A suprapubic catheter (SPC) is a flexible tube inserted directly into the bladder through a small incision in the lower abdominal wall, typically above the pubic bone. This method serves as an alternative to urethral catheterization, which involves passing the tube through the urethra. The SPC allows urine to drain from the bladder into an external collection bag, providing a route for urinary drainage when the natural or transurethral path is compromised. The insertion is performed as a sterile, minor surgical procedure by trained healthcare professionals.
Understanding the Suprapubic Catheter
The decision to place an SPC is often made when standard urethral catheterization is not feasible or suitable for long-term use. This alternative approach avoids potential trauma to the urethra, which can lead to complications like strictures or chronic inflammation. For patients requiring drainage for an extended period, the SPC is generally more comfortable and facilitates easier hygiene and sexual activity.
The indications for choosing an SPC are varied. These include cases of severe urethral strictures, prostatic enlargement that obstructs the urethra, or significant urogenital trauma. It is also a preferred option for long-term urinary diversion in patients with neurogenic bladder dysfunction or spinal cord injury. The catheter is inserted into the bladder, a muscular, hollow organ situated in the pelvic cavity.
Despite its benefits, the procedure is not appropriate for every patient. An absolute contraindication is the inability to confirm the presence of an adequately distended bladder. The bladder must be sufficiently full to minimize the risk of accidental bowel perforation during the puncture.
The procedure is also relatively contraindicated in patients who have had prior abdominal or pelvic surgery, as scar tissue can tether the bowel to the anterior bladder wall. Active bladder cancer or an uncorrected bleeding disorder also increases the risks associated with insertion. A careful assessment of the patient’s anatomy and medical history is required before proceeding with placement.
Pre-Procedure Assessment and Equipment Setup
Preparation for SPC insertion begins with a thorough patient assessment and confirmation of adequate bladder volume. The bladder must be filled, either naturally or by instilling sterile fluid via a temporary urethral catheter. This distension is confirmed using ultrasound, which allows the clinician to precisely map the bladder’s position and ensure no loops of bowel are present.
The intended insertion site is marked on the skin, typically in the midline about 4 to 5 centimeters above the pubic symphysis. Informed consent is obtained before the procedure begins. A sterile field is then meticulously established by cleaning the lower abdomen with an antiseptic solution, followed by sterile draping.
The equipment required for the percutaneous placement technique is usually provided in a sterile kit. This setup includes local anesthetic, a small scalpel for the skin incision, a thin-walled access needle, and a guidewire. The kit also contains a set of dilators and a peel-away sheath, which are used to progressively enlarge the tract.
The catheter itself is typically a silicone or hydrogel-coated latex type, ranging from 12 to 16 French gauge for most adults. The size is selected based on the anticipated duration of use and the required drainage lumen size. Before the procedure commences, the catheter’s retention balloon is tested for integrity, and all components are organized in the sterile field.
Step-by-Step Catheter Placement Technique
The insertion procedure begins with the administration of local anesthesia to numb the skin and the underlying layers of the abdominal wall. A fine needle is used to raise a skin wheal at the marked site, followed by deeper infiltration into the subcutaneous tissue and the fascia. The goal is to anesthetize the entire path the catheter will travel, minimizing patient discomfort.
Once the area is numb, a longer spinal needle is advanced through the anesthetized tract toward the bladder. The needle is typically aimed at an angle of 10 to 20 degrees caudally. A syringe attached to the needle is constantly aspirated as the needle is advanced. The return of urine confirms that the needle tip has entered the bladder lumen.
Following successful localization, a guidewire is threaded through the needle and coiled safely within the bladder cavity. The needle is then carefully withdrawn, leaving the guidewire in place. A small stab incision is made at the skin entry point with a scalpel blade to accommodate the introducer system.
The dilator and the peel-away sheath are then advanced over the guidewire in a single unit, penetrating the abdominal wall and entering the bladder. The dilator and guidewire are removed, leaving the sheath temporarily in the bladder as a conduit. The suprapubic catheter is then inserted through the sheath until the distal tip is well within the bladder, confirmed by the immediate flow of urine.
The retention balloon at the tip of the catheter is inflated with sterile water, usually 5 to 10 milliliters, to secure the catheter against the bladder wall. The peel-away sheath is then split and removed from the body, leaving only the catheter in place. The catheter is finally secured to the skin with a suture or a specialized fixation device to prevent accidental dislodgement.
Post-Insertion Care and Maintenance
Immediate post-insertion care focuses on securing the newly placed catheter and managing the drainage system. A sterile dressing is applied around the catheter insertion site (stoma) to protect the wound and absorb any initial drainage. The catheter must be anchored to the abdominal wall, often with a dedicated securement device, to prevent tension and minimize movement.
The catheter is connected to a drainage bag, which must always be positioned below the level of the bladder to ensure continuous, gravity-assisted flow of urine. The drainage bag should be emptied regularly, typically when it is about two-thirds full or at least every eight hours. Careful hand hygiene must be observed before and after handling any part of the drainage system.
Routine daily care involves cleaning the stoma site with mild soap and water. The area should be gently patted dry with a clean towel afterward. Creams or powders should be avoided as they can trap moisture and promote bacterial growth. Showers are generally permitted once the initial incision has healed, but baths or swimming are often restricted initially.
The SPC itself requires periodic replacement, with the typical interval ranging from four to twelve weeks. This routine exchange is performed by a trained healthcare professional. During the exchange, the old catheter’s balloon is deflated, the catheter is removed, and a new, lubricated one is inserted immediately into the established tract.
Recognizing and Managing Common Issues
Patients with an SPC must monitor for signs of potential complications, with infection being one of the most common issues. Signs of a local stoma site infection include increased redness, swelling, warmth, or the presence of pus-like drainage around the tube. Systemic infection, such as a urinary tract infection, may present with fever, chills, cloudy or foul-smelling urine, or discomfort in the lower abdomen.
Catheter blockage is another frequent problem, often signaled by a lack of urine output into the drainage bag or urine leaking around the catheter site. Blockage can be caused by mucus, sediment, or blood clots within the tube. If a blockage is suspected, a healthcare provider may attempt to flush the catheter gently with sterile saline. Increasing daily fluid intake to at least two liters is often recommended to dilute the urine.
Leakage of urine around the insertion site, known as bypassing, may indicate that the catheter is blocked or that the bladder is contracting involuntarily (bladder spasms). It can also signal that the catheter size is inappropriate. Bladder spasms can often be managed with specific medications prescribed by a physician.
Accidental dislodgement of the catheter is a serious event because the tract can close quickly, sometimes within hours. If the catheter comes out, it must be replaced immediately by a trained professional. Any occurrence of severe pain, heavy bleeding, or inability to pass urine requires immediate medical attention.