A Licensed Practical Nurse (LPN), known as a Licensed Vocational Nurse (LVN) in some states, provides direct patient care under the supervision of a Registered Nurse (RN) or physician. Changing a suprapubic catheter (SPC) is a procedure that often raises questions about professional boundaries. Determining whether an LPN can perform this procedure depends on medical complexity, state law, and institutional policy.
Understanding the Suprapubic Catheter Procedure
A suprapubic catheter is a hollow tube inserted directly into the bladder through a small incision in the lower abdomen. This method is preferred for patients requiring long-term drainage or those who cannot tolerate a standard urethral catheter due to injury or obstruction. The catheter is held in place inside the bladder by a fluid-filled balloon.
Changing an SPC is a non-routine procedure that carries a higher level of risk compared to basic catheter care. The tract, or stoma, needs time to mature, with the first change usually occurring at least four to six weeks after initial placement. The primary risk is the accidental loss of the tract, which can happen if the new catheter is not inserted quickly and correctly, potentially leading to the hole closing. Other serious complications include misplacement, resulting in the balloon being inflated in the tract instead of the bladder, or injury to the bladder or bowel.
State Regulation and LPN Scope of Practice
The ability of an LPN to change an SPC is governed by the State Nurse Practice Act (NPA) and the rules established by the state’s board of nursing. In many states, changing an SPC is classified as a complex, invasive procedure falling outside the standard LPN scope, which focuses on stable patients and routine care. This is considered an advanced skill due to the potential for complication and the need for immediate problem-solving if the tract is lost.
Some state boards of nursing explicitly permit LPNs to replace an SPC, but only under specific conditions. The procedure is almost always limited to an “established tract,” meaning the opening has fully healed and matured, typically after four to six weeks post-insertion. The LPN must be properly trained and competent, and often must perform the procedure under the direction of an authorized healthcare practitioner or a Registered Nurse (RN). Delegation is often involved, where an RN or physician may delegate the task to a trained LPN, provided state law allows the LPN to accept delegation.
Facility Policy and Competency Requirements
Even when the State Nurse Practice Act permits an LPN to change an SPC, the decision is also institutional. Every healthcare facility retains the authority to set internal policies that are more restrictive than the state’s minimum legal requirements. A facility may decide that only Registered Nurses can perform this procedure, regardless of the LPN’s legal scope of practice.
For an LPN to be authorized to perform this task, they must demonstrate and maintain documented competency. This involves completing specific, verifiable training that covers the procedure, potential complications, and emergency protocols. The LPN must typically undergo a skill checklist and be supervised by a competent RN or physician during initial procedures to confirm proficiency. These requirements ensure the LPN has the necessary knowledge and skill to perform the procedure safely and to recognize and respond to complications.