Tag Archives: supra pubic catheters

Changing Supra Pubic Catheters

Changing Supra Pubic Catheters

It is important to use a sterile technique when changing supra pubic catheters. It is also a good idea to watch a doctor or nurse perform a supra pubic catheter change before you attempt to do your first one. Check that the old and new catheters are the same size. Look for matching numbers eg: 18fr and that the catheter port ring colors match. A supra pubic catheter change of different sizes should only be performed in a hospital by qualified medical staff.

Why and how often to change a supra pubic catheter depends on the user and catheter type. Catheters are durable but they do not last forever. The longer a catheter is left in the more chance of infection, blockage, sticking and other problems. Depending on the type of catheter, they have a shelf life of several years and use life of one to three months max. Silicone Foley and silver coated catheters may be changed every 3 months. Check the catheter packaging for details.

Changing Supra Pubic Catheters Silicone Foley

NOTE: I take no responsibility for how you use or misuse these guides or any problems that may result from that use. Many have asked me things about changing supra pubic catheters. This is only my personal experience (and explanations). In an emergency such as a blocked catheter call an emergency service! In the event that is not possible and the situation is life threatening, here is a quick emergency 3 step guide to changing supra pubic catheters. You can do this in a seated position or laying flat. Please only attempt this if you have already called emergency services and you are really, really desperate.

3 Step Emergency Supra Pubic Catheter Change

  1. Plug a 10cc syringe onto the old catheter port and deflate the catheter balloon.
  2. Remove the old catheter and insert the new one as far in as the old one was.
  3. Plug the 10cc syringe onto the new catheter port and inflate the balloon.

I have had to do this and survived. Sterility comes second in an emergency. Your first supra pubic catheter change should be done by a doctor or a nurse six weeks after install.

10 Step Easy Safe Supra Pubic Catheter Change

Catheter Change Equipment:

  • Catheter change pack (often these include all below but the new catheter and drain bag).
  • Lubricant (to lessen the pain and ease the new catheter in).
  • New sterile catheter of appropriate size (to replace the old catheter).
  • New drainage bag (don’t plug a dirty drain bag onto a sterile catheter).
  • Pair of sterile gloves (to avoid infection).
  • Sterile saline or water (to inflate the catheter balloon).
  • Two 10cc syringes (one to deflate and one inflate the balloon).

Catheter Change Method:

Have the supra pubic catheter user take a big drink of water and lay face up. Thoroughly wash your hands and forearms, remove any dressing, and clean around the supra pubic catheter site. Prepare your workspace. Then take a deep breath and try to relax. We know it can be a daunting task. My mother has been changing supra pubic catheters for years. My beautiful Mum has done 100’s of catheter changes for me and still gets nervous every time I ask her too. I love you Mum.

Caution: When changing supra pubic catheters note how far the old one was inserted. This is where most people go wrong. I have bleed from the penis for days because a new catheter was pushed in to far. On two occasions at the hands of doctors who failed to make this vital observation. You can mark the old catheter with a pen or clip something onto it near the skins surface prior to removal if you wish.

  1. Using a sterile method open out your catheter change pack and check for or add; a new sterile catheter (open the packet dropping the catheter onto your sterile field), two 10cc syringes, sterile saline or water, a sterile lubricant and gloves.
  2. Wash your hands and forearms thoroughly and dry with a clean dry towel.
  3. Using a sterile technique put the gloves on.
  4. Open the lubricant and apply it liberally to the first two inches of the catheter tip (that is the pointy end where the eyelets are).
  5. Fill one 10cc syringe with 8cc of saline (or clean water) and plug it firmly onto the new catheter port (where the colored ring is, you may test inflate the balloon at this point if you wish, but don’t waste time).
  6. Plug the second empty 10cc syringe onto the old catheter port and draw back on it to deflate the balloon (it may have less than 8cc). Remove the catheter (you may feel some mild resistance. If you are sure the balloon is fully deflated, it’s alright to give it a little tug). 
  7. As you withdraw the old catheter it is VERY important to note how far in it was. Also note, your hands are now no longer sterile.
  8. Pick up the pre-lubricated catheter and insert it. Only push it in as far as the previous catheter was (if you insert it too far it may go into a ureter or the urethra).
  9. A little bleeding is common after changing supra pubic catheters. If some urine starts to flow it usually means you have the catheter in the correct position. Keep holding the catheter in position and slowly inflate the balloon with 8cc of sterile water. Once the syringe is empty unplug it from the catheter port.
  10. Attach a new clean drainage bag.

