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The size of catheters and instruments made for urethra insertion is usually designated according to the "French Scale." The numbers used refer to the circumference of the item measured in millimeters. A 30 French catheter is millimeters in circumference. Using the formula we were taught in junior high school, diameter equals circumference divided by pi (3.14), we can determine that the diameter of the 30 French catheter is just a little bit under 10 millimeters. Now if the metric system has you completely snowed, just relate this to something you are familiar with which measured in millimeters, for instance, a piece of 8 mm or 16 mm movie film. A chart of French sizes is shown at the end of this article. Also think of it this way: Take a soda straw (not a bar straw)–A 14Fr will go easily down a soda straw, a 16Fr will still fit inside it, an 18Fr will not go in the straw. Catheters are available in basically two different styles: straight and Foley with multitudinous variations of specific shape, coatings, etc. The straight catheter is a straight tube of pliable plastic or rubber. One end is rounded to prevent any trauma to tissue, with the opening of the lumen (the opening) down the center of the tube) on the side. The other end of a catheter is enlarged to form a connection to some type drainage or collection system, and more importantly prevent the catheter from being completely "lost" into the urethra. Any urethral insertion scene should be done under meticulously clean conditions. It should not be done in conjunction with a scene involving rectal or ass play, because of the risk of contamination of the urethral tract with bacteria such as E. coli normally present and harmless in the bowel, but can raise havoc when introduced to other parts of the body. Hands should be washed thoroughly with hot soap and water and the tip of the penis should be cleaned with soap and water or a non-irritating antiseptic solution such as a Benzalkonium Antiseptic Towelette followed by a Betadine wipe. To insert a catheter the penis is first pulled up to a right angle to the body or even slightly higher. This straightens out the first half of the normal "S" curve to the urethra, as shown in the illustration. The catheter and the opening of the penis should be copiously lubricated with a sterile water-soluble lubricant such as KY or Surgilube from a freshly opened tube or packet. If at all possible, the three or more inches of the catheter closest to the tip should remain "untouched by human hands."
The catheter is guided gently into the opening in the end of the penis. It should go fairly easily for the first six to twelve inches depending on how well-hung the recipient is, and then its normal to encounter some resistance. You will also, probably at the same time as you encounter resistance, perceive a change in the reaction of the person receiving the catheter. This means that the tip of the catheter is now in the area of the prostate, causing an altered sensation in that area, and encountering the sphincter muscles, which are probably closed at this time. A little firm, gentle pressure will usually overcome this resistance, resulting in a flow of urine through the catheter (did you provide something to catch it in?), and a sign of relief and satisfaction from your bottom. There's at least one person reading this by now who's turning red in the face and jumping up and down, screaming "You're giving him an infection!!! Catheterization is a STERILE procedure! Why aren't you wearing sterile gloves?" That person is probably either in a medical or hospital professional or has had a catheterization done in such a setting. In hospital catheterizations are done in one of the most infection-laden (most of them antibiotic-resistant) environments known. Most patients are there because they already have one infection or another; the staff is going from patient to patient; and in spite of the best infection control, techniques inadvertently spread some infection from place to place and patient to patient. Additionally, catheterizations in the medical setting are done on patients who have some difficulty in fighting infection or they wouldn't need the catheterization in the first place. Also, many catheters in hospital and nursing home settings are in place for days and weeks, as opposed to minutes or hours in the S & M setting. Still, the equipment must be sterile and all else should be scrupulously clean. If sterile gloves are available and add a degree of comfort, they certainly may be worn. In fact, if one plans on coming into contact with the urine, it probably is a good idea to wear latex gloves as a protection against body fluid contamination. The gloves should be clean and unused, if not sterile, so as not to become a source of contamination in themselves. Catheterization with a straight catheter such as described above is primarily an "in and out" procedure. It provides the satisfaction, for the bottom, of giving over control of a very intimate bodily function. In addition, the sensations of insertion and removal are very much present. It is also possible to place a small loop of tape around the catheter and up onto the penis to hold the catheter in place for a longer period of time. The Foley catheter is designed for in-dwelling, long-term use. The catheter has two lumens extending its length, essentially two tubes in one, one ending in an opening near the end for draining the bladder, the other communicating with a balloon just below the drainage opening which can be inflated with sterile water once it's inside the bladder anchoring it in place and preventing it from slipping back out until the balloon is deflated. NEVER use air for inflating in the bladder! The drainage lumen terminates in the same type of connector as the straight catheter, and the balloon lumen terminates in a valve arrangement which allows the balloon to be inflated with sterile water and deflated. A Foley catheter is inserted using the same technique as described for the straight catheter above; however; the balloon should not be inflated until a urine return has been obtained and the catheter advanced another two to three inches to ensure that the balloon is entirely within the bladder and not in the urethra, where inflation of the balloon could result in serious damage. A Foley catheter may he used for extended urine control scenes. It may be attached to a leg bag and worn under clothes, it can be left in place and the urine allowed to drip out slowly, or it may be clamped to prevent urination. In the latter case, care should be taken that it is not clamped too long. Excess filling of the bladder can cause reflux up the ureters which can contribute to severe kidney problems, or pressure down the ductus deferens and vas deferens, leading to epididymitis. Before this trip is attempted, one should be well aware of individual bladder capacities and methods of assessing bladder fullness-urgency fullness, palpability etc. Patients who have suffered some type of inability to urinate have been drained of as much 1,000 cc's (one liter, or about a quart of urine) or more at the time of the first catheterization. Forcing the retention of this much urine may well be dangerous. We don't know how much back-pressure has occurred, or what possible damage might have already been done in such a case. Additionally the medical rule of thumb is never to drain more than 1,000 cc's at one time without clamping off and waiting awhile, as the sudden loss of this much fluid could clause fluid shifts within the body leading to fainting or other complications. Care should also be taken when a Foley catheter is in place to protect the catheter from undue tension, which could cause trauma to the bottom of the bladder or the urethra where it joins the bladder. One drug overdose patient managed to pull his catheter and inflated balloon down into the urethra in such a manner that it would not go either way and in addition occluded the balloon lumen in such a manner that it could not be deflated. If the catheter is to stay in place for an extended period of time, it should be secured to the leg in such a manner that tension is not placed on the catheter or the balloon. Another type of catheter is the irrigation, or "three-way" catheter so named from the three lumens running the length of the catheter: one communicating with the balloon and two ending in two different openings beyond the balloon and terminating in two connections outside of the body. One lumen is for the introduction of a sterile isotonic irrigation solution and the other lumen is for draining irrigation solution and urine out of the bladder. In the S & M scene, this is a highly specialized technique meriting a DungeonMaster rating of "X Highly Restricted." If you don't have a source of sterile normal saline and a completely sterile infusion system, this is probably a trip to leave to someone more experienced and with a source of the proper supplies and equipment. Balloon capacities are normally marked on the inflation port for the balloon lumen. Five cc's will fill the balloon up to about the size of a thumbnail. Capacities vary anywhere from five to fifty cc's. Care should be taken not to over-inflate the balloon to any significant degree. This will weaken the latex and the balloon will not deflate properly for removing the catheter Instead, it will wrinkle, leaving potentially irritating irregular surfaces. In addition, there is always the risk that the balloon will burst when overly inflated. |
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