In the United States, when we talk about a strait cath, typically we mean a catheter that doesn't have a balloon on the end of it, often times they are red and usually a 14 F. But in all honesty, if we don't have any without the balloons and I have to get a sample to send to the lab then I just grab a regular 16 F that does have a balloon on it. I inserts it, collect my sample then pull it back out again. In my area when we talk about a strait cath we are usually referencing the procedure, not the product being used. So if I need to cath them for a sample to send to the lab typically I will say, "I have to go strait cath this guy". Which tells my STNA's that the catheter will be in and out, and will be tossed once my sample is collected.
Now, if I go and tell them I'm putting in a Foley, then the STNA's know that I'm placing the catheter and it will be permanent. But like I said, if you are out of the red 14's, then you grab the next closest in size which will always have a balloon, then you stick it in, get your sample, and pull it back out and toss it.
Now, we also have these nifty little other things called female catheters. They are meant for one time use and do not have a balloon, but they are really cool. They consist of a collection tube that is about 6-7 inches long and about an inch and a half in diameter. Inside them is a 6 inch catheter if you can even call it that, lol. But I don't know what size the catheter is, but if I had to guess I would say it's probably someplace between a 4F and a 6F. Putting it in perspective, it's probably the size of a round coffee stirrer, about the same length too. But it comes with two lids, one lid that seals the tube when the sample has been collected, and the other which is connected to the tube in the bottle. So you flip open the cap on the tube and the little catheter is pulled up with it so you have room do grab it and pull it totally up and lock it into place. The package also comes with a label, the extra lid, and the lube. So when the tube is full, or you have had enough you simply unscrew the lid with the little catheter attached to it and toss it, then replace that lid with the other one in the package so nothing leaks. Sounds great, however I have gotten more complaints from women when I have used them. They say they hurt so much more than a normal catheter. The tiny catheter tube is made of plastic, and being that small of a size it would stand to reason that it's going to be a bit stiff and ridged. So I don't really use them very often.
Now on te guys. I was taught in nursing school to slowly advance the catheter, when you start getting urine then you can be almost certain you have made it through the bladder sphincter and into the bladder. Then, advance the catheter another few inches, then inflate your balloon, then pull back on the catheter gently to seat the catheter balloon against the neck of the bladder sphincter to help prevent urine from leaking out and around the Foley. And don't be alarmed if the first urine you see is slightly dark in color or even reddish. That often happens after you have disturbed the fine and very sensitive mucosa lining of the urethra, but that will clear in a relatively short period of time. Another thing when cathing a male, often times, probably more often than not actually I have to advance the catheter all the way to the bifurcation (meaning the back end of the catheter where it splits into 2 different ports), and that's perfectly fine. I always play with it a little when I get urine. I will advance it a bit more to see if I am still getting urine, and I will pull it out a bit for the same reason. It give me a "measurement" of sorts, allowing me to be able to see and help form a mental image of what I'm dealing with. Then as mentioned earlier, fill the balloon, seat the catheter, ask the patient if they are having any pain or discomfort, voicing complaints of a burning sensation, or feeling like they have to pee is normal and will also subside after a few minutes.
Peaches you mentioned something about a 16F being the average size, yes, that's primarily what I use and most others as well. They pretty much fit everyone, meaning adults. Children are a totally different story as they are not fully developed and naturally would require smaller sizes. Not talking about doing this to kids, just tossed it out there to put the next paragraph into a more proper perspective.
Then you said it can vary a little, "occasionally a 14F for smaller ladies, or an 28 F for larger people." Well I hope by that statement in reference to size you are not referring to their physical outward body size, are you? I don't want anyone reading this to make the assumption, or association that a patients height, weight, or body frame should, would, or could be a way of determining the appropriate size catheter to use on a patient because nothing could be further from the truth. When it comes to internal organs and other various inner workings and parts of a human body, usually there is no connection or correlation. I could go into hundreds of examples here to prove my point but don't really feel like I should need to. Every patient is different, so your best bet as you sort of pointed out earlier is to start with a 16. If it's causing pain, or feels like you are having to push it a little harder than normal, then apparently it's too big and you will need to place a 14. If you get the 16 in and it goes in very easily and you have leaking, chances are, you need to place either an 18 or a 20.