Congratulations you are done.

Tips on Changing Supra Pubic Catheters

  • A quick change is a good change.
  • Using a topical numbing gel around the catheter site prior to change to help ease pain.
  • Sterilize water by boiling and set aside until cool.
  • Do not leave a person alone after changing supra pubic catheters. Watch for any bleeding or adverse reactions.
  • A few blood clots in the tubing are common. If it lasts for more than a few hours something may be wrong.
  • Some bleeding is common after changing supra pubic catheters. If it lasts for more than an hour something is likely to be wrong.
  • Profuse bleeding at the site, in the tube, or from anywhere else is not common. If it lasts for more than five minutes something is terribly wrong. Call a doctor.
  • Check, and if needed top up the amount of fluid in a catheter balloon every four weeks.
  • Never leave a supra pubic catheter out for more than a few minutes.
  • Never cut a catheter trying to release it.

Resources

 

Silicone Foley Supra Pubic Catheters

Super Supra Pubic Catheters

I hear people say Super but it is Supra Pubic Catheter. I have had an SPC for 16 years now and it has mostly been super. There is not much first hand info on the net so I will share my personal experience. Supra pubic catheters are a method of bladder management. It is a fairly simple procedure usually performed under a general anesthetic.

An incision was made about three inches below the belly button and a small hole is poked in the bladder. At this point, a catheter is inserted. It is held inside the bladder by plugging a syringe onto the catheter port and inflating a 5 to 40cc balloon with sterile water. The syringe is unplugged and a drainage bag is connected to the catheter flange. Usually the site (incision point) is low enough to hide below your pants belt line. It took three weeks for my supra pubic catheters site to settle and stop bleeding. I no longer keep it covered with any type of dressing.

With supra pubic catheters you must always keep a catheter in place. Your bladder can heal very quickly. In as little as ten minutes without a catheter in, you may not be able to get one in. Your body treats a suprapubic catheter as a foreign object. Forming a tube from stomach wall to bladder. Always trying to expel the foreign object, the catheter site never totally heals. It will always require a little cleaning. We use an alcohol wipe each morning and night. I’d much rather my carer clean around the super pubic catheters site than the pointy end of business (I’ll call him Sarge). Especially when your primary carer is a family member.

Silicone Foley Super Supra Pubic Catheters

Silicone Foley Super Supra Pubic Catheters

Changing Supra Pubic Catheters

Silicone Foley supra pubic catheters like these above are good for three months. I change mine every two months. Even then it often requires a little tug to remove. Some rotate their supra pubic catheters frequently to keep them free from sticking. This can cause leakage so I don’t do it.

Sterilize all equipment and around the catheter site. Deflate the old catheter balloon by firmly plugging an empty 10 cc syringe onto the supra pubic catheters port and drawing back. Remove the catheter taking note of how far it was inserted. So then you will know how far to push the new one in. Lubricate and insert the new catheter, then inflate the balloon. It should slip back a little to rest against the bladder wall. Holding the syringe plunger depressed, remove it and plug a new clean drainage device onto catheter flange.

You might like to check our 10 step guide on changing supra pubic catheters.

