Male external catheters in adults – Urinary catheter management

Intervention	Rationale
Wash your hands before (and after) the application and use gloves.	To prevent cross contamination.
Gather the equipment: • MEC • drainage bag (leg or bed) with tubing • water, soap, wash cloth, towel • scissors if needed	To ensure that the application process proceeds without any disturbance.
Explain the procedure to the patient.	To gain consent and co-operation and to ensure the patient understands the procedure.
Read the manufacturer’s instructions before applying a MEC with special features.	To ensure patient safety.
Wash the penis with soap and water	To ensure adhesion of the MEC.
Do not use re-hydrating soap as it may cause the adhesive to fail. If that is the only cleanser available do not put on a new MEC directly.
Rinse and dry.
Wait 5 to 10 minutes Wait for at least 15-20 minutes after a bath or shower before application.
Inspect the penis to make sure it does not have any broken or reddened skin.	To determine if a MEC can safely be used.
Trim the hair on the penis and its base.	The hair will not stick when the adhesive is applied.
Protective cloth placed over the base of the penis.	Can also assist in preventing hair from getting caught in the adhesive.
Another tip to keep the hair out of the way and to get a clean dry field around the base of the penis is to tear a small hole in the centre of a paper towel and then slip this over the penis to the base. [44]
Roll out the MEC as specified by the manufacturer’s instructions before rolling over the penis. [62]	Fig. 46. Roll out the MEC (Source: Manfred Sauer GmbH)
If the patient is not circumcised, hold on to the foreskin when you put on the MEC.	Pulls forward the retracted penis and makes it easier to apply the MEC Keeps the foreskin in the right place.
Leave 2-3 cm space between the tip of the penis and the end of the MEC.	More than 2-3 cm might promote catheter twisting and restrict the urine flow.
It is preferable if the penis is erect, but it is not absolutely necessary. If no erection is present, stretch the penis slightly by pulling.	It is easier to put the MEC over the penis.

Intervention	Rationale
Check patient’s records for allergies. If there is a possibility that the patient may be allergic to the MEC material or adhesive, do a skin test on a small area of skin before applying.	To prevent an allergic reaction in the patient.

Self-adhesive MEC
Stretch the penis gently as you roll on the MEC. When the MEC is unrolled, press it against the penis so that it adheres. No other glue or adhesive strip is needed.	Fig. 47.a, b, c. Press the MEC against the penis (Source: Manfred Sauer GmbH)
	Fig. 48. Self-adhesive MEC with a help stripe to roll on the MEC (Source: Coloplast)
MEC with tape strip
The tape strip is adhesive on both sides. A band of adhesive 2-3 cm wide is preferred.	To achieve the best adhesion of the MEC.
Apply the adhesive double-sided tape in a spiral overlapping fashion around the base of the penis.	Fig. 49. Spiral overlapping of the tape stripe (Source: Manfred Sauer GmbH)
Do not stretch the strip.	Make sure it is not too tight.
Roll on the MEC over the tape and press to attach.	To achieve the best adhesion of the MEC.
In the case of hydro-colloid tape, it is recommended that pressure is applied with the hands for about 30 seconds.	The warmth of the fingers will increase the adhesive strength. Fig. 50 Apply pressure on the MEC (Source: Manfred Sauer GmbH)
MEC with liquid adhesive
Apply the adhesive, in small quantities, in a ring on the middle of the penis shaft. Do not put adhesive on any skin defects.	To ensure the adhesion process is successful.
Spread the adhesive well and uniformly.	To ensure the adhesion process is successful.
Unroll the MEC over the adhesive.	To achieve adhesion of the MEC to the skin.
Do not wait too long before applying the MEC.	Or the glue may dry.
Press tightly on the MEC.	Fig. 51. Application in 4 steps (Source: Manfred Sauer GmbH)

Connect the drainage bag with tube to the connector tip.

To allow continent urine drainage into the urinary bag.

Make sure the system is free of twists and kinks.

When attaching a leg bag, adjust the length of the inlet tube, before connecting the MEC to the leg bag.

Fig. 52. Adjusting the length of the inlet tube
(Source: Manfred Sauer GmbH)

Fig. 53a. & b. Correct and wrong way to connect the MEC and the connector tube
(Source: Manfred Sauer GmbH)

Pay special attention to the foreskin of an uncircumcised male and make sure the foreskin is returned to its natural position.

Failure to return the foreskin can lead to swelling and possible constriction.

Check for proper size and adhesion of the MEC.

To prevent any complications in case of misfitting.

If necessary, to avoid pressure marks or if the penis retracts during micturition (emptying the bladder), the remaining rubber ring behind the adhering area can be removed by cutting or tearing the rim while the MEC remains adhered. [8,43]

Be careful that the skin is not damaged (special scissors are available).