Working in the medical field and being the person that places caths as part of the gazillion other things often times you can pick up little helpful hints, or you are taught or learn things like, men faint at the site of a needle almost 75 percent more than woman. So the lesson to knowing this fact is, play it safe. If you are giving a guy a shot in his fanny either make him get up on the table and lay on his belly, or make him lay his chest on the table, not just be able to stand close to it and slightly bend over with his hands on the table, because in that position if he goes down he's going to go down and down hard, possibly hurting himself. I have a thousand little nursing trick, I might actually start a blog about them, like on yahoo on their articles "The 10 thing a waitress won't tell you". I'm sure it would be an eye opener for a lot of folks. Another little helpful hint, if a woman has had multiple vaginal delivery's, no matter what she's like in stature automatically start with a 20 F. Vaginal child bearing is not kind to a woman's body at all. Things can only be stretched so far and so many times until they will no longer go back to the original size, a urethra is absolutely no exception to this stretching out process, which consequently enough is why most women who have vaginal births eventually develop urine incontinence issues. Most can start off handling a 20 without any difficulty at all, but on the off chance she can't, then move down to an 18.
For the play docs out there, if you are going to play with catheters, since you are not medical professionals you should take every chance you can to do things as close to sterile and perfect as you can, to keep YOU and your patient safe. So if you plan on cath play, the cath kits are your best bet probably, then follow the instructions accordingly.
Now, let me let you in on another thing on the list of "things medical professionals won't tell you." Most facilities never use cath kits. Cath kits if you are lucky can start out at the 7 to 10 dollar range, usually they are about 15 bucks a pop. When we have to cath you we get a single catheter, a packet of lube and a collection cup if we are sending it to the lab, which the lab provides as part of their services, and if it's going to be an indwelling catheter the we will not bring the cup, but we will bring, a drainage bag, and a few syringes filled with sterile water to fill the balloon with, and a few "sani-wipes". That's it. Breaking it down into a manageable price reference here's the bottom line. Now keep in mind, we are a corporation and buy in bulk so we are going to get a cheaper rate.
Box of 30 catheters = 6 bucks so each catheter is 20 cents
Box of surgi-lube, we have to buy a case at a time,=10 bucks. 12 boxes in each case, 250 packs in each box, making 3000 lube packets which means .03 cents each
Box of Sani-wipes, again, bought by the case,=10 bucks. 10 boxes in a case, 200 in a box making 2,000 sani-wipes, so they are 2 cents each, we use three to cath someone making the cost 6 cents
We no longer have to use sterile gloves either according to the CDC, I can't tell you the price of gloves, but as many as we buy, they are dirt cheap, I use two pairs, I would say max price for both pairs of gloves is 10 cents
A box of regular Foley drain bags, 50 in a case =20 bucks. One is used so cost would be 40 cents each.
A box of leg bags, 50 to a box = 14 dollars. One is used so cost would be, rounding up about 28 cents each.
Boxes of syringes are dirt cheap too, I have no idea on their price, but I would be close in the ball park to say 10 cents each and I use 2 of them usually, costing a total of 20 cents
So the cost of placing a catheter to obtain a urine sample without using a cath kit is..
1) 1 catheter=20 cents
2) 1 surgilube pack=3 cents
3) 3 sani-wipes=6 cents
4) 1 lab cup=free
5) 2 sets of gloves=10 cents
Grand total is a whopping 39 cents.
The cost of placing an indwelling catheter is.....
1) 1 catheter=20 cents
2) 1 surgilube pack=3 cents
3) 3 sani-wipes=6 cents
4) 1 leg bag=28 cents
5) 2 sets of gloves=10 cents
6) 1 regular Foley drain bag=40 cents
7) 2 syringes filled with sterile water==20 cents
so the grand total of placing an indwelling catheter is a whopping........$1.27
See why we don't use prepared cath kits? Yesterday I had to cath 7 people, all were to obtain a urine sample to be sent out for a UA C & S. Doing it our way I spent $2.73. Had I used a cath kit, I would have spent someplace between $70.00-$105.00, so I saved my company anyplace from $67.27- $102.27, just on one hall, (we have 3) on one shift, in one day, on one procedure. And because most licensed professionals have the skill of cath placement mastered, or should have we know how to be quick, as sterile/clean as possible, even without the fancy expensive cath kits. Most of you guys don't quite have that luxury just quite yet, and that's okay. You guys need to stay as safe as possible, and if that means every time you cath someone it's going to cost you 15 bucks a pop, no pun intended, then that's what you gotta do. And the sad fact is, and this is going to come off totally wrong and I know it will, but if we medical professionals happen to cause a patient a UTI from placing a cath, rarely anything ever even gets said because it happens and usually can't be avoided. But if a layman places a catheter and your "patient" develops a UTI, you could wind up in prison for all kinds of things like, oh, I don't know, practicing medicine without a license, which they would then turn around and try and get you into deeper crap because you admitting that you don't have a medical license could be grounds for getting you on a charge of purposeful intent to cause harm, and the list goes on. So, once again, play docs and nurses play safe, play smart, play clean.
