What is a Suprapubic Urinary Catheter?
A suprapubic urinary catheter is a hollow flexible tube that is used to drain urine from the bladder. It is inserted into the bladder through a cut in the tummy (abdomen), a few inches/ centimeters below the navel (tummy button). This is usually done under a general anesthetic by a urological surgeon.
Why Do I Have a Suprapubic Tube?
A suprapubic tube (SPT) is a catheter that is used temporarily (or permanently) to empty the bladder. Other reasons may be:
- The urethra (the tube where urine comes out) has been traumatized/damaged.
- For people who require long-term catheterization and are sexually active.
- After some gynecological operations e.g. surgery for a prolapsed uterus (womb) or bladder.
- Some wheelchair users find this method simpler to manage.
- People who cannot perform self-catheterization.
- Long-term catheterization for incontinence. Although this is not generally recommended, sometimes medical staff feel it appropriate to avoid skin problems or other medical complications.
Advantages of a SPT
- When using a urethral catheter, the water tube may become damaged over time, resulting in leakage of urine around the catheter. Additionally the balloon of the urethral catheter can cause damage to the bladder neck, leading to leakage or urine around the catheter. A catheter that is forced through the opening and closing mechanism of the bladder can also cause damage.
- The catheter is less likely to be sat on or accidentally pulled.
- If a supra pubic catheter becomes blocked, urine can generally drain via that urethra which can act as a safety net.
- A suprapubic catheter leaves your genitals free for sexual activity.
- It is easier to maintain hygiene around the site of a suprapubic catheter.
- If you have adequate hand function you can be taught to change your pubic catheter as the site is more accessible to you than the urethra.
- The procedure is reversible. The suprapubic catheter site will heal quickly on permanent removal of the catheter.
- A larger size catheter can be used reducing the risk of blocked catheters. Urethral catheters are generally no larger than 16 Charriere (Ch), whereas a sub catheter can be gradually increased over. Of time from size 16 Ch up to size 20 Ch.
Disadvantages of SPT: What Are the Risks?
- A few people experience heightened feeling around the supra pubic catheter site but this often reduces with time.
- If you are very overweight it may be difficult to cite the catheter.
- The catheter site may produce a discharge. And for some people this dries up after a few weeks but for others it may be persistent. It may be necessary to wear a simple dressing over the site.
- Spasm (bladder and urethra cramps and) may increase for a few weeks after the procedure.
- All indwelling catheters (catheter inserted into the bladder and) are more likely to cause urinary tract infections and bladder stones than other platter management methods such as intermittent self catheterization or a penile sheath urinary collection system.
- Over time you may suffer from frequent catheter blockages which may require you to have a cystoscopy — a surgical instrument (telescope) is inserted into your bladder to view the inside and allow it to be washed out.
- Very occasionally the catheter may need to be re-sited if the opening becomes too tight causing routine catheter changes to be difficult.
What Stops a Suprapubic Catheter From Falling Out?
You may have a stitch in place after initial insertion which may be removed by your district/ practice nurse after 7 days. A small balloon at the tip of the catheter is inflated with sterile water to prevent it from falling out.
What Happens to the Urine?
There are two options:
Free drainage: the urine drains out of the catheter and is then stored in a drainage bag.
Catheter valve: a valve at the end of the catheter is used in place of a drainage bag. Urine is stored in the bladder and is emptied through a catheter straight into a toilet or receptacle. Your urology health care professional will advise you whether this method is suitable for you.
How Do I Care For My SPT?
- Always wash your hands with soap and water before and after handling your catheter.
- Cleanse skin around catheter with soap and water daily.
- Make sure that the catheter tubing does not get twisted or kinked, and that urine is flowing out of the catheter into the urine collection bag.
- Keep the urine collection bag below the level of your bladder.
- Make sure that the urine collection bag does not drag and pull on the catheter.
- You can shower with your catheter and urine collection bag in place unless you have been told not to.
- Clean the bag every day after removing it from the catheter. To clean the bag, fill it with 2 parts vinegar to 3 parts water and let it stand for 20 minutes. Then empty it out and let it air-dry.
- Wipe connection between the bag and catheter with alcohol when attaching bag or plug.
- Use a new catheter plug each day or soak catheter plug overnight in alcohol.
How and When Do I Plug My SPT?
There are two types of drainage bags:
Day bag – A leg bag which is worn under your normal clothes during the day is held in place by straps. There are many different types of day bags available; your Healthcare Professional will help you decide which bag is most suitable for you.
Night bag: A bag used whilst you are in bed. This bag is much larger and is attached to the leg bag to hold all the urine that drains from the bladder overnight. It is a good idea to place a basin under the night drainage bag incase of leakage during the night. Night bags may be darinable or non-drainable.
Generally day bags and drainable night bags are changed every 5-7 days according to manufacturer guidelines. Non drainable night bags are changed daily. It is recommended that should the leg bag become detached from the catheter a new bag should be used. If bags become damaged or visibly dirty they should be changed sooner.
Disposal: Drainage bags should be emptied, wrapped and placed with domestic waste.
- Use overnight drainage bag at night while sleeping.
- Plug catheter upon awakening.
- Attempt to urinate every few hours while awake, but only unplug the catheter every 4 hours or if you feel your bladder is full.
- Always attempting to void prior to unplugging your catheter.
When Should You Call For Help?
Call your doctor or seek immediate medical care if:
- Your catheter becomes blocked and urine does not collect in the drainage bag.
- Your catheter leaks.
- You have blood or pus in your urine.
- You have pain in your back just below your rib cage. This is called flank pain.
- You have a fever, chills, or body aches.
- You have groin or belly pain.
- Your urine is cloudy or smells bad.
- You have pain, increasing redness, or bleeding around the catheter.
- You have swelling around the catheter or in your belly.
Information derived from a NHS pdf.