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How To Care For Your Suprapubic Catheter


What is a suprapubic catheter?

A suprapubic catheter is a sterile (germ-free) tube that drains urine out of your bladder. It is inserted through a stoma (created opening) in your abdomen and into your bladder. Suprapubic means that the catheter goes into your body above your pubic bone. The catheter has a small balloon filled with solution that holds the catheter inside your bladder. These catheters are used when you have problems urinating because of a medical condition. A suprapubic catheter is also called an indwelling urinary catheter.

What is a closed drainage system for my suprapubic catheter?

The drainage system consists of your suprapubic catheter and a sterile urine drainage bag attached to the catheter. This forms a pathway that goes from the tip of the catheter inside your bladder to the urine bag. It is a closed drainage system when there are no leaks or disconnections. Your urinary system normally is sterile and a closed drainage system prevents germs from getting into it. Your catheter should always be attached to other equipment to form a closed drainage system.

Why is it important to take care of my suprapubic catheter and drainage bag properly?

Urinary catheter-based infections are common and can lead to serious illness and death. An infection can be caused by bacteria (germs) that get inside the catheter or drainage bag tubing when the drainage system is opened. This can happen when the urine bag is changed or when a urine sample is collected. You can also get an infection if the catheter equipment is not cleaned well or if you do not wash your hands. Actions that help prevent catheter-based infections include:

  • Drinking liquids: Adults should drink about 9 to 13 cups of liquid each day. One cup is 8 ounces. Good choices of liquids for most people include water, juice, and milk. Coffee, soup, and fruit may be counted in your daily liquid amount. Ask your healthcare provider how much liquid you should drink each day.
  • Good hand washing is the best way to prevent infection. Always wash your hands with soap and water before and after you touch your catheter, tubing, or drainage bag. Do this to remove germs on your hands before you touch these items. Do this after you touch these items to remove germs that may have been on them. Wear clean medical gloves when you care for your catheter or disconnect the drainage bag. This will help stop germs from getting into your catheter. Remind anyone who cares for your catheter or drainage system to wash his or her hands.
  • Always do proper care and cleaning of the catheter, the insertion site, and the drainage bag.
  • Ask your healthcare provider when your catheter will be removed or replaced with a new one. Your risk for infection is greater the longer you have a catheter.
  • Keep the catheter drainage system closed.
  • Keep the catheter tube secured to your skin or leg so it will drain well.

How do I care for my drainage bag?

  • Use good hand hygiene: Keep your hands clean and as free of germs as possible. Always wash your hands before and after you touch the catheter or the insertion site. Wear clean medical gloves when you care for your catheter.
  • Position the drainage bag and tubing:
    • Allow gravity drainage: Do not loop or kink the tubing so urine can flow out.
    • Position the drainage bag properly: Keep the drainage bag below the level of your waist. This helps stop urine from moving back up the tubing and into your bladder.
    • Keep the bag off the floor: Do not let the drainage bag touch or lie on the floor.
  • Empty the drainage bag when needed: The weight of a full drainage bag can pull on and hurt your stoma. Empty the drainage bag every 3 to 6 hours or when it is ½ to ⅔ full.
    • Place a large container on the floor next to your chair. You may also hold the urine bag over the toilet.
    • Remove the drain spout from its sleeve at the bottom of the urine bag. Do not touch the tip. Open the slide valve on the spout.
    • Let the urine flow out of the urine bag into the container or toilet. Do not let the drainage tube touch anything.
    • Clean the end of the drain spout when the bag is empty. Ask your healthcare provider which cleaning solution is best to use.
    • Close the slide valve and put the drain spout into its sleeve at the bottom of the urine bag. Write down how much urine was in your bag if your healthcare provider has asked you to keep a record.
  • Clean and change the drainage bag as directed: Ask your healthcare provider how often you should change the drainage bag. You may buy a special solution to clean the drainage bag, or you may make a solution with tap water and household bleach or vinegar. Wear medical gloves if you must disconnect the tubing. Do not allow the end of the catheter or tubing to touch anything. Clean the ends with a new alcohol pad or as directed by your healthcare provider before you reconnect them.

How do I clean my stoma?

