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Urinary Catheterization Pants for Standardized Patients

  Submitted by: Jeff Carmack on July 15, 2016
  HomeGrown Solution Number: 283
Identification of the Problem
In an effort of deliberate practice, we wanted to increase the fidelity of urinary catheterization of a standardized patient to increase the opportunity for communication with a live person during a procedure that is often uncomfortable and embarrassing for the patient as well as can be embarrassing for students.
Unique Idea
Creating a pair of leggings that can be donned by a standardized participant to make the experience of talking to a patient while performing an intimate procedure such as a catheterization with capability to receive urine return.
Objectives
Create a pair of pants that allows a Standardized Patient to be catheterized
Supplies/Ingredients
1. Mannequin genitalia (male or female)
2. 3-Foley bags per set-up (1 that remains intact and the other for parts)
3. Brush-on super glue
4. Scissors
5. Appropriately sized adapters
6. 1000 ml IV fluid bag
7. Yellow food coloring
8. 10 ml syringe fitted with 18g needle
9. Primary (non-cartridge) straight IV tubing
10. Various sizes of flesh-colored (peach, dark brown, light brown, etc) leggings made of stretchable material (use the most appropriate colored legging to fit SP in size and color)
Steps to Creating the Solution
1. Using syringe and needle. Withdraw yellow food coloring to fill syringe and use to color 1000 ml IV bag (for simulated urine).
2. Cut a hole in the crotch of each pair of leggings that will still snugly fit around the selected mannequin genitalia being used.
3. Remove the rubber catheter off of one of the Foley set-ups and cut the largest diameter end off as close to the bifurcation as possible. (This piece will be used for the simulated urethra).
4. For the female version: Cut a large section of the clear foley tubing apart form the foley bag set-up. Super glue the large end of the rubber "urethra" to one end of this clear tubing. Feed the rubber urethra through the mannequin vagina as shown in picture. Continue with connection sequence listed in step 6.
5. For the male version: Cut a large section of clear tubing that will be glued to the back of the Mannequin's genitalia to the as seen in picture E. Use plumber's tape and super glue to create a water-tight seal. Continue with the connection sequence as listed in Step 6.
6. Connection Sequence: Attach the following pieces together in this order with super glue and or plumber's tape to prevent leaking. Female: simulated urethra in female mannequin genitalia--->clear foley tubing segment--->rubber catheter (full piece) with very tip cut off--->tip of IV tubing (cut off the luer-lock portion)--->IV tubing to spike IV bag of simulated urine (See Picture A) Male: male genitalia---->clear foley tubing segment--->bifurcation of rubber foley---> IV tubing tip (remove luer lock portion)--->IV tubing spiked IV bag of simulated urine (See Picture E)
7. Standardized patient should then don the leggings over another pair of tight fitting, thin material pants (to protect privacy), and place the appropriate mannequin genitalia though the cut hole. The tubing that runs to the bag of simulated urine should run up the side of the head of the bed to an IV pole. This portion should be hidden from the student view (can hide by placing a sheet over it or hanging behind a monitor), while allowing the SP to maintain control of the IV roller clamp (which controls urine flow). See Picture D.
8. Students should be instructed to insert the catheter just slightly further than expected for a normal female but male is about accurate anatomically. Once they are ready to fill the balloon, they should only use about 1mL of fluid. (Picture B shows the tip of the catheter as it appears in the clear foley tubing segment).
9. Standardized Participant should be instructed to open the roller clamp once they notice that student(s) have filled the balloon and removed the syringe. This will allow urine flow in to the catheter that the students placed. (See Picture B & E)
10. Absorbent pads should be used in the bed in case of leaking. The SP should bring a change of clothes in case of leaking as well.