What are the guidelines for managing and exchanging a suprapubic (urinary) catheter in a home health setting?

From the Guidelines

I recommend a home health order for suprapubic catheter management that includes weekly nurse visits for the first month, then biweekly visits for catheter care and exchanges every 4-6 weeks, as this approach is supported by the most recent and highest quality study available 1.

Key Components of the Order

• The order should specify a 16-18 French silicone catheter with 10cc balloon, with supplies including sterile gloves, antiseptic solution (chlorhexidine preferred), sterile water for balloon inflation, drainage bags (both leg and bedside), and catheter securement devices.
• Nurses should assess the stoma site for signs of infection, perform peristomal skin care with mild soap and water, and apply a split gauze dressing if drainage is present.
• The patient should be instructed to maintain daily catheter care by cleaning the site with mild soap and water, keeping the tube secured to prevent tension, emptying the drainage bag when 2/3 full, and maintaining adequate hydration (2-3 liters daily) to prevent blockage.

Parameters for Contacting the Provider

• The order should include parameters for when to contact the provider, including:
  • Fever above 101°F
  • Cloudy/foul-smelling urine
  • Increased leakage around catheter
  • Bleeding
  • Catheter dislodgement
  • Persistent pain

Rationale

The recommended approach is based on the guidelines for the diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults, which emphasize the importance of proper catheter maintenance and care 1. While the evidence is not definitive on the optimal frequency for catheter exchanges, the recommended approach is supported by the most recent and highest quality study available 1. Additionally, the use of a closed catheter drainage system, as recommended by the Infectious Diseases Society of America 1, can help reduce the risk of catheter-associated bacteriuria and urinary tract infections.

From the Research

Suprapubic Catheter Management and Exchanges

• A suprapubic catheter is used to drain the bladder of urine as an alternative to an indwelling urethral catheter 2
• The catheter can be inserted as a temporary or permanent measure in patients with urinary dysfunction or if initial urethral catheter insertion or recatheterisation is problematic 2

Home Health Order for Suprapubic Catheter Management

• The home health order for suprapubic catheter management should include:
  • Catheter insertion and removal instructions
  • Catheter care and maintenance instructions
  • Instructions for changing the catheter and drainage system
  • Patient education on catheter management and care 2
• Antibiotic prophylaxis may be considered at urinary catheter removal to prevent urinary tract infections, especially in high-risk patients 3, 4

Exchange of Suprapubic Catheter

• The suprapubic catheter should be exchanged regularly to prevent urinary tract infections and maintain catheter patency
• The frequency of catheter exchange will depend on the individual patient's needs and the type of catheter used
• A silver-alloy-impregnated suprapubic catheter may be considered to reduce the risk of urinary tract infections 5

Prevention of Urinary Tract Infections

• Urinary tract infections can be prevented by:
  • Using sterile technique when inserting or removing the catheter
  • Maintaining a closed drainage system
  • Changing the catheter and drainage system regularly
  • Using antibiotic prophylaxis at catheter removal, if indicated 3, 6, 4
• Patients with diabetes or non-white race may be at increased risk of urinary tract infections and should be closely monitored 5