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of different sizes, which generally increase in increments of 5–10 mm, and in either standard or short lengths (Robinson 2006). Silicone sheaths are advantageous as they are transparent, allowing the patient’s skin to be observed and to breathe by allowing the transmission of water vapour and oxygen (Booth and Lee 2005).

Fixation

The main methods in current use follow two different approaches. First, the sheaths can be self-adhesive, so that the sheath itself has a section along its length with adhesive on the internal aspect that sticks to the penile shaft as it is applied. The second method is a double-sided strip of hypoallergenic or foam material applied in a spiral around the penis (which increases the surface area of the conveen adhered to the penis) and then the sheath is applied over the top. Newer devices have been developed which move away from the condom catheter-based system and employ a unique hydrocolloid ‘petal’ design which adheres only to a small area of the glans penis around the meatus, ensuring a comfortable and secure fit and are ideal for men with a retracted penis (Wells 2008).

Procedure guideline 6.3 Penile sheath application

Essential equipment

Bowl of warm water and soap

Non-sterile gloves

Selection of appropriate penile sheaths

Bactericidal alcohol handrub

Disposable plastic apron

Drainage bag and stand or holder

Hypoallergenic tape or leg strap

Catheter leg bag

Preprocedure

Action Rationale

1 Explain and discuss the procedure with the patient. To ensure that the patient understands the procedure and gives his valid consent (NMC 2008a, C).

2 Screen the bed. To ensure patient’s privacy. To allow dust and airborne organisms to settle before the field is exposed (NMC 2008b, C).

3 Assist the patient to get into the supine position with the legs extended. To ensure the appropriate area is easily accessible. E

4 Do not expose the patient at this stage of the procedure. To maintain patient’s dignity and comfort (NMC 2008b, C).

5 Wash hands using bactericidal soap and water or bactericidal alcohol handrub. To reduce risk of infection (Fraise and Bradley 2009, E).

6 Put on a disposable plastic apron. To reduce risk of cross-infection from micro-organisms on uniform (Fraise and Bradley 2009, E).

7 Prepare the trolley, placing all equipment required on the bottom shelf. The top shelf acts as a clean working surface. E

8 Take the trolley to the patient’s bedside, disturbing screens as little as possible. To minimize airborne contamination (Fraise and Bradley 2009, E).

Procedure

9 Remove cover, maintaining the patient’s privacy, and position a disposable pad under the patient’s buttocks and thighs. To ensure urine does not leak onto bedclothes. E

10 Clean hands with a bactericidal alcohol handrub. Hands may have become contaminated by handling the outer packs (Fraise and Bradley 2009, E).

11 Put on non-sterile gloves. To reduce risk of cross-infection (Fraise and Bradley 2009, E).

12 Retract the foreskin, if necessary, and clean the penis with soap and water. Dry completely and reduce or reposition the foreskin. To remove old adhesive and ensure sheath sticks to the skin and to prevent retraction and constriction of the foreskin behind the glans penis (paraphimosis) which may occur if this is not performed. E

13 Trim any excess pubic hair from around the base of the penis. To prevent sheath from painfully pulling pubic hair when applied. E

14 Apply sheath following manufacturer’s guidelines, ensuring that there is a space between the glans penis and the sheath. Squeeze the sheath gently around the penile shaft. To prevent the sheath from rubbing the glans penis and causing discomfort and potential skin irritation and to ensure sheath has adhered to penis (Pomfret 2003, C).

15 Connect catheter bag and ensure tubing is not kinked. To facilitate drainage of urine into catheter bag. E

16 Dispose of equipment in a orange plastic clinical waste bag and seal the bag before moving the trolley. To prevent environmental contamination. Orange is the recognized colour for clinical waste (DH