A suprapubic catheter (SPC) offers an alternative method for draining the urinary bladder when traditional access through the urethra is not possible or desired. This procedure involves the placement of a flexible tube directly into the bladder through a small incision in the lower abdomen, just above the pubic bone. The procedure is minimally invasive and must be performed by a trained medical professional, such as a urologist or advanced practitioner. This approach provides an effective and often more comfortable solution for long-term bladder management.
Defining the Suprapubic Catheter and Its Indications
A suprapubic catheter is a flexible tube inserted into the bladder through the abdominal wall, bypassing the natural urinary passage. It is secured inside the bladder, typically by inflating a small balloon with sterile water, allowing urine to drain continuously into an external collection system. This route is selected when the urethra is obstructed, damaged, or cannot tolerate a long-term indwelling catheter.
Indications include urethral trauma, stricture disease, or failed attempts at urethral catheterization. For long-term catheterization, the SPC is preferred due to increased patient comfort, reduced urethral irritation and meatal erosion, improved hygiene, and preservation of sexual function.
Essential Pre-Procedure Preparation
Preparation begins with a complete patient assessment, including coagulation status and any known allergies. Prophylactic antibiotics are administered before the procedure to minimize the risk of post-insertion infection. The bladder must be adequately distended, typically filled with at least 200 to 300 milliliters of fluid, to elevate the bladder dome and push intestinal loops away from the insertion site.
Accurate site identification is marked on the midline of the lower abdomen, approximately four to five centimeters above the pubic symphysis. Imaging guidance, most commonly ultrasound, is used to confirm the bladder’s location and verify that no loops of bowel are situated between the abdominal wall and the full bladder. Local anesthesia is then infiltrated into the skin and along the planned tract to manage pain.
Step-by-Step Overview of the Insertion Technique
The procedure begins with establishing a sterile field on the lower abdomen to prevent contamination. Following local anesthetic administration, a small skin incision, usually one to two centimeters, is made at the pre-marked site superior to the pubic bone. This incision allows the insertion device to pass through the skin and subcutaneous tissue.
Two primary techniques are used: the trocar method and the Seldinger technique. The trocar method involves a direct puncture into the bladder with a sharp instrument, creating a tract for the catheter sheath. The Seldinger technique uses a fine needle to locate the bladder and confirm its position by aspirating urine.
Once urine return is confirmed, a guidewire is threaded through the needle into the bladder, and the needle is removed. A dilator and sheath assembly are advanced over the guidewire into the bladder, and the guidewire and dilator are removed, leaving the sheath in place. In both methods, the catheter is passed through the sheath into the bladder, and correct placement is confirmed by a free flow of urine into the drainage bag.
To secure the device, the catheter’s retention balloon is inflated with sterile water once fully inside the bladder, preventing accidental dislodgement. The sheath is then removed, and the catheter is anchored to the skin with a suture or a specialized fixation device. This securement prevents movement at the insertion site and maintains the integrity of the newly formed tract.
Immediate Post-Procedure Care
Continuous monitoring of the urine output is required to check for adequate volume and color. Initial blood-tinged urine, known as hematuria, is common and usually resolves within the first 48 hours. Patients are encouraged to increase their fluid intake, which helps to flush the system and minimize initial bleeding.
A sterile dressing is applied to the incision site to protect the area and absorb minor drainage. Pain management protocols are initiated, often including non-steroidal anti-inflammatory drugs to address discomfort and potential bladder spasms. Securing the drainage tubing to the skin is important to prevent tension or pulling on the catheter insertion site, which can cause pain and damage the surrounding tissue.
Recognizing and Managing Common Complications
Potential complications may arise following suprapubic catheterization.
- Wound infection or cellulitis at the insertion site presents as localized redness, swelling, increased pain, or purulent discharge, typically requiring antibiotic treatment.
- Urinary tract infections (UTIs) remain a concern, indicated by fever, cloudy, or foul-smelling urine, necessitating prompt medical attention and antibiotics.
- Accidental dislodgement is a serious event; if the catheter falls out, it must be replaced urgently by a medical professional, often within an hour, before the tract closes.
- Leakage of urine around the catheter, known as bypassing, may occur due to bladder spasms, catheter blockage, or an incorrectly sized balloon. Management involves checking for blockages, administering anti-spasmodic medication, or replacing the catheter.