Suprapubic Catheter Flashcards
SHO Fails Catheter Insertion in a 64M in ACUTE retention
Assess, Exam and Initiate management
Assess
History -
Prev Catheter Attempts, Instrumentation, Urological History, Pelvic SurgeryRadiotherapy.
LUTS
Haematuria
RFs - Smoker, Weight Loss, Change in appetie, Lower limb swelling
PMH - ?Fit. ?On any anticoagulations
DH - Anticoagulants. Any Allergies - ?Gentamicin/Penicillin
Examination
Ensure adequately resuscitated / observations stable
Abdomen
- ?Palpable bladder
- ?Loin tenderness
- ?Scars
Genital
-?Hypospadias (LTC)
? Meatal stricture
Attempt catheterisation with 14 Ch catheter
- Purpose - try to establish level of obstruction
- If this fails re-attempt with 16Ch Coude Tip catheter. Curve tip towards 12 o clock position
- All attempts at catheterisation with Asceptic Non Touch Technique + ample lubrication (2 -3 Tubes of instillagel)
Unable to catheterise- still in retention
Next Options
- Consider using a catheter introduce if any colleagues are comfortable using this
- Flexible Cystoscope to point of obstruction and pass a guidewire past the point of obstruction (attempt to rail road an open tipped catheter over the wire)
- Suprapubic Asipirate
- Suprapubic Catheter
Suprapubic Catheter
Indications
Contra indications
Equipment
Consent
Procedure
Op Note
Indications
Failed urethral catheterisation in urinary retention
Urethral Trauma
Post penectomy
Neurological Disease
Intractible urinary incontinence
Recurrent Urethral Stricture disease
Suprapubic Catheter
Indications
Contra indications
Equipment
Consent
Procedure
Op Note
Contra-Indications
Absolute - Known/Suspected Bladder cancer, Abdominal wall sepsis, Fem-Fem Cross Over Graft
Relative - Lower abdominal surgery, Obesity, Anticoagulation
Suprapubic Catheter
Indications
Contra indications
Equipment
Consent
Procedure
Op Note
Equipment
Cleaning Soloution
Sterile Gloves
Drape
Local Anaesthetic (Lidocaine)
21 Gage Needle
Scalpel
Seldinger Suprapubic Catheter Set
14 Ch 2 Way catheter
Urine collection bag
Urine Sample Bottle
Suprapubic Catheter
Indications
Contra indications
Equipment
Consent
Procedure
Op Note
Consent
Confirm patient details. Explain the procedure in simple terms, using pictures and BAUS information leaflet.
Indication - Urinary Bladder Drainage
Alternatives - Rigid Cystoscopy under GA and attempted catheterisation
Risks:
Bleeding, Infection, Pain, Urinary Tract Symptoms
Bladder Stones, Catheter Blockage, Catheter encrustation. Recurrent UTIs, Damage - bowel/bladder/blood vessels/ Urethra
Urine Leakage
Anaesthetic Risks
Risk of death (1%)
Other Procedures - Open Procedure to repair damaged organs
Sign, print, date - patient to do the same
Suprapubic Catheter
Indications
Contra indications
Equipment
Consent
Procedure
Op Note
Perform
Ensure consent, Adequate positioning, Patient cleaning & preparation. Check local anaesthetic
Use ultrasound if available
If not available - 2 fingers breadths above pubic symphysis
21 Gage needle - infiltrate local anaesthetic and then aspirate urine
Insert guidewire through needle
Remove needle
Make a stab incision using a no 11 blade
Insert trocar over guidewire
Remove guidewire
Remove inner trocar and occlude
Insert 2 way catheter
Inflate balloon
Peel away outer sheath
attach catheter to urometer
Take a urine sample for urine culture
Suprapubic Catheter
Indications
Contra indications
Equipment
Consent
Procedure
Op Note
Indications
Failed urethral catheterisation in urinary retention
Urethral Trauma
Post penectomy
Neurological Disease
Intractible urinary incontinence
Recurrent Urethral Stricture disease
Contra-Indications
Absolute - Known/Suspected Bladder cancer, Abdominal wall sepsis, Fem-Fem Cross Over Graft
Relative - Lower abdominal surgery, Obesity, Anticoagulation
Equipment
Cleaning Soloution
Sterile Gloves
Drape
Local Anaesthetic (Lidocaine)
21 Gage Needle
Scalpel
Seldinger Suprapubic Catheter Set
14 Ch 2 Way catheter
Urine collection bag
Urine Sample Bottle
Consent
Confirm patient details. Explain the procedure in simple terms, using pictures and BAUS information leaflet.
Indication - Urinary Bladder Drainage
Alternatives - Rigid Cystoscopy under GA and attempted catheterisation
Risks:
Bleeding, Infection, Pain, Urinary Tract Symptoms
Bladder Stones, Catheter Blockage, Catheter encrustation. Recurrent UTIs, Damage - bowel/bladder/blood vessels/ Urethra
Urine Leakage
Anaesthetic Risks
Risk of death (1%)
Other Procedures - Open Procedure to repair damaged organs
Sign, print, date - patient to do the same
Perform
Ensure consent, Adequate positioning, Patient cleaning & preparation. Check local anaesthetic
Use ultrasound if available
If not available - 2 fingers breadths above pubic symphysis
21 Gage needle - infiltrate local anaesthetic and then aspirate urine
Insert guidewire through needle
Remove needle
Make a stab incision using a no 11 blade
Insert trocar over guidewire
Remove guidewire
Remove inner trocar and occlude
Insert 2 way catheter
Inflate balloon
Peel away outer sheath
attach catheter to urometer
Take a urine sample for urine culture
Op Note
Date and Time
Setting: Emergency / Elective
Surgeons
Anaesthetic: 10 ml Lidocaine 1%
Antibiotics: Gentamicin + ?
Position: Supine
Name of procedure
Describe procedure
Follow Up:
Eat + Drink
Monitor urine output for evidence of post obstructive diuresis (>200 ml/hour)
Monitor for signs of abdominal pain
Catheter to be changed in 6 weeks in hospital (arrange)
Catheter should not be removed
Consider management of stricture/prostate etc.
Give contact detail for catheter nurses
