A suprapubic catheter (SPC) is a flexible tube inserted through a small incision in the lower abdomen, directly into the bladder, to drain urine into an external collection bag. This method provides an alternative to a traditional urethral catheter, often reducing irritation and offering greater comfort for long-term use. Catheter irrigation, or flushing, is a routine procedure involving the gentle introduction of a sterile solution into the tube to maintain its patency. This process helps clear out any debris or sediment that could otherwise impede urine flow. The following guide provides detailed instructions for caregivers or patients who must perform this maintenance procedure at home.
Understanding When and Why Irrigation is Necessary
The primary purpose of suprapubic catheter irrigation is to prevent blockages, ensuring the device functions optimally to drain the bladder. Urine naturally contains sediments, mucus, and sometimes blood, which can accumulate inside the narrow tubing over time. This buildup can slow or stop the flow of urine, leading to discomfort and potential complications.
Irrigation is often scheduled routinely, such as daily or several times a week, based on a healthcare provider’s orders and the patient’s individual needs. It becomes immediately necessary if urine output suddenly decreases or stops completely, or if the urine appears thick, cloudy, or contains visible blood clots. Flushing the line helps dislodge the obstruction, restoring continuous drainage. Maintaining a clear catheter also reduces the risk of ascending bacterial infections by preventing stagnant urine and debris accumulation.
Gathering Supplies and Preparing the Work Area
Preparation is fundamental to performing this procedure safely and aseptically, minimizing the risk of introducing bacteria. Supplies are typically provided in a sterile irrigation kit or gathered individually. These include a 60 milliliter (mL) catheter-tip syringe, a sterile irrigation solution (usually normal saline or sterile water), and antiseptic wipes. You will also need non-sterile gloves, a sterile drape or clean towel, and a clean container to catch the used fluid.
Begin by washing your hands thoroughly with soap and water for at least 20 seconds, then dry them with a clean towel. Lay out the drape or towel on a flat, clean surface, and arrange all the supplies within easy reach. Open the irrigation kit, ensuring sterile components remain untouched inside the wrapper or tray. Pour the prescribed amount of sterile solution into the designated basin.
Performing the Catheter Irrigation Procedure
Once the area is set up, put on the non-sterile gloves. Use an antiseptic wipe to clean the connection point where the suprapubic catheter meets the drainage tube, swabbing the area for about 15 to 30 seconds and allowing it to air dry. Gently separate the catheter tube from the drainage bag tubing, taking care to keep the ends from touching any non-sterile surface.
Draw the prescribed volume of sterile solution, typically 30 to 60 mL, into the catheter-tip syringe, avoiding contact with the syringe tip. Insert the syringe securely into the open end of the suprapubic catheter tubing. Slowly and gently push the plunger to instill the solution into the bladder, watching for any resistance. If significant resistance is met, stop immediately and do not force the fluid.
After instilling the solution, gently pull back on the syringe plunger to aspirate the fluid and debris. The fluid will contain sediment, often appearing cloudy or containing particles. If the fluid does not return easily, allow it to drain by gravity into the collection basin. This process can be repeated two or three times until the return fluid is visually clearer.
When the irrigation is complete, disconnect the syringe and clean the end of the catheter tubing and the drainage bag connector with a fresh antiseptic wipe. Reconnect the catheter tubing to the drainage bag tubing securely, ensuring the connection is firm. Note the total volume of fluid instilled and the amount returned to ensure a close balance, confirming the procedure was successful.
Recognizing Signs of Trouble
It is important to know when to pause the irrigation procedure and contact a healthcare professional for guidance. If you encounter significant resistance when attempting to instill the fluid, or if the patient reports immediate, sharp pain upon instillation, the procedure must be stopped. A lack of fluid return after instilling the solution, or a failure to restore urine output within 15 minutes, also requires immediate attention.
Beyond procedural issues, several signs indicate potential complications or infection requiring medical evaluation:
- A fever above 100.5 degrees Fahrenheit (38 degrees Celsius) or the presence of shaking chills, which can signal a systemic infection.
- Persistent or severe pain in the abdomen or around the catheter insertion site.
- The sudden onset of cloudy or foul-smelling urine.
- Continuous leakage of urine around the insertion site.
- The presence of persistent, large blood clots in the drainage bag.