January 15, 2022
According to a recent study published in the Journal for Specialists in Pediatric Nursing , a recent survey found that 43% of American nurses incorrectly consider foreskin retraction an appropriate step for catheter placement in infant males. [1] However there are a number of complicating factors to this study.
The researchers recruited 345 respondents from social media groups for nursing professionals. The researchers admitted that "this sampling method often results in a homogenous sample of largely caucasian females ... [which] may limit the generalizability of the findings."
The study alternated between references to "retraction" and "forced retraction." One survey question asked, "Do you retract the foreskin of an infant male child for catheter replacement?" Another question asked, "Which of the following are appropriate genital hygiene practices for the intact infant male client?" One possible response was, "Retract the foreskin." But in their discussion of the responses, the authors cited the American Academy of Pediatrics guidance against forced retraction of the foreskin, which is more specific guidance than the survey questions asked.
The study indicates that retracting the foreskin is not an appropriate step during placement of a catheter, and the authors imply that American nurses are uniquely ignorant of this guidance. However several medical training materials from medical authorities outside the United States do recommend gentle foreskin retraction of an uncircumcised patient when placing a catheter.
Queen's University School of Medicine in Kingston, Ontario, Canada advises, "If the patient is uncircumcised, retract the foreskin. Replace the foreskin at the end of the procedure." [2]
University of Glasgow School of Medicine, Denistry & Nursing in Scotland recommends, "Ask the patient to retract the foreskin (or help to do this if he cannot)." A later step is "Replace the foreskin over the glans..." A checklist at the end of the guide reiterates, "Retract the foreskin, if necessary..." [3]
The Royal Children's Hospital Melbourne in Australia instructs nurses to "lift the penis and retract the foreskin if non-circumcised. Do not force the foreskin back, especially in infants." [4]
So it would seem that nurses who have been trained that foreskin retraction is an appropriate step during catheter insertion are in alignment with their international peers.
[1] Nadine Wodwaski DNP, MSN-ed, RN, ACNS, Kristen Munyan DNP, RN, FNP-BC; "As nurses, are we meeting the unique needs of the intact client?"; Journal for Specialists in Pediatric Nursing; August 25, 2021
[2] "Steps in male catheterization"; Queen's University School of Medicine
[3] "Male Catheterisation Guidance"; University of Glasgow School of Medicine, Dentistry & Nursing
[4] "Clinical Guidelines (Nursing): Indwelling urinary catheter - insertion and ongoing care"; The Royal Children's Hospital Melbourne; Updated September 2020