We once pushed my catheter in to far, right through the bladder and half way out my urethra. When we inflated the balloon it ruptured my urethra. Sarge was wounded by friendly fire! I bled from the penis for three days. The same can happen if it’s not in far enough. A little bleeding is common after a change or trauma (yanking on the catheter) but any bleeding should stop quickly.

Plug a leg bag or whatever drainage receptacle you prefer. I use a 16fr gauge Silicone Foley catheter with a 4-Sure 2000 cc overnight drain bag in a cover slip hung up under my power wheelchair. The 4-Sure is emptied morning and night, changed weekly. The boys get jealous when we have a session at the pub. They run back and forth to the bathroom while I don’t need to go at all. Check and top up the amount of sterile water in the supra pubic catheters balloon monthly. Some osmosis can occur in time and you don’t want the catheter falling out when asleep.

Lifestyles Diet Flying Sex and Swimming

Drinking is essential with Supra Pubic Catheters. It’s recommended you drink at least 3 liters daily to keep sediment levels down and the catheter eyelets clear. A lower urinary pH can be of benefit in reducing sediment and bacteria causing UTI’s. Bacteria don’t like acidic urine. Some pH lowering drinks and those of general benefit to supra pubic catheters are; cranberry juice, coffee, naturally brewed beer, buttermilk, wine, green tea, colloidal silver, distilled and filtered water.

Diet is unrestricted. You can eat anything you like. Some foods that lower urinary pH and help to reduce urinary tract infection are; beef, berry juices, corn, corn silk, eggs, fermented milk products (yogurt), fish, fowl, goldenseal, grape seed extract, gravy, horsetail, marshmallow root, probiotics, sour cream and whole grains. Avoid processed foods and artificial sweeteners. Please keep in mind it is all about balance. A healthy pH range is between 6.5 and 8.0.

Flying is no problem though be aware silicone slightly expands at 20 000 ft. Some tell me they like to use a smaller gauge catheter on international flights. I have never tried this. I fear I would be soaked in pee before I even got on-board the plane. I have flown many times without making any changes to my daily use of SPC. I’ve been in gliders, stunt planes, across the country and on international flights. I’ve never had a problem. I do suggest reducing fluid intake. If you can’t, or the free booze is too tempting, ask the staff if you can pee in a bottle rather than trying to get to the bathroom.

Sex is the main reason I went for Super Pubic Catheters. How can I put this… Sarge is always battle ready, free to stand to attention at anytime. No having to fold an indwelling catheter back and cover with condom. No having to do a quick self catheter drain to prevent leaking pee during sex. I’m good to go anytime. Now I just need to find someone to have sex with! Haha. A friend tapes her supra pubic catheters down to her side during sex. It’s a good tip if you like it rough, your partner is worried about hurting you, or you or your partner are turned off by the sight of a suprapubic catheter. You can tape it down.

catheter-blockSwimming is not a problem. Disconnect your drainage device and press a stent (sterile cone shaped stopper, can use anything really) into the catheter and splash on in. Avoid drinking to much before and during swimming. If for some reason the urine cannot be drained via the suprapubic catheter you will usually bypass. The sphincter muscle which controls urination can only hold so much pressure before it will leak and you go the old fashioned way. That is a good thing! While it is inconvenient at times it acts as a safety valve. When urine can’t escape it backs up into your kidneys and will nearly always cause kidney infections (renal sepsis can be life threatening).

Sleeping puts your bladder into a dormant state, yes it sleeps too. Sleep on your back, side or front as long as it doesn’t kink the suprapubic catheter or tubing. Having a large drink just prior to sleeping will help your urine remain clear overnight. Keep your tubing and drainage device lower than your bladder. I clip the tubing full of urine onto my bottom sheet so it can’t pull on my catheter. A quick look around this web site will show you, quadriplegia and supra pubic catheters don’t prevent me from living a happy full and active life.

