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 This sits inside the bladder and should prevent the whole thing being withdrawn.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.