Suprapubic and Clean Intermittent Self-Catheterisation

Table of Contents

1. Introduction
2. Indications for suprapubic and intermittent catheterisation
   1. Suprapubic catheters
   2. Intermittent Catheterisation
3. Risks and complications of suprapubic catheters
4. Care and management of suprapubic catheters
   1. Managing the abdominal wound
5. Changing a suprapubic catheter
   1. Managing bypassing and suprapubic catheter blockage
6. Teaching patients to self-catheterise
   1. Frequency of catheterisation
7. Product choice
   1. Other information needs
8. Summary
9. References

Changing a suprapubic catheter

Appropriately trained and competent nurses can change a suprapubic catheter and community nurses often carry out this procedure in the patient's own home. The catheter should be changed in accordance with manufacturer's instructions, normally every 8-12 weeks. The first change should not be undertaken for at least two weeks and should preferably be delayed for at least six weeks to allow the newly formed tract to "mature" (Harrison et al, 2010).

Task 11

1

Is this statement true or false? The first change of catheter should be undertaken by the team who inserted the original. Choose one option and then select Check answer. a) True b) False Yes, it is false. It is a commonly held misconception and there is no reason why the first change should not be performed by a competent nurse (Anderson et al, 2002).It is false. It is a commonly held misconception and there is no reason why the first change should not be performed by a competent nurse (Anderson et al, 2002).Your answer has been saved.

Task 12

2

If a patient has a history of recurrent catheter blockage, how often should the catheter be changed? Enter your answer in the box below and then select Check answer. The catheter should be changed if it becomes blocked, but ideally the patient's catheter history should inform the frequency of changes. If a patient is known to be at risk of blockage after five weeks, then planned catheter changes should be instituted to pre-empt this happening.

The catheter should be replaced by a long-term self-retaining (Foley) catheter of the same Charrière size (minimum 16Ch) and standard length for both males and females. Latex based or silicone catheters may be used, but silicone catheters are known to be prone to "cuffing" as the balloon does not lie flush against the catheter once deflated (Parkin et al, 2002). This can lead to painful or difficult removal.

Task 13

3

How far should the catheter be inserted? Enter your answer in the box below and then select Check answer. There is a risk that the catheter might be either not inserted far enough, which would result in balloon inflation within the tract, or pass through the bladder into the urethra. The catheter should be inserted until the inflation arm touches the skin and the balloon then inflated slowly, while observing the patient for any discomfort or feeling for obvious resistance to inflation (Harrison et al, 2010). In women it is prudent to check that the balloon has not passed right out through the urethra. Once inflated the catheter is drawn back to settle the balloon against the wall of the bladder.

Urine does not always flow when a new catheter is inserted, especially if the previous catheter has just been removed and the bladder is empty. It is acceptable to fill the bladder with a small amount of sterile saline prior to removal of the old catheter (Harrison, et al, 2010) or the nurse can wait for a few minutes to allow urine formed to enter the bladder, however the new catheter must be passed within 30 minutes or there is a risk that the tract will start to close.

If the nurse is concerned about the patency of an existing tract on changing the catheter or if problems are encountered with the reinsertion then urgent advice should be sought from urology/urogynaecolgy teams as a matter of urgency (NPSA, 2009b; Harrison et al, 2010). It may be possible for the tract to be salvaged if the patient is referred urgently to secondary care.

Task 14

4

Can patients and/or carers be taught to change suprapubic catheters? Choose one option and then select Check answer. a) Yes b) No Yes. This option should be considered if possible as this will help to promote independence (Harrison et al, 2010).The correct answer is Yes. This option should be considered if possible as this will help to promote independence (Harrison et al, 2010).Your answer has been saved.