Suprapubic Catheter; What to consider?

The catheters for urinary problems have been used for ages. They have come a long way from being stiff hollow tubes or bamboo reeds to modern day soft less irritating means to achieve short term urinary drainage or long term urinary diversion or control.
The catheters can either be introduced into the bladder from
urethral opening
or
Through the abdomen (Suprapubic catheter)
The catheter placement can be short-term as part of managing any medical or surgical condition or it can be long term when it is difficult for the patient and carer to manage the urinary continence related issues or if the patient cannot pass urine normally.
The catheter cannot be left in indefinitely and regular catheter changes are needed.
The bladder normally is sterile (free of bacteria) reservoir and gets colonised by bacteria once catheterised.

Various other issues with long term catheter are as below

Bacteriuria (100% cases) & UTI (10% cases)
• Haematuria (30% cases)
• Blocking (48% cases)
• Bypassing (37% cases)
• Expulsion (3% cases)
• Equipment failure
• Bladder stones (45% cases)
• Discomfort & Pain
• Urethral & bladder neck trauma
• Cancer EAU UTI guidelines say “patients with UC in place for ≥5 years
should be screened annually for bladder cancer”




Catheter care:

• Smallest catheter inserted aseptically with lubricating gel to minimize trauma.
• Silicon catheters least inflammatory & prone to encrustation.
• Closed gravity drainage system emptied 8 hourly.
• Urine output 100ml/hr
• Frequency of change depends on pt - No consensus
• Infection control principles.
• Prophylactic antibiotics for the routine catheter change are not
necessary (Polastri 1990).
• If bypassing, use smallest possible balloon + antimuscarinics (tablets to calm the bladder0.
• If blocking – treat UTI, acidify urine if good UO.
• Citric acid bladder washouts widely used, no good evidence