Clean the skin around your stoma every day or as directed by your healthcare provider. Do the following:

  • Gather the items you will need:
    • Warm water and soap without lotions or perfumes in it
    • Clean washcloth or sterile gauze bandage
    • Clean towel
    • New gauze bandage for dressing, if used
    • Clean medical gloves
    • Trash can
  • Prepare the site:
    • Wash your hands. Put on clean gloves.
    • Gently remove the bandage, if you use one. Hold the skin around the stoma with one hand. With the other hand, gently pull any adhesive tape in the direction of hair growth. Throw the bandage in the trash can.
    • Look for redness, skin injuries, red spots, drainage, and swelling. Report any skin changes to your healthcare provider.
  • Clean the site:
    • Throw away your used gloves. Wash your hands and put on clean gloves.
    • Hold the end of the catheter tube near the insertion site so you do not pull it out while you clean your skin.
    • Wash the catheter with a washcloth or sterile gauze bandage as directed to remove blood or other material. Start at the end near your stoma and move up the catheter, away from the stoma.
    • Clean the skin around your stoma by moving your hand in a circle away from the stoma as you clean. Clean off any mucus. Rinse the stoma and the skin around it with the washcloth or sterile gauze bandage.
    • Pat the area gently with a clean towel or gauze bandage to dry it.
  • Dress the stoma site and secure the catheter:
    • Throw away your used gloves. Wash your hands. Apply a new bandage if you use one.
    • Secure the catheter tubing with tape or the device that holds the catheter to your leg or abdomen. Do not kink or block the tubing.

How is my suprapubic catheter changed?

Usually a healthcare provider will do routine catheter changes for you. You or someone who helps take care of you may be taught how to change the catheter if you have it for a long time. You also need to know how to change the catheter in case it comes out accidently. This must be done right away because your stoma can close quickly. Do the following to change a suprapubic catheter:

  • Gather the items you will need:
    • New catheter kit that has the catheter, lubricating gel, skin cleaning supplies, and a syringe and water for filling the catheter balloon
    • Syringe for removing the water from the balloon of the old catheter
    • Sterile medical gloves
    • Clean medical gloves, if used
    • Bandages and surgical tape, if used
    • Anesthesia (numbing) gel, if used
  • Prepare to remove the catheter:
    • Wash your hands with germ-killing soap and warm water.
    • Open the catheter pack as directed on the package or as you have been shown. Fill a syringe with sterile water as directed. Attach the drainage bag to the new catheter as directed. It can be connected to the new catheter before or after the new catheter is inserted.
    • Put on the clean gloves. Healthcare providers may show you how to use 2 sterile gloves on each hand when you are changing your own catheter.
    • Remove the dressing and throw it away.
    • Clean around the insertion site as directed with saline or a cleaning solution. Remove the gloves, wash your hands, and put on new clean gloves. Do not remove the sterile gloves if you are changing your own catheter.
    • Get into a position that is comfortable for you, such as lying on your back. Use a waterproof pad underneath you in case any urine leaks out.
    • Remove the tape or device that holds the catheter to your leg or abdomen. Hold the catheter firmly and gently rotate it to loosen it.
  • Remove the old catheter:
    • Attach a syringe to balloon port and remove all of the water from the catheter balloon. Throw away the syringe.
    • Have a new gauze bandage available as there may a small amount of urine coming from the site after the catheter comes out.
    • Hold the catheter at a point close to the insertion site. Compare the old and new catheters by looking at where your fingers are as you hold the old catheter near the stoma. This will show you how far to insert the new one.
    • Keep your fingers on the tube close to the insertion site and gently pull the catheter up and away from you. Stop if the catheter is hard to pull and rotate it more while you press down gently.
    • Pull the catheter until it comes all of the way out and throw it away.
  • Insert the new catheter: Do this within 10 minutes after you remove the old catheter.
    • Remove the gloves, wash your hands, and put on the sterile gloves. If you are changing your own catheter and wearing 2 sets of sterile gloves, remove 1 glove from each hand.
    • Put sterile lubricating gel on the new catheter to make it easier to move through the stoma. Use anesthetic gel if directed by your healthcare provider.
    • Insert the new catheter.
  • Secure the new catheter:
    • Check to see that urine is draining from the catheter. When urine begins to flow through the tubing, fill the catheter balloon with the sterile water in the new syringe. Use the amount of water as directed or as stated on the catheter kit.
    • Gently move the catheter in or out a small amount if you feel pain or the balloon is hard to fill and try again. If that does not work, remove the catheter and insert a new one.
    • Clean the catheter insertion site again if needed. Apply a bandage if you use one.
    • Throw away your used gloves, and wash your hands.
    • Secure the catheter tube with tape or a device. Catheters should be secured to the thigh for women and the abdomen or thigh for men. The catheter tube should be secured loosely so it does not pull on the catheter.

