Double diapering is a method used to protect the urethra and stent or catheter after surgery where the inner diaper contains stool and the outer diaper contains urine allowing separation between the bowel and bladder output.
Double diapering in pediatrics is a specialized technique used primarily after urologic surgeries—such as hypospadias or epispadias repair—to protect catheters or stents and reduce the risk of infection or accidental dislodgement.
Indication
- Post-operative drainage after urethral or bladder surgery (e.g., repair of hypospadias/epispadias)
- Any situation with a catheter or stent exiting near the diaper area where secure urinary diversion is needed
Purpose of Double Diapering
- Separates urine and stool to minimize contamination of the surgical site.
- Stabilizes catheters or stents by preventing tugging or kinking.
- Maintains cleanliness and reduces infection risk during the healing period.
Diapers
| Item | Specification |
|---|---|
| Inner diaper | Child’s usual size |
| Outer diaper | One size larger than usual |
| Catheter/stent | As placed by surgeon |
How It Works
| Component | Function |
|---|---|
| Inner diaper | Collects stool; same size as the child normally wears. |
| Outer diaper | Collects urine via catheter/stent; one size larger than usual. |
Procedure
- Cut a hole or a cross-shaped slit in the front of the smaller diaper.
- Unfold both diapers and place the smaller diaper (with the hole) inside the larger one.
- Place both diapers under the child.
- Carefully bring the penis (if applicable) and catheter/stent through the hole in the smaller diaper and close the diaper.
- Close the larger diaper, making sure the tip of the catheter/stent is inside the larger diaper.
Nursing Responsibilities
- Change the outer diaper every 3–4 hours or when wet.
- Change the inner diaper when soiled or at least three times daily.
- Monitor for urine output—a dry outer diaper may indicate a blocked catheter.
- Educate caregivers on proper technique and signs of complications.
Special Considerations
- Surgical type and catheter design determine whether double diapering is appropriate. Some stents may require closed drainage instead.
- Avoid cutting holes in the inner diaper—this can release absorbent gel beads that may clog the catheter.
- Always ensure urine flows “downhill” to prevent backflow and reduce infection risk.
- Change the outer diaper every 3–4 hours or when wet; change the inner diaper when soiled or at least three times daily.
- Use barrier creams to protect peristomal skin from moisture and irritation.
- Monitor for signs of UTI or peristomal infection: fever, foul odor, redness, or swelling.
- Ensure the catheter is not kinked or twisted—a dry outer diaper may indicate blockage.
- Position the catheter between the two diapers, not through a hole, to maintain separation of urine and stool.
- Secure the catheter to prevent tugging or dislodgement, especially during diaper changes.
- Teach caregivers the step-by-step technique, signs of complications, and when to call the provider.
- Emphasize the importance of gentle handling and frequent monitoring.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- De Pellegrin M, Damia CM, Marcucci L, Moharamzadeh D. Double Diapering Ineffectiveness in Avoiding Adduction and Extension in Newborns Hips. Children (Basel). 2021 Feb 26;8(3):179. https://pmc.ncbi.nlm.nih.gov/articles/PMC7996815/
- Double diapering facilitates hip maturation in newbornsLee, Wei Chun et al.Pediatrics & Neonatology, Volume 63, Issue 2, 159 – 164
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