OWN THE PENIS

Surgical registrars say the darnedest things. Last week a surgical registrar, a good friend of mine, tried to impress his consultant in the operating theatre. Totally unprompted and from out of the blue he claimed the penis could be a reliable alternative for gaining venous access in shocked patients. The consultant gave him the longest and blankest stare ever stared. Time stopped.

Then afterwards, in an attempt to make up for his awkward faux pas, my surgical registrar pal sent me an e-mail with two references. None of those two journals are available to me where I am at the moment.

I have no intention of replying to his e-mail.  I won’t let him get out of the weirdness he created that day just yet.

 

Thomas D says:
Funny, weird – but also interesting. This seems as viable as an I.O. access. The I.P., intra penile, access. I did get to read the Urology article, and they got flow rates comparable to good I.O. needles by inserting i.v. cannulas into the corpus callosum, and much higher flows with bigger or multiple cannulas in place. The penile corpora was easily identifiable and accessable even after they had drained the animals for blood to the state of shock. All attempts at I.P. access was successful, and no major adverse effects were observed:

“Throughout the 18 attempts of intracavernosal vascular access, no failures occurred, and a single trial was all that was needed for each attempt. The dense tunica albuginea allowed easy identification of the corpora from the surrounding structures, rendering corporeal cannulation easy. This dense fascial covering keeps the sinusoidal network opened even in states of extreme volume depletion. Additionally, our transfusion lines were established within 14 to 48 seconds and were easily maintained throughout all sessions.”

But I think as long as the medical profession is still male dominated, we won’t really see this method being used much – let alone mentioned much. Still, I can’t wait for Cliff to teach this at his HEMS induction course!

Articles:
Corpus cavernosum as an alternative means of intravenous access in the emergency setting, Aust N Z J Surg, 2000.

Blood transfusion and resuscitation using penile corpora: an experimental study, Urology, 2005.

This entry was posted in Emergency Medicine, Prehospital Medicine, Trauma. Bookmark the permalink.

11 Responses to OWN THE PENIS

  1. Nothing like a short fat one in the short fat one.

    Used this route once back in 2003 and still remember the weird looks from intensivist…

    If your surgical colleague attended an EMST course in Adelaide, I may be to blame for sowing this seed…

  2. Thomas D says:

    Good story, Tim! So, it’s called a Leeuwenburg access?

  3. Minh Le Cong says:

    can anyone describe or explain how to practically do this? Do you get a normal 14G PIV cannula set and just stick it into the ventral aspect of the penile shaft and aspirate for blood then pass the cannula..or do you need to use a metal needle? Have there been reported complications such as compartment syndrome like we are seeing with prolonged IO use?
    I have aspirated blood from the cavernosum for emergent treatment of priapism..thats easy to do..on others. But in the non erect penis..I imagine that its tricky in the non donkey..non dog. I am sure there is a subculture that exists that probably has the experience.

  4. 14G cannula, advance, flashback, slide cannula forward a few mm, flush, tape to side of willy, infuse.

    I should probably allocate one nurse to ‘tend’ the infusion and ensure runs well…

    As I said, done this once years ago…I will stick to std routes and RIC or IO in future

    Still cross my legs thinking of it…

    • Thomas D says:

      Thanks for the description, Tim! So, I guess you insert it at a fairly low angle to the penis, to avoid going through the corpora? According to the study, you should also feel a pop going through the tunica albuginea surrounding the corpus cavernosum?

      And Tim, what was the background story for you going for an IP access in 2003?

      I doubt the IP access will ever be a popular choice – for a lot of reasons…

  5. Minh Le Cong says:

    I am not blind, its just that I have seen enough.

  6. Daniel Knowles says:

    This has been reported in humans as well. From a quick PubMed search I found two studies reporting successful cannulation of the corpora allowing transfusion of blood and infusion of crystalloid in a total of 48 patients. The only reported complications were subcutaneous hematoma in three patients.

    The second article includes an illustration of the setup.

    Ann Emerg Med. 1982 May;11(5):266-8.
    The penis-a possible alternative emergency venous access for males?
    Godec CJ, Cass AS.

    Front Biosci. 2006 Sep 1;11:2535-7.
    Corpora cavernosa as an alternative route for transfusion.
    Shafik A, El Sibai O, Shafik IA, Shafik AA.

  7. FERAIDOON KHAYYAMFAR says:

    Hi .I have used the IC rout .I am urologist and my Pts BP was systolic 50 mmHg .Pts iv line was lost & getting IV access was not possible. It was during open prostatectomy surgery,you can pass a large IV cannula through the glans penis in to corpora.we infused 800 ml N/S in about 5 min Pts BP raised to 90 mmHg systolic and then the anesthesiologist gained a venous access

Leave a Reply

Your email address will not be published. Required fields are marked *