Urinary Incontinence: Changing Suprapubic Catheters

1. Urinary Incontinence:Changing Suprapubic Catheters Jennifer Burgess RN, BScN, GNC(C) Nurse Educator

2. Objectives • To understand the indications for changing a suprapubic catheter • To understand the scope of practice for nurses • To understand the procedure and skills involved in changing a suprapubic catheter • To understand the common problems associated with suprapubic catheters • To understand the required communication and documentation

3. What’s happening in there?

4. Advantages • Easier to clean and change. • Less likely to block. • Do not cause urethral damage. • Can be clamped rather than removed to facilitate assessment of the resident’s ability to void via the urethra. • Reduced risk of catheter contamination with micro-organisms found in the bowel. • More comfortable, less pain. Especially for females.

5. Reasons for a SPC • Drainage of urine after major urological or gynaecological surgery. • Management of urinary retention due to bladder outlet obstruction or atonic bladder. • Where it is not possible to insert a urethreal catheter (e.g. pelvic trauma) • Sexually active residents. • Skin sensitivities.

6. Caring for a SPC • Hygiene is important. Once healed, the insertion site should be cleansed with warm soapy water with morning and bedtime care. • Talc, creams and strongly perfumed soaps should be avoided. • Direct cleaning away from the insertion site.

7. General Catheter Care Principles • Ensure drainage bag is placed below the level of the bladder. • Catheter bag is NOT to be placed on the floor. • Ensure catheter tubing is secured to clothing before moving resident. • Ensure bag clamp is closed at all times, unless emptying the bag.

8. When should it be changed? Suprapubic catheter changes are usually done every 4-10 weeks, depending on the resident. Changes occur: • On an individually scheduled basis • As needed for signs of degradation, balloon breakage, malfunction, bypassing of urine or irreversible blockage.

9. Is this within my scope of practice? If you feel you have the knowledge, skill and judgment The Registered Staff may replace a SPC once the stoma is fully mature. • If you are unsure, seek assistance and further training.

10. A resident comes in… They have a suprapubic catheter. What do we need to know? Every new admission coming into LTC with a suprapubic catheter should come with the following information: • Name of person who inserted the catheter • Type and size of the catheter • Manufacturer of the catheter • Date it was last changed If they don’t come with that information, call to find out and document it clearly on the resident’s chart.

11. Procedure • Clamp old catheter 30min prior to change. • Assemble all required supplies at the bedside. • Explain the procedure to the resident, where appropriate. • Ensure privacy for the resident. Place the resident in a supine position and expose the abdomen. • Wash your hands and don clean gloves. • Open and prepare the catheter tray using aseptic technique. Ensure that the new drainage bag is attached to the new catheter. Lubricate the new catheter tip up to 10cm.

12. Procedure • Place the protective pad from the tray over the resident’s abdomen below the level of the stoma. • Gently rotate the catheter to release any ingrowth into the catheter that may have occurred. • Cleanse the stoma site using forceps with a cotton ball moistened with sterile water. Start at the centre and work outward in a circular manner. Repeat this cleansing two more times using a clean cotton ball each time.

13. Procedure • Deflate the balloon of the old catheter using a sterile syringe and note the amount of sterile water removed. • Holding the catheter at a point close to insertion site (keeping fingers at this site on tubing) with the old catheter from the bladder. Note the distance from fingers to the tip of the catheter. This distance indicates how far to insert the new catheter. • Remove old gloves, wash your hands and put on sterile gloves.

14. Procedure • Gently pass the tip of the new catheter through the stoma into the bladder until urine flows freely, with the dominant hand, then insert slightly further than the old one to ensure that the balloon is in the bladder but not too far to ensure that it doesn’t pass out through the urethra. Work quickly. Do not leave the stoma open for more than 1-2 minutes or it may begin to close. If this happens, try inserting a smaller catheter.

15. Procedure • Inflate the catheter balloon with the appropriate amount of sterile water and disconnect the syringe. • Confirm that the catheter is securely in the bladder by gently pulling on the catheter. • Tape the catheter to the abdomen and place a dressing around the stoma. • Dispose of equipment and wash your hands.

16. Document • the procedure performed • integrity of the catheter removed • size of catheter • verification of catheter placement • the appearance of urine before and after catheter change • resident tolerance • Update the change date of next catheter replacement on care plan

17. Timing is everything Replacing a suprapubic catheter in a timely manner is VERY important. The stoma can begin to close over if insertion is delayed for more than a few minutes.

18. Common Problems • Poor or absent urine drainage. Usually kinked tubing or occluded by tight clothing or urinary sediment. Try: • repositioning the tubing • adjusting clothing or • doing a sterile irrigation

19. Irrigation • Clamp the drainage tube just below the access port • Assemble necessary equipment and explain procedure to resident. • Provide privacy. • Position resident for comfort and place a waterproof pad under access port. • Wash hands

20. Irrigation • Put on sterile gloves • Cleanse access port with alcohol swab • Open sterile supplies and draw required solution into syringe. • Insert syringe into access port and gently instill solution. • Remove syringe, reconnect the drainage bag and unclamp. • Remove and dispose of gloves. Wash hands. • Document.

21. Common Problems • Catheter may become blocked with urine. The drainage down the catheter creates a negative pressure in the tubing, causing the wall of the bladder to be sucked into the catheters’ eyelets. Try: • Raise the drainage bag (no urine in the tubing) above bladder level to release negative pressure and reestablish flow.

22. Common Problems • Urinary drainage can be hampered if resident becomes constipated. Maintain adequate fluid intake and a high fibre diet. • May become encrusted, usually with alkaline urine. Can treat with Vitamin C. • Frequent “blockers”. Regular or intermittent irrigation to prevent catheter occlusion.

23. Common Problems • UTI’s. See handout on prevention of infection in residents with catheters. • Overgranulation at incision site. • Urethral leakage (women) due to kinked or blocked tubing or as a result of bladder spasm.

24. For Bladder Spasms • If bladder resistance is encountered while changing the catheter, pause to allow the muscle to relax and attempt reinsertion. If resistance continues, use a smaller catheter. If still unable to insert catheter, stop procedure and inform the NP or Physician.

25. Where to go for help? Policy Colleagues Nursing leadership Nurse practitioner or educator