please help - Page 2

[mamaverdi]

If one had no choice but to "go by feel" (which is different from fishing IMO), then TONS of lube needs to be applied to the very very very smallest catheter available.

I would cautiously say to someone who understood that the idea is to move as much of the easily moveable skin down. But this type of direction is somewhat ambiguous and can be followed in a way with very undesirable results.

Another key is to watch the child very carefully for signs of pain. A catheter can be uncomfortable, but it should not be painful. Someone who is very praticed should cause very little discomfort even.

I agree pictures would be very helpful.

Too many catheters in my life. Not a nurse, just a mom. I've taught some nurses how to cath my baby pre- and post-stoma.

[caricandothis]

This is one of my biggest fears since having my intact son. I'm so sorry that your son was hurt, that just breaks my heart.

[MCatLvrMom2A&X]

It is possible to move the tip of the foreskin back enough to see the meatus without forcing anything. Not that you should do so but when it comes to cath. they can do this there is no need to rip the whole thing back. They do this because they think it needs to be cleaned under it but since it is fused down there is nothing under there to clean.

If you look closely at the foreskin opening you can see the overhang and it can tighten down some without causing a problem.

There is of course no reason at all to do this but if your ds has to be cathed this much manipulation is acceptable. You have to see the hole so that you dont hurt the glans by "fishing" but you dont have to rip the whole thing back to see the hole either.

I have seen ds's meatus by gently moving the foreskin around before without it ever getting tight. I am sure not all boys work the same but the principle is the same gentle manipulation when cath is needed wont hurt anything. But it has to be the bare minimum to prevent problems.

[AllieFaye]

As a mother of a special needs boy, I'm cath'ing him twice a day (down from six times, hopefully soon to be only once a day.) I've never moved his foreskin when I do it, not even a bit. Here's my process: I wash my hands. I dab a bit of iodine around the tip of the penis, with a Q-tip. Then, I put a generous amount of lubricant on a single-use catheter. I gently insert the catheter straight into the tip. I hold the penis with my left hand where the shaft meets the glans, so there is no chance that the foreskin can accidentally get pushed back. There is no fishing or visualizing or anything. The meatus is front and center, and easy to find (kind of like the clitoris: ) Most importantly, I'm relaxed and calm. Sometimes I let my son play with a toy, or I sing to him. Whatever makes the catheterization experience as pleasurable as can be. At the end, I remove the catheter straight out.

Male or female, baby or adult - why wouldn't one use lube? I mean, seriously, why not make it as comfortable as possible? Now that I've done it, I have no idea why anyone would make such a fuss over cath'ing an intact boy, vs. a circ'ed boy. Inserting the catheter is easy; it's the wiggly baby part that's hard. In fact, now I'm so much more enraged that "ease of catheterization" was presented as a reason to circ my son. I would think that a girl would be much more difficult, but nobody's suggesting that girls be circ'ed over cath'ing. I don't understand why someone thinks they need to see where the tube is going in; it's not rocket science. Anyone who insists that they need to must have a serious lack of skill. I learned in all of two minutes. It's not that hard!

[jessjgh1]

I have no understanding of catheterization.... how the tube would actually work, how careful you have to be, etc... I had it done to me... but I've never had to do it or actuallhy seen it done, but it is my understanding is that there is a lot of variation with where the meatus/hole is, and that for many boys it is slightly off center.

Perhaps your son's is lined up and that's why this works for you??

It certainly doesn't seem simple to me...

I'd certainly like to see a downloadable print out on this. One that is very 'simple' that even the most arrogant medical professional can understand. One with options of cathing or the bagging method. Perhaps with a little nice side note about damages that are known to occur with forced retraction and that this medical incompetence (ie lawsuit material) for a little incentive.

BTW, I don't think the term 'flange' is specific enough to feel comfortable using it to describe the care needed to do this... I think it leads to be interpreted as gentle retraction.. and 'fishing around' sounds incredibly painful.

Jessica

[mamaverdi]

It's actually fairly easy to do, fairly hard to explain. The wording is going to depend upon the person interpretting it which is why just words is not enough. I agree flange is probably not an exact enough word. But I can't think of another word. Sorry.

And they do always use lube. It's how much lube. And if they have to try again, sometimes they forget to get more lube.

[jessjgh1]

Well the other point (of many) is that as long as the practitioner is fairly gentle and respectful of the foreskin, there is unlikely to be a serioius problem-- unlike a nurse just forcibly retraction with no reason/care/or sense of possible injury.

So even if the wording is hard to explain, etc.... just having such a guideline is VERY likely to prevent many problems even if it won't be failproof.

How can we make this happen??? Ask NoCirc Marilyn Milos?? DOC?

Jessica

[mamaverdi]

The problem is, and I will try to say this nicely, it's hard to explain gentleness to some HCPs. Ideally all would be caring. Some though are just "doing their job." Having exact words and/or pictures and/or proper training would alieviate pain w/o expecting anyone to care.

I really hate that I even have to say that. But there it is.