Lecture Notes: Circumcision Procedure Overview by Dr. Kirschner at Pediatrics Northwest

Introduction

• Dr. Kirschner from Pediatrics Northwest discusses the circumcision procedure for infants.
• Focuses on ensuring the comfort and safety of the child during and after the procedure.

Comfort Measures

• Anesthetic Use:
  • Anesthetic injected on both sides of the penis.
• Pain Reduction Techniques:
  • Sugar water given via gloved finger or pacifier.
  • Aims to decrease pain perception.
  • Some infants might sleep during the procedure, while others may cry.

Parental Involvement

• Option to Observe:
  • Parents may choose to watch or not.
  • Comforting role can be taken by nursing staff if parents opt out.

Circumcision Techniques

• Procedure Overview:
  • Various techniques exist, but all aim for a circumcised outcome.
  • Aesthetic differences between circumcised penises, as with noses.
• Pediatrics Northwest Method:
  • Uses the Plastibell device.
  • Plastibell is a plastic ring placed over the penis head.
  • Foreskin pulled, tied with string, excess skin trimmed.
  • Ring and string remain attached, falling off in 3-10 days.

Post-Procedure Care

• Bleeding Management:
  • Normal to see blood spots up to a quarter size in diaper.
  • Larger bleeding or prolonged oozing should be reported.
  • Apply pressure with cloth for 3-5 minutes if bleeding occurs.
• New Skin Care:
  • New skin at the tip of the penis is sticky; risk of sticking to diaper.
  • Apply ointment (Vaseline, Aquaphor) liberally at each diaper change.
  • Use damp cloth instead of wipes for cleaning the front.
  • Avoid full baths for first 2 days; careful cleaning if stool contacts area.

Ring Separation and Monitoring

• Ring Separation:
  • Ring may separate unevenly; this is normal.
  • Contact the office if it remains over 2 weeks.
• Pain Management:
  • Initial anesthetic lasts 1-2 hours; wrap, feed, or soothe for discomfort.
  • Discuss Tylenol dosing if needed.

Potential Complications

• Ring Displacement:
  • Rarely, the ring can slide down the shaft, affecting blood flow.
  • Urgent contact required, regardless of office hours.
• Skin Reattachment:
  • Skin may slide back over or reattach; prevented by gentle backward pressure.
  • Higher risk will be discussed by provider.

Conclusion

• Encouragement to ask questions before the procedure.
• Assurance of support throughout the healing process.