› Suprapubic Catheter Insertion

Suprapubic Catheter insertion

This is a pretty good video for the suprapubic (SP) catheter change, but I do have a few comments:

1) Most times, irrigation is NOT performed. If you decide that a patient usually has a lot of sediment in the urine and think flushing the bladder would be beneficial, then you will need a physician’s order. You must ask for a specific fluid, amount, frequency. For example: 

"May irrigate bladder via suprapubic catheter with 60 mls of normal saline solution prior to catheter change and prn leaking or blocked cath." 

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2) Usually, you will only have 1 set of sterile gloves in the catheter kit, so removal of the old catheter is done with clean exam gloves before opening the catheter insertion kit. Each patient is different, but it is not uncommon to have the catheter “stick” to the opening, so gently twisting the cath first will make it easier to remove. 

3) In this video, the used betadine swab was placed on the sterile field. This breaks the sterile technique. Have a trash can or bag to discard used supplies close by. Also have the sterile field far enough away that the used catheter doesn’t touch the sterile field as it did in this video.

4) You will feel some resistance removing and inserting a new catheter as the tube passes thru the abdominal wall and muscle.

5) The catheter can be any size, usually starting small and increasing in size if there are problems with blockage.

6) A dressing around the catheter is not necessary unless there is drainage or the patient prefers one.

7) In this video the catheter is simply plugged for an unknown reason. Almost always, the suprapubic catheters are attached to a drainage bag.

8) As with any catheter, it may take a few minutes to see urine in the tube.

At times, if the patient experiences bladder spasms, he or she may experience leaking of urine from the urethra even with the catheter inserted and patent.  

At times when someone has a long time suprapubic opening, the area can grow hyper-granulation tissue. It is soft and red and looks like the soft tissue in a clean wound. I have heard one patient call it “proud flesh”. 

It is not harmful, but it can cause some weeping and drainage which can be annoying to the patient. Depending on which State you practice nursing, some allow the nurse to utilize silver nitrate. You can ask the physician for a prescription for silver nitrate sticks. 

They look like matchsticks with a silvery head. With the hyper-granulation tissue cleaned and still moist, roll the silver nitrate head over the red area and it will turn gray, killing the tissue. In a few days the extra tissue will shrink or disappear for quite a while. This is done periodically, as needed. 

Terminology for Suprapubic Catheters

Suprapubic: supra- “above”, pubic- “area near the symphysis pubis bone” Note that the spelling is SUPRA, not SUPER.

Hyper-granulation tissue: overgrowth of soft tissue.

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