A suprapubic catheter (SPC) is a flexible tube inserted directly into the bladder through a small incision in the lower abdomen. This method drains urine when the urethra cannot be used, often due to obstruction, injury, or long-term conditions like spinal cord injury. Regular exchange, typically every four to twelve weeks, is necessary to prevent complications such as blockage, infection, and encrustation. Changing an SPC is a medical procedure that requires prior, hands-on training and instruction from a healthcare professional before it is attempted independently.
Gathering Supplies and Preparing the Site
The exchange process begins with meticulous preparation to ensure a sterile field and minimize infection risk. You will need a new catheter (identical size and material), along with a sterile catheter insertion tray. This kit should include sterile gloves, an antiseptic cleansing solution (such as povidone-iodine or chlorhexidine), and sterile, water-soluble lubricant. A syringe is required to deflate the retention balloon on the old catheter, and a separate syringe pre-filled with sterile water or saline is needed for the new catheter’s balloon inflation.
Begin by performing thorough hand hygiene and preparing a clean, flat surface for the supplies, ensuring they are easily accessible to maintain sterility. The new catheter should be checked for integrity, though modern guidelines often advise against pre-testing the balloon. Disconnect the old catheter’s drainage bag for disposal. A clean receptacle or the new drainage bag must be ready to attach immediately after insertion. This arrangement ensures a swift transition, which is important because the tract between the bladder and the skin can begin to close quickly.
The Catheter Exchange Procedure Step-by-Step
The first step is ensuring the retention balloon of the existing catheter is fully deflated to allow removal without causing trauma. Connect a syringe to the balloon port and release the plunger, allowing the sterile water or saline to drain passively back into the syringe. Never pull back on the plunger, as this can damage the balloon or the catheter; the fluid must return naturally until the syringe is empty, confirming deflation. Once deflated, remove the catheter by gently pulling it out steadily and slowly, noting the insertion depth as a guide for the new placement.
After removal, immediately cleanse the stoma site (the opening in the skin) using the antiseptic solution and a sterile technique. Use sterile gauze, wiping in a circular motion beginning at the stoma and moving outward to prevent introducing skin bacteria. The new catheter tip must be generously lubricated with sterile water-soluble gel to reduce friction during insertion. Holding the catheter at a 90-degree angle to the abdomen, gently insert the tip into the stoma.
Advance the catheter slowly and steadily down the tract, which can sometimes feel like a slight resistance followed by a subtle “pop” as the tip enters the bladder cavity. Never use force; if significant resistance is met, stop and attempt slight rotation or repositioning. Insert the catheter to a depth slightly beyond where the previous catheter was positioned. Correct placement is confirmed by the free flow of urine into the tubing. If urine does not flow immediately, wait a few moments or gently advance the catheter a little further.
Once the catheter is positioned and urine is draining, slowly inflate the retention balloon by injecting the pre-measured amount of sterile water or saline. The volume (usually 8 to 10 milliliters) is specified on the catheter and must be precise to secure the device without risking bladder wall injury. If the person experiences pain during inflation, immediately stop injecting the fluid, as this suggests the balloon may not be fully inside the bladder. After inflation, gently pull back on the catheter until the balloon rests lightly against the inner bladder wall, confirming secure placement.
Post-Procedure Monitoring and Recognizing Complications
Following the successful exchange, secure the new catheter to the abdomen with a specialized fixation device or tape to prevent accidental pulling and movement that could irritate the stoma. Ensure the connected drainage bag is positioned below the level of the bladder to allow gravity to facilitate urine flow and prevent backflow. Immediate monitoring focuses on the quality and quantity of urine output; the urine should be clear or light yellow, and flow should be continuous.
Several signs require immediate medical attention. The most pressing is the inability to insert the new catheter into the bladder, as the tract can close quickly, leading to painful urinary retention. Significant pain, especially during balloon inflation, is a serious warning sign that the balloon may be inflating prematurely within the abdominal wall tract. Leakage around the stoma (known as bypassing) could indicate a blockage in the catheter or severe bladder spasms.
Other complications include prolonged bleeding from the stoma site or signs of infection, such as fever, chills, increased redness, swelling, or thick discharge. Cloudy, dark, or foul-smelling urine, sometimes accompanied by lower abdominal discomfort, can indicate a urinary tract infection. If any concerning symptoms arise, or if there is doubt about the catheter’s correct placement, contact a healthcare provider immediately for guidance.