I am going to stick my head out on a plate here and tell you all a story I probably shouldn't. But you all need to really understand the severity and possible dangers of the toys you play with in your med fet games. Never forget that they are real medical equipment, to be handled by medical professionals. (Public Service Announcement)
My story goes....I had an order to strait cath a man for a UA C&S because he was suddenly becoming confused, staggering, unsteady gait etc, classic signs and symptoms of a UTI in the elderly. Well, that facility, (not the one I am at now) had a policy that if a urine needed to be collected for a UA, the sample was to be collected via strait cath for everyone whether they were continent or not. This cut down on a lot of repeat urine collection having to be collected due to the patient not being clean enough or whatever and the sample was contaminated. So, getting them by strait cath pretty much avoided that from happening completely. The facility was charged to have them run even when they were contaminated. Private insurances and medicare/medicaid wouldn't pay for the second test, but the facility was charged and had to pay for it, so you can see where I'm going, it was cheaper to spend the extra 2 bucks to strait cath them and get a good sample than to pay the 80 bucks or however much they cost for a test that would have no results and be worth nothing.
Okay, so I have to cath this guy. Our company changed supply companies and the new company stocked us with plastic strait catheters. I had never seen them before. Well, I went to his room at 2 am told him I had to cath him and blah blah blah, he agreed. I did my thing as I have been doing it for 7 years at that time, probably placed well over 1500 of them, have never caused anyone a UTI, and I have and still haven't ever been uncessful, not trying to brag, but they call me the cath queen and the shot queen, lol.
So I followed protocol in preparing his penis. The plastic catheter looked like the others, but it was a bit on the stiff side, but it's all I had to use because that's what the company went to due to costs. Well I stuck the catheter inside, was advancing it slowly, evenly, and with constant pressure just as I have always done. I didn't hit any resistance, things were going great. Next thing I knew, and this was a split second later, there was blood everywhere. It was all over me, him, the floor. I rushed him 911. The hospital called back and said that the catheter went right through the wall of his urethra. He lost a lot of blood. The surgeon ended up placing a very very large catheter to basically keep constant pressure on it to stop it from bleeding, it's called tamponod I believe. They sent him back, bleeding had stopped, no UTI, but he either had a brain bleed, or stage brain cancer and only had a few months to live. He died a week later. He got up out of bed after turning off his alarm, fell and hit is head and basically died instantly.
You can bet you sweet tush I had called my lawyer at the cath incident, then again when he died, I wasn't there that day thank goodness. My company by the way made their new suppliers take back all the plastic caths and replace them with either silicone or rubber ones. This mans daughter is one of the top RN's in the ER in one of the major hospitals in our state's capitol. She asked me what happened, gingerly I told her the truth, she asked me what kind of cath I used, she flipped. She stormed to the DON's office then came back and hugged me. She told me it wasn't my fault and that he didn't die from me puncturing his urethra, had absolutely nothing to do with it, but as a nurse herself, she knew I had to be blaming myself, and I absolutely was. I know better now, but still. I am not sure what she said to my DON at the time, but all of those plastic catheters were gone in less than 14 hours and replaced with the good softer ones.
So folks listen, things happen, I don't care how many times you have done them, things still happen. And trust me, when they do it really sucks. Putting in catheters really can actually kill someone and absolutely can do a lot of damage if you don't have at least the basic knowledge of placing/inserting a catheter, basic knowledge of human anatomy, common sense, and basic first aid.
And last by not least, play safe, play smart, don't be an idiot, ask for help, information, instructions or guidance when needed, that way you can actually have a crap ton of safe and sane play.
Mashie