he’d tried to discharge himself; he’d pulled out his I.V. lines and his urinary catheter.

“Did he pull it straight out? Without deflating the balloon?’

“Yes, he was in agony”

Blimey, two patients in the same shift who’ve yanked out their own catheters with the balloon still up. Maybe this is a new male rite of passage or something. Makes me cringe just thinking about it.

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8 Responses to Enough To Make Your Eyes Water

  1. Carmelo says:

    OWWWWWWWWWWWWWWWWWWWWWW!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
    Ouch Ouch Ouch OUCH!

    Any man who has had an operation on their “lower regions”, you know the one I mean, will also know the pain of stiches. I’m crossing me legs now…

  2. ecparamedic says:

    Eyes watering………………

    Looking back over the last couple of years I don’t think I’ve taken out a properly sited catheter yet, the last couple were definitely below the level of the prostate and had been partially refilled…………………. there go my eyes again.

    SD đŸ˜‰

  3. Murphy says:

    Thanks Magwitch. Reminded me of a certain visit to the vets when I was a mere puppy….

  4. Mart says:

    Ouch. Ouch. Ouch. I thought it was bad enough as I glanced at the second picture and assumed it was a 1 penny, but a 10 pence piece, Ouch, Ouch Ouch just…. I think i am going to go and lie down,

    Incidently, would a female ECP only cathaterise a female patient?

  5. magwitch says:

    ecparamedic: nearly all the catheters I’ve re-sited seem to have been inserted correctly. What normally puzzles me is why they blocked up in the first place. Some have all that horrible gunk around the tip but others seem clear.
    So far, I’ve failed completely to ever get a bladder wash to work.

    Murph: sorry for bringing back that nightmare day – still it was very noble (no ball getit!) of you to go through with it. Sorry, it’s been a long day.

    Mart: Oh you’ve touched on an ethical problem there. All ECPs in my county can catheterise males: no one is allowed to do females, not even the girls. We asked about it on the course but were told that as most in-home catheterisations are done by DNs who are, for the most part, women then it was OK for the girls to catheterise men. However, for male ECPs to catheterise women could involve all sorts of nightmare scenarios – the result is no female catheterisation

  6. Jo says:

    That makes me shudder – and I’m female!

  7. ian says:

    OUCH is all I can say

  8. ecparamedic says:

    Mag. I suspect that most of those that I have seen in this job have been buggered about with by someone with little or no knowledge of the A&P of the male GU system. It would be fair to say most have been in Nursing Homes.

    Having said that, one absolute cracker was the female length catheter inserted into a male, unsurprisingly he was having difficulty walking. That one was inserted by a Doc.

    Quite often they aren’t blocked at all, the bypassing can be caused by bladder spasm and urethral irritation, a common misconception is that you replace a bypassing catheter with a larger tube, the truth is the opposite, you should replace with a smaller catheter.

    Bladder irrigation is more relevant post TURP or TURBT when there is frank haematuria and debris present
    .
    SD đŸ˜‰

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