Sediment and Urinary Tract Infection Prevention

You will never completely stop Urinary Tract Infections (UTI). Anytime you have broken skin you’re vulnerable to bad bacteria, especially when you have a suprapubic catheter pointing the way in. Good hygiene is very important. I suffer less than one UTI/yr. The only indicators are that my urine has a stronger odor and is darker in color. Other quadriplegics shake, shiver, sweat, suffer headaches, blotchy skin or possibly display autonomic dysreflexia symptoms. Females seem to be more prone to adverse reactions to UTI.

The latest research suggests drinking large amounts of water to flush the infection through works as fast as antibiotics. UTI can grow from sediment so keeping sediment levels down is paramount. Cranberry products, corn silk, naturally brewed beer, and wine are also good UTI preventatives (see Diet above for more). I have a few beers near everyday and haven’t needed anti-sediment medicines for a number of years now.

Infections at one time were so frequent we had to change my Super Pubic Catheter every two weeks. Bacteria grows on sediment and can build up blocking the catheter’s draining eyelet’s. We would perform a bladder washout daily. Taking a large 50cc syringe and sterile bottled water (or cooled boiled water) we would push the fluid in and out to “flush” the catheter. I don’t recommend frequent bladder wash-outs. It’s much better to cure the sediment and UTI problem.

The catheter insertion point (site) itself is also at risk of infection. If the super pubic catheters site becomes red, warm to touch, crusty, tingles, smells bad and/or is pusy you probably have a site infection. A doctor can take a swab to confirm. Keep hair trimmed back away from the site as it promotes bacteria. Exposure to the sun, saltwater baths, cleaning with an alcohol wipe morning and night, keeping it dry and with good air flow, will all help avoid site infections.

Silver is a highly effective antibacterial substance which can be applied to various types of catheters. Multiple studies have suggested that silicone urethral catheters coated with hydrogel and silver salts reduce the risk of developing bacteriuria. Specifically, silver alloy catheters (coated on both internal and external surfaces) were shown to provide a greater than 3x reduction in the development of catheter-associated bacteriuria over silver oxide (coated on the external surface only), silicone Foley, and standard laytex catheters respectively. Silver alloy catheters cost around $5 more than standard laytex catheters but if you find you are prone to urinary tract infections they are worth trialing.

UTI Medications and Drugs of Benefit

Hiprex tablets (Mandelamine) Urex or Ural the anti-infection drink can help. Hiprex is a pro-drug absorbed from the gut passing into the urine where it’s hydrolysed to formaldehyde. Formaldehyde causes the breakdown of proteins/sediment essential to bacteria. However this only occurs if urinary pH is less than 5.5 acidic which is considered an unhealthy level. It’s a big pill to swallow and tastes like horse piss but they work. They recommended twice daily but one every three days was enough for me.

You may like to try D-Mannose or Ethical Nutrients Urinary Tract Support (in Aus) and Probiotic supplements (see Diet above for more). Everybody produces sediment it’s just that “regular” people don’t notice it. Tell them to pee into a jar and wait 6 hours, they’ll see sediment.

With supra pubic catheters the bladder is constantly drained. Over time the bladder may contract or shrink (like any muscle does) frequently spasming. The condition is called an overactive bladder. Ditropan, Vesicare, Enablex and Detrol LA are bladder specific muscle relaxants. These are prescribed to help reduce spasm and shrinking. You can imagine how hard it would be to get a replacement catheter located correctly when your bladder is the size of a grape. Of course, please consult your doctor before taking any new medications.

Ceasing Use of Supra Pubic Catheters

No need to worry if supra pubic catheters are going to be the right type of bladder management for you. If for any reason you are unhappy with your SPC it is fully reversible. Just leave it out and resume your old method. Of course you must consult your doctor first. The last thing you want is a raging infection left trapped inside your body.

