Suprapubic and Clean Intermittent Self-Catheterisation

Question 1

Identify some other indications for suprapubic catheterisation.

Answer 1

• To reduce the risk of urethral trauma and erosion in long-term catheterisation
• To improve quality of life, comfort or dignity
• For people with neurological disorders who are unable to self-catheterise
• To facilitate self-management of the catheter
• To facilitate surgical approaches during urological procedures
• Phimosis
• Urethral stricture

Question 2

Can you identify potential contra-indications to suprapubic catheterisation?

Answer 2

• The bladder is empty
• Bladder tumours
• Abdominal wounds, especially if associated with infection or significant scarring (adhesions)
• Coagulation and bleeding disorders, including those on anticoagulation or antiplatelet treatment
• The presence of a subcutaneous vascular graft in the suprapubic region (e.g. a femorofemoral crossover graft) (Harrison et al, 2010)

Question 3

two most serious complications of suprapubic catheter insertion

Answer 3

Bowel perforation or intestinal injury

Haemorrhage from perforation of vascular structures within the pelvis (Intra-abdominal bleeding)

Question 4

What might indicate a bowel perforation had occurred?

Answer 4

• Abdominal pain (persistent lower abdominal pain, spreading away from insertion site)
• Pyrexia
• Signs of localised peritonitis

Question 5

Managinng Abdominal wounds:
When would antibiotics be indicated for treatment of a suspected wound infection?

Answer 5

If cellulitis is present around the insertion site and the patient is showing signs of infection, e.g. pyrexia, then systemic antibiotics would be indicated.

Question 6

Exudate around the wound puts the patient at risk of moisture associated skin damage.

How should moisture associated skin damage be prevented?

Answer 6

• Gentle cleansing of surrounding skin using pH neutral skin cleansers
• Moisturisation of the skin
• Protection using an appropriate barrier

Question 7

Over-granulation is another problem that can commonly occur at the wound site.

How should over-granulation be managed?

Answer 7

Silver nitrate sticks can be used to cauterise granulation tissue if this forms around the catheter. A barrier cream should be applied to healthy skin to prevent damage from the application of silver nitrate.

Question 8

How frequently should you change a suprapubic catheter

Answer 8

8-12 weeks

Question 9

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

Answer 9

1. Catheter blockage
2. Insufficient bladder neck closure, e.g. due to sphincter insufficiency
3. Overactive bladder

Question 10

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

Answer 10

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