A catheter is a hollow tube inserted into the bladder. A suprapubic catheter is surgically inserted through the abdominal wall into the bladder diverting urine from the urethra. A supra-pubic catheter, also known as an indwelling catheter, might be used for the following reasons:

• Urinary tract obstructions, possibly caused by an enlarged prostate in men, renal stones/calculi, tumours, strictures or anatomical abnormalities.
• A Neurogenic Bladder which can affect people with Parkinson’s disease, multiple sclerosis and other neurological diseases.
• Retention of urine caused by an atonic bladder or overactive bladder.
• Bladder dysfunction post surgical procedures, especially in the pelvic area.
• Palliative care or terminally ill patients, for example people with cancer related illness.
• Extensive skin breakdown caused by excoriation of the skin from faecal or urinary incontinence.

Catheters can be free draining; the catheter is attached to either a urine drainage bag such as a leg bag or a larger 24-hour or overnight urinary drainage bag. When a leg bag and an overnight bag are used together, a closed drainage system becomes essential, especially when the leg bag is attached to the overnight bag each day. A valve system can also be used. A valve is attached to the catheter and released at two to three hourly intervals. It is important to attach an overnight bag to the valve for free drainage overnight.

Advantages of having a supra-pubic catheter
Supra-pubic catheters are generally considered to be easier to look after and easier to change, for both the patient and the health professional. Because the catheter is located away from the genital area there is less risk of infection from faecal matter. The catheter’s position in the abdomen is also beneficial for people who are sexually active. There is no risk of pressure areas in the urethral meatus occurring as in some cases of clients with urethral catheters.

Disadvantages of having a supra-pubic catheter
Supra-pubic catheters must be replaced immediately if they fall out because the opening of the wound may close over. Urine may leak from the urethra and bladder spasms can occur in some people. Prolepses through the urethra are rare. The catheter may be difficult to remove when changing it and some risks have been noted in some studies such as cellulites or hematoma around the insertion site.

Care of supra-pubic catheter
Check the catheter site daily when you shower. The site should be washed well and dried with a soft towel. Check the site for redness, discharge or infection and inform your health professional immediately if you notice anything.
Rotate or “twirl” the catheter 360 degrees daily to avoid the catheter adhering to the skin. Avoid using talcum powder, creams or deodorants around the site. Maintain a diet high in fibre to avoid constipation and drink at least two litres of fluid a day. Check the colour and amount of urine output. Maintain a closed drainage system as stated. Take cranberry capsules (10 gms) or two glasses of juice a day. Check with your doctor first as some medication may have adverse effects.

Have a spare catheter on hand in case of emergency. The catheter can be changed every six weeks or longer if there are no problems. Your GP, specialist or Continence Nurse Advisor will advise you when to change your catheter. Drink a couple of glasses of water before the catheter change to ensure there is urine in the bladder. The first catheter change should be done in a hospital urology department, then it can be changed by a registered nurse in the home.

Problem solving

• Is the catheter not draining? Check for kinks in the tubing and that the drainage bag is below the waist and adjusted to the position of the person. If the catheter is blocked it may have to be changed.
• Is the urine cloudy or has an odour? Sedimentation may be present and more fluid may need to be drunk. Or it may be a urinary tract infection; a urine specimen must be taken for examination. Drink at least two litres of fluid a day, especially in hot weather.
• Are you unable to remove the catheter? Make sure the catheter is being rotated on a daily basis. Admission to hospital may be necessary to remove the catheter.
• Bleeding around the site or in the urine? Check if the catheter is anchored to the abdomen/leg with an appropriate anchoring device and that it’s not being “pulled”. Visit the doctor if any bleeding persists.

Kay Josephs, RN Continence Nurse Advisor