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The Risks and Benefits of Suprapubic Catheters

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The Risks and Benefits of Suprapubic Catheters Copyright EMAP Publishing 2015 This article is not for distribution Keywords: Bladder/Catheter/ Suprapubic/Urology Nursing Practice Review ●This article has been double-blind peer reviewed Continence Suprapubic catheters can improve some patients’ quality of life but health professionals must also understand the associated risks and limitations The risks and benefits of suprapubic catheters In this article... 5 key Indications for indwelling suprapubic catheterisation points Health Situations when suprapubic catheters should not be used 1professionals How to manage a patient with a suprapubic catheter must understand indications for suprapubic Author Ann Yates is director of continence should be reviewed regularly (Loveday et catheterisation services, Cardiff and Vale University Health al, 2014; Royal College of Nursing, 2012), Alternatives Board, Cardiff. Insertion of an indwelling catheter is 2should be Abstract Yates A (2016) The risks and indicated in any of the following clinical considered before benefits of suprapubic catheters. Nursing circumstances: a suprapubic Times; 112: 6/7, 19-22 . » Acute urinary retention; catheter is used Suprapubic catheterisation can improve » Chronic urinary retention – only if Suprapubic some patients’ quality of life but the symptomatic and/or with renal 3catheter insertion procedure, as well as changing compromise; insertion is and managing the catheter, carry risks of » Monitoring renal function during associated with infection and other negative patient critical illness; risks as well as outcomes. This article highlights the » During and after surgery for a variety of advantages advantages and disadvantages, indications reasons, such as radical prostatectomy; Only and contraindications, and the potential » Bypassing an obstruction such as an 4appropriately benefits, so health professionals can enlarged prostate, urethral strictures or trained staff should Female understand the relevant issues and assess urethral damage; change a Retention balloon and inform patients accordingly. » Facilitating continence and suprapubic maintaining skin integrity (when all catheter ndwelling suprapubic catheters are conservative treatment methods have BladderStaff must be hollow, flexible tubes inserted into the failed) (RCN, 2012). 5aware of the bladder through a small cut in the However, when identifying whether a complicationsCatheter Iabdomen (Fig 1). They are used to drain patient is suitable for a suprapubic cath- associated with urine from the bladder and, in the eter, certain indicators also apply, which suprapubic management of bladder dysfunction, are are listed in Box 1. catheters often considered an alternative to a ure- Suprapubic catheters are not suitable Pubic bone thral catheter. Insertion of indwelling suprapubic catheter is becoming an increasingly common urological proce- FIG 1. MALE SUPRAPUBIC CathETER dure, but is not without risks (Harrison et Female Male al, 2011). Health professionals need to be Retention balloon Retention balloon aware of the: » Indications and contraindications for suprapubic catheters; Bladder Bladder » Advantages and limitations; » Insertion techniques; Catheter Catheter » Subsequent catheter changes, management and complications. Indications and contraindications Pubic bone The decision to catheterise a patient should be taken after careful assessment Pubic bone by a competent health professional, and Lamb Peter Male www.nursingtimes.net / Vol 112 No 6/7 / Nursing Times 10.02.16 19 Retention balloon Bladder Catheter Pubic bone Copyright EMAP Publishing 2015 This article is not for distribution Nursing Practice Review BOX 1. INDICations FOR SUPRAPUBIC CathETER BOX 3. LIMitations OF INSERTION SUPRAPUBIC CathETERS In addition to the indications for urethral term urethral catheterisation, such as ● Haemorrahage, including haematuria catheterisation, the following apply for urethral trauma and intra-abdominal bleeding suprapubic catheter insertion: ● When long-term catheterisation is ● Infection, including UTI and infection ● Acute and chronic urine retention that used to manage incontinence of the track site cannot be adequately drained with a ● Complex urethral, abdominal surgery ● Pain and possible injury to abdominal urethral catheter or where urethral or gynaecological surgery organs (Harrison et al, 2011) catheterisation is contraindicated ● Faecally incontinent patients who are ● Insertion is an invasive procedure that ● Preferred by patient due to needs for constantly soiling urethral catheters or carries with it the risk of bleeding and comfort and access to catheter care, experience moisture lesions visceral injury such as wheelchair user ● Sexually active patients ● The patient may still leak urine via ● Acute prostatitis ● Neuropathic disorders causing the urethra ● Obstruction, stricture, abnormal frequent catheter expulsion ● Specialised training is required to urethral anatomy ● Restricted hip mobility, spasticity teach health professionals and carers ● Traumatic injury to lower urinary tract Source: Adapted from European Association of how to change a suprapubic catheter or pelvic trauma Urology Nurses (2012), Royal College of Nursing ● Patients with artificial heart valves ● To minimise complications of long- (2012); Rew and Smith (2011) may require antibiotic therapy before initial insertion or routine catheter changes, although this will depend on FIG 2. A SUPRAPUBIC BOX 2. local healthcare management policy CathETER INSERTION KIT ContRAINDICations ● Patients on anticoagulant therapy FOR SUPRAPUBIC will require coagulation levels to be CathETERS checked before a suprapubic catheter is inserted Absolute contraindications Source: European Association of Urology Nurses ● Non-palpable bladder (2012) ● Unable to visualise a distended bladder by ultrasound Relative contraindications » The procedure is less intimate than ● Coagulopathy (until the abnormality insertion via the urethra. is corrected) Suprapubic catheterisation has also ● Known or suspected carcinoma of the been highlighted as contributory to for everyone and there are a number of bladder – absolutely contraindicated in patients’ improved recovery times, com- contraindications. These are highlighted the absence of an easily palpable or pared with urethral catheterisation (Nwa- in Box 2. localised distended urinary bladder on diaro et al, 2007; Wyndaele et al, 1985). ultrasound Advantages of suprapubic ● Localised distended urinary bladder Risks and limitations catheters ● Previous lower abdominal surgery Although suprapubic catheters have many There is little evidence-based research on ● Ascites advantages, there are also several risks and the use of suprapubic catheters but, ● Prosthetic devices in lower abdomen limitations. These are outlined in Box 3. according to the RCN (2012) and the such as a hernia mesh One risk of suprapubic catheterisation European Association of Urology Nurses Source: European Association of Urology Nurses is of bowel perforation. Sheriff et al (1998), (2012), there may be several advantages to (2012), Harrison et al (2011) reviewed 185 cases and identified a 2.7% their use compared with urethral incidence, with one fatal outcome, but the catheterisation: National Patient Safety Agency (2010) » There is no risk of urethral trauma, catheter is removed (trial without placed the figure at 0.15% (NPSA, 2010). necrosis or catheter-induced urethritis catheter, or TWOC); and urethral strictures; » Micturition is still possible if the Insertion techniques » Greater comfort, particularly for urethra is not surgically closed or The initial insertion of a suprapubic cath- patients who are chair bound as the obstructed; eter should be undertaken by a clinician catheter is not positioned between their » Evidence of greater satisfaction and with the appropriate skills (Harrison et al, legs and there is less risk of sitting on it; quality of life when compared with 2011). It can be done under a local or gen- » Reduced risk of catheter contamination urethral catheterisation (Reitz et al, eral anaesthetic and different insertion with micro-organisms that are 2006). kits are available for different clinical pres- commonly found in the bowel; Other benefits have also been identified entations. The procedure is usually carried » Easier access to the entry site for by Dingwall (2008), including: out in theatres but some specialist clini- cleansing and catheter change; » Decrease in urinary tract infection rates cians can insert the initial catheter in » Makes it easier to engage in sexual through reduced contact with genitalia home or community settings. Fig 2 shows intercourse than a urethral catheter; before the catheter is introduced into an insertion kit for a suprapubic catheter. » Can be blocked off and the ability to the bladder; Suprapubic catheters can be divided void via the urethra assessed before the » Reduced pain on catheter insertion; into different types: 20 Nursing Times 10.02.16 / Vol 112 No 6/7 / www.nursingtimes.net Copyright EMAP Publishing 2015 This article is not for distribution For more articles on continence, go to Nursing nursingtimes.net/continence Times.net » Foley balloon catheter (the most FIG 3. BELLY BAG Complications commonly used); DRAINAGE BAG Although suprapubic catheters have many » Catheter without a balloon, which advantages, they are still associated requires a suture to secure; with complications. Addison and Mould » Foley balloon with open end. (2000) identified that suprapubic catheter- The patient should have a palpable isation
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