Basically you restrict fluid intake, remove the catheter, and cover the old site with a dressing. It is that simple. For best results we suggest you cease all activity for a few days to allow the site to heal. Keep the dressing clean. Also avoid showering and over-distending the bladder. Generally your bladder will seal itself off within 10-60 minutes. The suprapubic catheter site takes a few days to weeks to fully heal and will leave a small scar. Like I said however, please consult your doctor before you go leaving it out.

Kind Regards
Graham Streets
MSC Founder

Further Resources

  • Care Guide: How To Care For Your Supra Pubic Catheters
  • Queensland Health: What is a Suprapubic Catheter? PDF
  • Spinal Injury Center: Managing your bladder with a suprapubic catheter
  • Wikipedia: Suprapubic cystostomy
  • Library of Congress Cataloging-in-Publication Data. Spinal cord injury / editor, Thomas N. Bryce; associate editors, Naomi Betesh. Rehabilitation medicine quick reference.
  • I. Spinal Cord Wounds and injuries handbooks, manuals, etc. Bryce, Thomas N.
  • II. Series: Rehabilitation medicine quick reference. [DNLM]
  • III. Spinal Cord Injuries, rehabilitation handbooks: [WL 39 S757 2010] RD594.3.S6683 2010.
  • Maki DG, Tambyah PA. Engineering out the risk of infection with urinary catheters. Emerging Infectious Diseases. 2001; 7:342-347.
  • Karchmer TB, Giannetta ET, Muto CA, Strain BA, Farr BM. A randomized crossover study of silver-coated urinary catheters in hospitalized patients. Archives of Internal Medicine. 2000;160:3294-3298.
  • Saint S, Veenstra DL, Sullivan SD, Chenoweth C, Fendrick AM. The potential clinical and economic benefits of silver alloy urinary catheters in preventing urinary tract infection. Archives of Internal Medicine. 2000; 160:2670-2675.
  • Riley DK, Classen DC, Stevens LE, Burke JP. A large randomized clinical trial of a silver-impregnated urinary catheter: lack of efficacy and staphylococcal superinfection. The American Journal of Medicine. 1995;98:349-356.
  • Newton T, Still JM, Law E. A comparison of the effect of early insertion of standard latex and silver-impregnated latex Foley catheters on urinary tract infections in burn patients. Infection Control and Hospital Epidemiology. 2002;23:217-218.
  • Thomas L, Valainis G, Johnson J. A multi-site, cohort-matched trial of an anti infective urinary catheter. presented at Society for Healthcare Epidemiology of America (SHEA), April 7-9, 2002.
  • Leape LL, Berwick DM, Bates DW. What practices will most improve patient safety? Evidence-based medicine meets patient safety. JAMA. 2002;288:501-507.
  • Ahearn DG, Grace DT, Jennings MJ, Borazjani RN, Boles KJ, Rose LJ, Simmons RB, Ahanotu EN. Effects of Hydrogel/Silver Coatings on In Vitro Adhesion to Catheters of Bacteria Associated with Urinary Tract Infections. Current Microbiology. 2000;41:120-125.
  • Liedberg H. Catheter induced urethral inflammatory reaction and urinary tract infection. An experimental and clinical study. Scandinavian Journal of Urology and Nephrology. 1989;Suppl. 124. BARDEX System with Anti-Infective Foley Catheter ®I.C.® 49629_0304-25.qxd 12/28/06 2:13 PM Page 1
Bladder Washout Kit

Bladder Washout

A bladder washout is a technique used to flush blood clots or debris from the bladder by pushing water solution into the bladder and immediately draining.

