Suprapubic Catheter Care

Urinary Catheterization

• Apply drain dressing around catheter and tape in place
• Secure catheter to lateral abdomen with tape or Velcro multipurpose tube holder
• Coil excess tubing on bed, ensuring drainage bag is always below level of bladder
• Dispose of supplies in an appropriate receptacle
• Remove gloves and perform hand hygiene

Suprapubic Catheter Care

• Monitor vitals signs, I&O, observe amount, color, consistency of urine, and assess site if patient develops symptoms of UTI or catheter site infection
• Cover site with sterile dressing and notify healthcare provider if suprapubic catheter becomes dislodged
• Notify healthcare provider and change dressing more frequently to keep site dry if skin surrounding catheter exit site becomes red or irritated or develops open area

Documentation

• Document and report character of urine and type of dressing change, including assessment of insertion site and patient’s comfort level
• Record urine output on the I&O flow sheet, separately documenting outputs from suprapubic and urethral catheters if applicable
• Evaluate patient and caregiver learning

In-Dwelling Catheters

• Come in various balloon sizes (3ml to 30ml) and are attached to a urinary drainage bag
• Bag should always hang below the level of the bladder to facilitate gravitational flow

Types of Catheters

• Intermittent or “Straight” catheter (In and Out)
• Indwelling “Foley” catheter
• 3-Way Catheter
• Coude Catheter

Indications and Contraindications

• Indications: relieve urinary retention or incontinence, obtain a sterile collection of urine, irrigate the bladder, pre/post-operative care, and monitoring input and outputs
• Contraindications: current urinary tract infection, urethral strictures, prostate and/or bladder surgery, urethral trauma, and severe pelvic fractures

Equipment

• Catheter Tray/Kit (Straight or In-dwelling)
• Sterile drainage tubing and bag (Small “leg bag”, large “night bag”, Urometer bag)
• Device to secure catheter (Statlock)
• Basin with warm water, washcloth, towel, and soap for perineal care
• Flashlight or additional light source
• Additional catheter and sterile gloves (in case of contamination)

Procedure/Steps

• Confirm MD’s order and facility policy regarding urinary catheters
• Review patient’s chart for allergies, medical record, and prior experiences with urinary catheterization
• Assess patient’s knowledge, positioning, and potential need for extra help
• Provide privacy, perform hand hygiene, and inspect perineal region
• Drape patient, position light source, and open sterile wraps and catheter kit tray

Catheter Care and Management

• If equipment or supplies become contaminated, replace with sterile items or start over with a new sterile kit.
• Monitor catheter output for color, clarity, odor, and amount.
• Be aware of unexpected findings, such as bladder discomfort, and notify the healthcare provider.

Complications and Risks

• Catheterization comes with risks, and long-term catheterization is not recommended.
• Infection is a common complication, and observe patient's urine for concentration, color, and odor.
• Urethral trauma can occur from improper care or insertion technique, leading to bleeding or infection.
• Obstruction can occur due to infection or other conditions, and report to the doctor immediately.
• Bladder spasms are common with catheterization, and report to the healthcare provider if they persist.
• Leakage around the catheter is another problem associated with indwelling catheters.

Procedure and Steps

• Connect drainage tubing/bag to catheter port.
• Secure catheter tubing to inner thigh using a Statlock device.
• For uncircumcised men, replace foreskin back to its normal position.
• Clip drainage bag tubing to the edge of the mattress, and position it lower than the bladder.
• Dispose of supplies in appropriate receptacles.
• Remove gloves and perform hand hygiene.
• Document the procedure and patient's response.

Documentation

• Document and report the reason for catheterization.
• Record the type and size of catheter, amount of fluid used to inflate the balloon, and specimen collection (if applicable).
• Document the characteristics and amount of urine, and patient's response to the procedure.
• Document urine output on the intake and output (I&O) flow sheet and/or chart.

Unexpected Findings and Outcomes

• Report persistent catheter-related pain, inadequate urine output, and discomfort to the healthcare provider.
• If the catheter is inserted into the vagina, leave it as a landmark, cleanse the urinary meatus again, and reinsert another sterile catheter into the meatus.
• If sterility is broken during catheterization, replace gloves if contaminated and start over.

Suprapubic Catheter Care

• Monitor vitals signs, I&O, and observe the amount, color, and consistency of urine, and assess the site.
• Notify the healthcare provider if the patient develops symptoms of UTI or catheter site infection.
• Cover the site with a sterile dressing and notify the healthcare provider if the suprapubic catheter becomes dislodged.
• Change the dressing more frequently to keep the site dry and consult with a wound care nurse if the skin surrounding the catheter exit site becomes red or irritated.

Documentation - Suprapubic Catheter Care

• Document and report the character of urine and type of dressing change.
• Document the assessment of the insertion site and patient's comfort level with the catheter and dressing change.
• Document urine output on the I&O flow sheet, and separately for each catheter if there is both a suprapubic and urethral catheter.
• Evaluate the patient and caregiver learning.

In-Dwelling Catheters

• Come in various balloon sizes, ranging from 3 ml for children to 30 ml for continuous bladder irrigation (CBI)
• The size of the balloon and catheter is printed on the catheter port (most commonly 10 ml)

Urinary Drainage Bag

• Attached to an in-dwelling catheter to collect the continuous flow of urine
• Should always hang below the level of the bladder on the bedframe or chair, using gravitational flow

Types of Catheters

• Intermittent or "Straight" catheter (In and Out)
• In-dwelling "Foley" catheter
• 3-Way Catheter
• Coude Catheter

Indications and Contraindications

• Indications: relieve urinary retention or incontinence, obtain a sterile collection of urine, irrigate the bladder, pre/post-operative care, monitor input and outputs
• Contraindications: current urinary tract infection, urethral strictures, prostate and/or bladder surgery, urethral trauma, severe pelvic fractures

Equipment

• Catheter Tray/Kit (Straight and In-dwelling)
• Sterile drainage tubing and bag (Small "leg bag", large "night bag", Urometer bag)
• Device to secure catheter (Statlock)
• Basin with warm water, washcloth, towel, and soap for perineal care
• Flashlight or other additional light source

Procedure/Steps

• Confirm MD's order and verify facility's policy regarding urinary catheters
• Review patient's chart for allergies and medical history
• Assess patient's knowledge and experience with urinary catheterization
• Determine patient's positioning for catheterization (dorsal recumbent for females, supine with legs extended for males)
• Urine output should be 30 ml or greater per hour

Importance of Urinary Catheterization

• Conditions that require use of urinary catheters include monitoring urine output, relief of urinary obstruction, postoperative care, or a bladder that empties inadequately due to neurological conditions
• Excessive accumulation of urine in the bladder increases the risk for UTI and can cause kidney infection or damage

Catheter Selection

• Based on factors such as latex allergy, history of complications, and susceptibility to infection
• In-dwelling catheters are made of latex or silicone
• Straight or intermittent catheters are made of rubber or polyvinyl chloride
• Catheter size is based on the French (Fr) scale, with most adults requiring a size of 14 to 16 Fr to minimize trauma and risk for infection