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Managing bypassing and suprapubic catheter blockage

Bypassing may occur either through the urethra or around the catheter site.

Task 15

1

What are the three main potential causes of bypassing in patients with suprapubic catheters?

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The three main potential causes are:

1. Catheter blockage

2. Insufficient bladder neck closure, e.g. due to sphincter insufficiency

3. Overactive bladder

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Detrusor overactivity can be treated with antimuscarinic medication and surgery may be required for sphincter insufficiency (Harrison et al, 2010). Repeated catheter blockages are associated with the development of renal and bladder stones and it has been recommended that this should be investigated via cystoscopy (Harrison et al, 2010).

Task 16

2
If the blockage is not caused by small stones, what action should the nurse take to reduce the risk of further blockage?

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- Advise the patient to increase their fluid intake

- Increase the Charrière size of the catheter

- Increase frequency of planned catheter changes

- Consider introducing citric acid bladder instillations (e.g. Suby-G or Solution R)

- Raise the level of the drainage bag if this is suspected to be causing a siphoning effect and drawing bladder tissue into the catheter eyelets (Harrison et al, 2010)

- Change to a catheter valve rather than a bag if the patient has sufficient safe bladder capacity without risk to upper tracts

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