Who Requires a Bladder Washout

You may need a bladder washout if:

  • You have a lot of sediment in your urine
  • You are unsure if your catheter is draining correctly
  • Your catheter has blocked and you have no replacemnent
  • You have been advised by your doctor or community nurse to do bladder washouts in the treatment of a specific urinary tract infection

Advantages of a Bladder Washout

  • If you are unable to drink large amounts of fluids to treat a urinary tract infection or heavy sediment this may be an alternative method
  • If your catheter repeatedly blocks off and you are unwilling or unable to do frequent catheter changes
  • Stretching the bladder frequently can help avoid shrinkage

Disadvantages of a Bladder Washout

  • Every time you disconnect a catheter from drainage bag you create an entry point for infection
  • You are introducing foreign fluid into your bladder
  • The procedure is time consuming
  • If not done carefully it can cause bleeding and blood clots
  • There is risk of damage to the epithelial lining of the bladder
  • Studies have shown it has little or no effect on most infections
  • Bladder washouts may induce autonomic dysreflexia in quadriplegics

Bladder Washout Equipment

  • 60ml plastic syringe
  • 2 clean plastic trays (ice cream containers or similar)
  • 500mls of sterile bottled water or treated tap water boiled and cooled to room temperature (not* bore water tank water or chlorhexidine)
  • Small supply of cotton wool balls
  • Alcohol wipes (or small amount of methylated spirits or sterilizer for swabbing the catheter connections only)
  • Clean bench area
Bladder Washout Kit

Bladder Washout Kit

Bladder Washout Procedure

If you experience pain at any time during the bladder washout procedure you should cease immediately and call a doctor or paramedic!

  1. Select a clean area where the procedure is to be carried out. (We suggest a bench area in the bathroom with a clean towel over the top of it).
  2. This procedure can either be carried out by the patient or their carer – the instructions are the same for both.
  3. Take the 500mls of prepared water and place within reach on the bench. Ensure the second container is alongside the first as this will be used for the used irrigation fluid and urine that is ‘washed out’ of the bladder during the procedure.
  4. Place the clean 60ml syringe alongside the containers on the prepared area. This is used to insert the water into the bladder.
  5. Place the cotton balls beside the container and have the methylated spirits within reach.
  6. Ensure the connection between the catheter and the drainage bag is exposed so you can get to it easily.
  7. Wash your hands thoroughly.
  8. Take a cotton ball soaked with methylated spirits and wipe the connection thoroughly. Dispose of the cotton ball.
  9. Carefully take the connection apart and rest the catheter end in the empty container.
  10. Fill the syringe with 60mls of water from the water container. Insert the syringe into the end of the catheter and gently insert the water by pressing on the plunger of the syringe. Do not withdraw any fluid through the catheter at this stage.
  11. Remove the syringe being careful to put the open catheter end into the empty container. You will notice that some of the urine/water will drain into the container.
  12. Fill the syringe again with 60mls of water and insert into the bladder. Once the syringe is completely empty withdraw 40mls of the mixture of urine/water into the syringe then discard into the drainage container. Again you will notice there is drainage of urine/water from the catheter into the drainage container.
  13. Repeat step 12 until all 500mls of water has been used.
  14. On completion take another cotton wool ball soaked with methylated spirits and wipe the catheter connection again before reconnecting to the drainage bag.
  15. Discard urine/water into the toilet and using a small amount of disinfectant clean out the container.
  16. Both containers should be kept covered and scalded out once a week with boiling water.

Care of Bladder Washout Equipment

You will need to make fresh milton solution each time you sterilise your bladder washout equipment before and after each procedure by doing the following;

  • Into your clean water container place 500mls of tap water and either ¼ milton tablet or 7mls of milton solution (you can use vinegar and clean water at a 1:10 ratio or gently boil the equipment for 5 minutes)
  • Once the solution has mixed place syringe with plunger removed from main barrel into this solution
  • Leave the syringe to soak in the solution for one hour
  • After one hour remove syringe and discard milton solution from container
  • Using a clean towel or disposable paper towel dry container and syringe and store syringe in sealed container

Resources

  • The Spinal Injuries Unit: Phone (07) 3240 2215 or (07) 3240 2641
  • The SIU Consultant on Call Through PAH switchboard (after hours)
  • Queensland Spinal Cord Injuries Service: www.health.qld.gov.au/qscis