Transcript Suprapubic Catheterization

Urinary Incontinence:
Changing Suprapubic
Catheters
Jennifer Burgess RN, BScN, GNC(C)
Nurse Educator
Objectives
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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
What’s happening in there?
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.
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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.
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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.
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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.
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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.
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.
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:
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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.
Procedure
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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.
Procedure
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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.
Procedure
9.
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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.
Procedure
13.
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.
Procedure
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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.
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
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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.
Common Problems
1.
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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
Irrigation
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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
Irrigation
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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.
Common Problems
2.
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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.
Common Problems
3.
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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.
Common Problems
6.
UTI’s. See handout on prevention of
infection in residents with catheters.
7.
Overgranulation at incision site.
8.
Urethral leakage (women) due to kinked
or blocked tubing or as a result of
bladder spasm.
For Bladder Spasms
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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.
Where to go for help?
Policy
Colleagues
Nursing leadership
Nurse practitioner or educator