Fig. 54. Cut the rim
(Source: Manfred Sauer GmbH)

Intervention

Rationale

Gather the following items:

o Waterproof pad or bath towel

o Bowl of warm water, soap, washcloth, and hand towel

o Correct size of MEC (small, medium, large, extra large)

o Velcro, tape, or other type of sheath holding material

o Urine bag with tube

• Wash your hands and your penis with soap and water. Rinse and dry your penis carefully.	To avoid cross contamination.
• Inspect your penis.	To ensure that it does not have any broken or reddened skin.
• Gently roll the MEC over your penis. Leave 2-5 cm of the MEC at the end of your penis.	To create enough space between the penis and tube.
• Wrap the sheath holder around the MEC at the base of your penis. Do not wrap the sheath holder too tightly because this may stop blood from going to your penis.	To prevent hair from becoming caught in the adhesive.
• Connect the MEC to the tube of the urine bag.	To ensure continent urine drainage.
• If you are using a small leg bag, use the catheter leg strap that came with your kit to secure the urine bag to your leg just below your knee. Leave some slack in the tube so the catheter will not be pulled when you move your leg.	To prevent disconnection of the tube from the drainage bag.
• The urine collection bag must be placed so that your urine flows downward. If you are in bed, you may attach the collection bag to your bed under the mattress. If you are sitting in a chair, you may attach the urine bag to the chair below the cushion you sit on.	To prevent disconnection of the tube from the drainage bag.

Problem	Possible reasons	Possible solutions
Pressure sore at the penis shaft	MEC is too small	Select a larger size MEC
	Pressure from the rim is too strong	Select a different product with shorter length
		Cut the rim with special scissors Fig. 54 Cut the rim (Source: Manfred Sauer GmbH)
	Pressure from the adhesive stripe/tape is too strong	The adhesive stripe/ tape should not be glued in a circular pattern, but in a spiral pattern
Pressure sore at the foreskin	Pressure from the MEC is too high due to e.g. an erection	Unroll the urinary sheath 4-6 cm to ensure that there is sufficient space between the foreskin and the tip of the MEC
Leg bag drainage problems - disruption of urine flow	The MEC is trapped beneath the elastic trim of the under garment Clothing is too tight	Select more loose fitting clothes
	The tube is too long or kinked	Check the tube
	The leg bag is not secured properly	Check the leg bag for security and position
	The leg bag is not positioned correctly	Replace the drainage bag
	The leg bag contains air
	The urine is cloudy	• Check for infection • Check fluid intake • Check pH of the urine
Leakage of the MEC	MEC does not fit well	Measure again and select the correct size
	The adhesive glue is not sufficiently effective	Use more adhesive glue Use a different brand of adhesive
	The adhesive and the MEC material are not compatible (glue does not stick to the catheter)	Use compatible material
	Technique used to apply adhesive is incorrect	Practise technique on a model first
	Hairs may be caught between the MEC and the skin - thereby producing small leakages	Remove the hair
The connecting tube keeps slipping away from the MEC		Choose compatible materials Roll the connecting tube a little further over the tip of the MEC for more security
Air in the urinary bag	Never allow air to enter the leg bag through the outlet tap	Always leave a small amount of urine in the bottom of the bag. This increases the suction in the system (creating a partial vacuum) which helps drainage and prevents build-up of urine in the buffer zone of the urinary sheath
Skin irritation or sores	Sensitivity / allergy to skin care products or material	Test an alternative product on a neutral area of skin; e.g. inside the wrist, to ensure there is no allergic reaction
	Prolonged use of adhesives	Replace MEC with one made of different material. Use a different brand of adhesive - before use, test on a neutral area of skin
	Talcum powder	Use MEC containing no talcum powder
Allergic skin reaction	Latex sensitivity or allergy	Use talcum powder-free MEC as well as latex-free MEC
Skin too damp	MEC was applied too soon after a bath or shower	Ideally, wait at least 15 minutes after a shower or a bath before applying the MEC
Skin abrasions, fungal infections
Urinary tract infection	Check that urine can flow freely, tube is not kinked Do bladder scan to see if any residual urine	Patient education, inform on the mechanism of UTI development and provide clear instructions on the hygienic aspects involved in using MEC
	Low fluid intake	Increase fluid intake
	MEC replacement interval is more than 24 hours	Replace more often
MEC does not stay in place	Redundant or hyper-mobile prepuce	After consultation with a doctor and the patient, circumcision may be a consideration (will apply to long-term usage)

Male external catheters in adults – Urinary catheter management (2016)

15. APPENDICES

Appendix B. Patient’s teaching procedure for applying MEC

Appendix C. Troubleshooting

Appendix D. Flowchart MEC - Urinary bag decision tree

Appendix E. Voiding diary