Suprapubic Catheter Insertion and/or Change

CHAPTER 113 Suprapubic Catheter Insertion and/or Change



Robert E. James, James R. Palleschi


Suprapubic catheters are normally used to provide short-term urinary drainage. If the patient’s age or comorbid conditions preclude corrective surgery, the temporary catheter may be left in place or, with the aid of an exchange wire and appropriate dilators, may be replaced with a permanent suprapubic catheter.



Indications



• An impassable urethral stricture, bladder neck contracture, or obstruction

• Inability to pass a urethral catheter over an elevated bladder neck or an enlarged median lobe of the prostate gland

• Urethral trauma

• Recent urethral or bladder neck reconstructive surgery

• Inability to tolerate a urethral catheter and unwilling or unable to perform intermittent self-catheterization

• Bladder drainage required in the presence of a significant urethral or prostate infection

• Severe phimosis precluding the insertion of a urethral catheter (see Chapter 119, Dorsal Slit for Phimosis)


Contraindications



• Uncooperative patient

• Anticoagulated patient or patient with coagulopathy (either the anticoagulation/coagulopathy should be reversed or urology consulted)

• Cellulitis over the insertion site

• Surgical scar in suprapubic area, or bladder or pelvic anatomic abnormality from previous surgery, cancer, or trauma (small bowel may be interposed in the retropubic space; however, ultrasonographic guidance may be helpful for avoiding small bowel; see Chapter 225, Emergency Department, Hospitalist, and Office Ultrasonography [Clinical Ultrasonography])


Equipment



• Local anesthetic: 10-mL lidocaine 1% to 2%

• 10-mL syringe; image-inch, 22-gauge spinal needle

• Antiseptic skin preparation (e.g., povidone–iodine)

• Sterile towels

• Sterile saline, to possibly fill the bladder, irrigate the catheter, or inflate a Foley bulb

• Mask and sterile gloves

• Mounted scalpel blade (no. 11 or no. 15)

• Suture scissors, needle holder, and 2-0 nylon suture

• Closed urinary drainage system

• Suprapubic catheter set

NOTE: There are many manufacturers of suprapubic catheters and insertion kits, including the Bonnano catheter (Becton-Dickinson Corp.), Stamey percutaneous suprapubic catheter set (Cook Medical/Urological), and the Simplastic suprapubic catheter/SupraFoley suprapubic catheter introducer (Rusch, Inc./Teleflex Medical).


The principal components of each set, except for the SupraFoley suprapubic catheter introducer, are a metal obturator and the suprapubic catheter. The metal obturator is placed down through the suprapubic catheter and is subsequently removed when the catheter is appropriately positioned within the bladder. The end of the catheter may consist of a coudé tip (with balloon), Malecot tip, or Foley. Unlike the red rubber catheter (also known as the Robinson), which is not self-retaining, all of these catheters are equally effective in retaining themselves within the bladder (Fig. 113-1).


image

Figure 113-1 Commonly used catheters. A, Foley-type balloon catheter. B, Malecot self-containing, four-wing urethral catheter. C, Malecot self-retaining, two-wing catheter. D, Coudé hollow, olive-tip catheter. E, Robinson urethral catheter.


(From Walsh PC, Retik AB, Vaughan ED Jr, Wein AJ [eds]: Campbell’s Urology, 7th ed. Philadelphia, WB Saunders, 1998.)



Preprocedure Patient Preparation


Explain the indications for, alternatives to, and risks of the procedure to the patient. Informed consent should be obtained. The patient should know what to expect during the procedure, including the need for injection of local anesthetic before the procedure. Also explain to the patient that mild to moderate suprapubic discomfort may be experienced for a few hours to days after this procedure.



Technique



1 Place the patient in the supine position. If the bladder is not palpable, either the procedure should be delayed until the bladder can be easily identified or else the insertion should be completed with ultrasonographic guidance (see Chapter 225, Emergency Department, Hospitalist, and Office Ultrasonography [Clinical Ultrasonography]).

NOTE: If the patient has a bladder or pelvic anatomic abnormality from previous surgery, cancer, or trauma, the procedure should be performed only with the aid of ultrasonographic guidance.


2 Maintain sterile technique and observe universal blood and body fluid precautions. Prepare the suprapubic skin with an antiseptic solution and drape with sterile towels. Inject the local anesthetic into the skin overlying the abdominal wall, into the subcutaneous layer, into the fascia, and down to the dome of the bladder. After penetrating the subcutaneous layer, aspirate before injection to avoid intravascular injection.

3 With the scalpel, make a 1-cm horizontal skin incision (some clinicians also incise the anterior rectus fascia) 5 cm above the symphysis pubis in the midline (in both adult and pediatric patients). At this point, some clinicians prefer to pass a 22-gauge spinal needle down and into the bladder. This will verify the bladder location before the suprapubic catheter is inserted. If the bladder is distended, this procedure is not necessary. If the bladder is not distended sufficiently to guide the obturator, the long needle can also be used to fill the bladder with sterile saline solution. Alternatively, ultrasonography can be used to determine if the bladder is full and for guidance.

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May 14, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Suprapubic Catheter Insertion and/or Change

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