INSERTION OF A SUPRAPUBIC CATHETER
What is it?
A catheter that is inserted through the skin on the lower part of the abdomen just above the pubic bone, directly into the bladder. The urine then drains out of this tube into a bag. The bag is emptied periodically. A balloon on the end of the catheter inside your bladder stops the tube from falling out.
Why is it placed?
Usually for the management of severe incontinence or urinary retention. There are other reasons. It is an alternative to a urethral catheter, one that comes out of the tube from the bladder where urine is usually passed.
What are the advantages over a urethral catheter?
Some patients find a suprapubic catheter is more comfortable, especially if they find the urethra is sore or irritated by a urethral catheter. A suprapubic catheter prevents urethral erosion. This is where the urethra (tube from the bladder) is eroded by the catheter balloon resulting in a big hole in the bladder so that the urethral catheter keeps falling out even with the balloon inflated and urine leaks out despite a urethral or suprapubic catheter. A suprapubic catheter is usually more convenient if you are sexually active. It is probably less likely to block than a urethral catheter as a large size tube can be placed. A suprapubic catheter can still cause urine infection or bleeding. Suprapubic catheters still need to be changed about every 6 weeks, (4-12 weeks). Changes are straightforward, this can be done by district nurses, continence nurses or your doctor.
Are there any disadvantages?
Some patients can get pain at the suprapubic site with infection, discharge or weeping from the site requiring them to wear a dressing over it. Some patients just prefer to wear a dressing over the site even if it is dry. If there is infection this may be treated with antibiotics but sometimes it requires removal of the suprapubic and then it replaced at a new location.
Some patients can leak urine from the urethra or around the catheter despite having a suprapubic catheter. Some patients can get granulation tissue growing at the suprapubic site. This can be burnt off, often in the rooms. If you have a suprapubic catheter placed and you don’t like it, it can easily be removed and a urethral catheter replaced. (The decision to have a suprapubic catheter is usually reversible).
How is it placed?
This is a minor procedure that takes about 15 minutes. It can be done with local anaesthetic although usually performed with some sedation or general anaesthesia. A cystoscopy at the same time confirms correct positioning in the bladder.
What are the risks of having a suprapubic catheter placed?
It is possible to get bleeding from the site. Urine leakage into the abdomen is rare. Perforation of the bowel at the time of placement is rare but a serious complication requiring further open surgery on the abdomen to repair the bowel. There are also general risks with surgery including cardiovascular (heart), and pulmonary (lung) illnesses; 2-5%. These include Deep Vein Thrombosis (blood clots in deep leg veins), Pulmonary Embolus (these clots dislodging and going to the lungs), pneumonia, Myocardial Infarction (heart attack) and Cerebrovascular Accident (stroke).
There is a small risk of death; 5 in 10,000 with surgery under anaesthesia.
What are the drainage options?
A leg bag - a smaller bag usually worn during the day concealed under your clothes.
A night bag - a larger bag holding more urine so it doesn’t need to emptied overnight.
A flip flow valve is a stopper like device with a tap. This can be plugged into the end of the catheter tube so that no bag is required. When the bladder is full the tap is opened to allow the bladder to drain into the toilet. This is not suitable for everyone as some patients have a bladder condition that means they leak urine around the catheter with this option. Always wash your hands before and after emptying the bag or using the valve.
How do you take care of your suprapubic catheter?
You will be instructed how to clean the skin around the catheter as well as the tube were it enters the skin each day. Cleaning with boiled water or saline is sufficient but some people use a betadine solution or antiseptic wipes. You may also need to apply a dressing. Usually a gauze dressing is all that is required. The catheter is usually secured to the leg with tape to prevent it moving or pulling. You should maintain a good fluid intake. The catheter bag should be washed out with soap and water once a week. You can also use one part white vinegar and three parts tap water to clean out the bag.
Keep the urine bag below the level of your bladder to prevent backflow of urine from the bag to your bladder. This will help prevent infection. Avoid sitting or lying on the tubing or kinking it which will block it and prevent urine draining. Vary the site or leg you tape the catheter to, to minimise skin irritation. If it falls out the hole can close over so it needs to be reinserted straight away, within about 20 minutes. Contact whoever usually changes your catheter or attend a medical clinic or emergency department to have it reinserted. If you have a spare catheter at home you may be instructed how to insert this until you get help to prevent the passage from closing over.
These occur periodically in patients with urethral or suprapubic catheters. With a catheter you can occasionally see some blood in the urine. It doesn’t always mean that there is an infection. If you feel unwell, feverish, the urine is very cloudy like pus or there is bladder pain then you should contact your local doctor for a urine test for infection. Antibiotics may be prescribed. When a catheter is in place a urine test will always show infection but only those that cause symptoms need to be treated with antibiotics. The catheter should also be changed if there is a symptomatic infection requiring treatment.
For a list of catheter supplies visit our website page.
Version: V3, July 2017