STAN AND THE TEXAS CATHETER

One of my demented patients, I will call Stan, was being worked up to find the source of infection because of an elevated white blood cell count of 15.8 and fever. The usual orders to determine the source of infection is blood work (CBC), urinanalysis (UA) with culture, and chest x-ray (CXR). The CXR was negative. I was figuring it had to be in his urine since urinary tract infections (UTI’s) are common in the nursing home population. Stan is totally incontinent of stool and urine. He also has periods of agitation and has been known to hit the nursing staff. When it is necessary to do any type of procedure on Stan he needs to be held down because he fights. The nurses tried to get a urine sample by cathing him without success. Stan also has benign prostatic hypertrophy and they could not get the catheter around the prostate. His confusion would not allow for a urinal or indwelling urinary catheter. He would pull the catheter out and cause more problems. The nursing staff came up with plan D, a condom catheter, or what I was taught a Texas catheter. This type of catheter is basically a condom with the tubing and bag like a regular urinary catheter, just less invasive for the patient. When the staff went in to put the Texas catheter on Stan they needed to hold him down. Stan talks using common words but they are not in any particular order. He pretty much speaks in a nonsense speech pattern but every once in a while comes up with a complete sentence. When the nursing assistants and LPN’s went in to put the Texas catheter on Stan he boldly told them:

“Don’t dress him up. He isn’t going anywhere.”

Well for a demented old man that had to be one of the funniest things I had ever heard. The staff apparently had to contain themselves from laughing out loud while putting on the catheter. Once the sample was obtained it was obvious he had a UTI. He was treated and is now his happy demented self.