What problems may occur with changing my suprapubic catheter and what should I do about them?

  • Catheter does not come out easily during change: Some types of catheter balloons get ridges on them or may hold their inflated shape after the water is removed. You may need a different type of catheter if this happens. A catheter that does not come out easily can damage your stoma and increase your risk for infection. Tell your healthcare provider if you have problems with removing your old catheter.
  • Not able to insert the new catheter: If you have trouble, cover the stoma with a sterile bandage and call your healthcare provider right away.
  • New catheter balloon in the wrong place: A catheter balloon that is in the wrong place may cause pain when you try to fill it.
    • Not inserted deep enough: This can cause pain and may damage your stoma if the catheter balloon is in the stoma when the balloon is filled. Damage to your stoma can make inserting a new catheter harder or lead to an infection. Insert more of the catheter and try to fill the balloon again.
    • Inserted too deep: A catheter that is inserted too far into your bladder can pass into your urethra. This can cause pain and leaking urine when the balloon is filled. In women the end of the new catheter may poke out of the urethra. Your catheter will not drain urine as it should if this happens and may damage your urethra.

What other problems may occur with my suprapubic catheter and what should I do about them?

  • Catheter comes out accidently: You or a person who helps care for you will need to learn how to put in a new catheter. This must be done right away if your catheter comes out. Always keep an extra catheter with you in case this happens. Make sure you have enough supplies to be able to change your catheter and keep your drainage system closed.
  • Loss of stoma: Your stoma can start to close if it goes longer than 5 to 10 minutes without a catheter in it. This can happen when your catheter is changed or if it comes out accidently. Healthcare providers may be able to save your stoma if you seek care immediately .
  • Blocked tubing or catheter: Keep the tubing in a straight line when you hang your drainage bag to prevent it from getting blocked. Increase the amount of liquids you drink if you see mucus or sand-like material in your urine. This can block your catheter and increase your risk for infection. You may need to change the position of your drainage bag. You may get bladder stones that can block your catheter.
  • Tissue overgrowth around the stoma: Too much tissue may grow around your stoma. Move the catheter to a different place on your abdomen to reduce the pressure. This will help keep the tissue from growing too much. Healthcare providers may need to treat you if the tissue keeps growing.
  • Signs of problems related to your catheter:
    • Lower abdomen pain: This can be a sign of infection. You may also have pain if the catheter is in the wrong place.
    • Urine leaking from your stoma or urethra: Wet clothes or a wet bed may be signs that your catheter is not draining as it should. You may get some urine leaking from your stoma or urethra if you have bladder spasms. A lot of urine leaking is not normal. The catheter may be blocked or in the wrong position The drainage tubing may be blocked or kinked. Leaking urine can also be a sign of infection.
    • No urine draining from the catheter: No urine drainage for 6 to 8 hours is a sign that your catheter is not working properly. Pain or fullness in your lower abdomen can also be signs of catheter blockage or infection problems. You may also feel restless. If you have any of these signs, do the following:
      • Check to see if the urine tubing is twisted or bent or if you are lying on the catheter or tubing.
      • Make sure the urine bag and tubing are located below the level of your waist
      • Move to a different position.
      • Contact your healthcare provider immediately if there is still no urine draining or if you continue to have pain or fullness or feel restless.

When should I contact my healthcare provider?

  • You have a fever.
  • You have changes in how your urine looks or smells, or you have blood in your urine.
  • Urine keeps draining out of the catheter insertion site or from your urethra.
  • You have an overgrowth of skin at the insertion site that is getting larger.
  • The closed drainage system has accidently come open or apart.
  • Your catheter keeps getting blocked.
  • Your catheter came out accidently and you have replaced it with a new one.

When should I seek immediate care?

  • There is less urine than usual or no urine draining into the drainage bag.
  • The catheter comes out and you are not able to put a new catheter in.
  • Your insertion site is red, has green or yellow discharge, smells bad, or is bleeding more than usual.
  • You have pain in your hip, back, pelvis, or lower abdomen.
  • You are confused or have other changes in the way that you think.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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Further information

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