What are the guidelines and recommendations before placing a suprapubic catheter?

From the Guidelines

Before placing a suprapubic catheter, it is essential to confirm the indication, ensure a distended bladder, obtain informed consent, and check for contraindications, as recommended by the most recent guidelines 1. The guidelines emphasize the importance of careful patient selection and preparation to minimize the risk of complications.

• Confirm the indication for suprapubic catheterization, such as urinary retention not manageable by urethral catheterization, urethral trauma, or need for long-term bladder drainage.
• Ensure the patient has a distended bladder that is palpable or visible on ultrasound, as this reduces the risk of bowel injury 1.
• Obtain informed consent after explaining the procedure, risks, and alternatives, including the potential long-term risks and benefits of chronic indwelling catheterization 1.
• Check for contraindications including coagulopathy, previous lower abdominal surgery, pelvic malignancy, or inability to identify the bladder.
• Administer appropriate anesthesia and use sterile technique, including skin preparation with chlorhexidine or povidone-iodine and sterile draping.
• Verify bladder distension immediately before the procedure using ultrasound guidance when available, as recommended by the guidelines 1.
• Position the patient supine with the insertion site identified 2 fingerbreadths above the pubic symphysis in the midline. These guidelines help ensure safe placement while minimizing complications such as bowel perforation, bleeding, or catheter misplacement. It is also crucial to consider the potential risks associated with suprapubic catheter placement, including bowel perforation or vascular injury, and to mitigate these risks with routine use of ultrasound-guided placement 1. Ultimately, the decision to place a suprapubic catheter should be made in the context of shared decision-making, taking into account the patient's individual needs and preferences, as well as the potential risks and benefits of the procedure 1.

From the Research

Guidelines and Recommendations for Suprapubic Catheter Placement

Before placing a suprapubic catheter, several guidelines and recommendations should be considered:

• The decision to use a suprapubic catheter should be made on an informed basis, taking into account the patient's specific needs and medical condition 2.
• Suprapubic catheters are recommended for patients with acute urinary retention, as they cause less urinary tract infection and are more comfortable for the patient 3.
• The catheter should be securely anchored to the anterior abdominal wall with adhesive tape or a BioDerm Tube Holder to prevent traction and consequent displacement of the catheter or Foley balloon 4.
• A basic understanding of how suprapubic catheters are initially placed is essential for proper care and avoidance of possible complications 5.
• The type of catheterization (intermittent, indwelling, urethral or suprapubic) should be chosen based on the patient's individual needs 2.
• Nurses should be involved in the decision-making process regarding catheter selection and subsequent catheter care 2.

Key Considerations

• The patient's ability to void should be assessed prior to removal of the catheter to avoid the need for recatheterization 3.
• Suprapubic catheters are more cost-effective and easier to manage than urethral catheters in patients with acute urinary retention 3.
• The use of suprapubic catheters can reduce the risk of urinary tract infection compared to urethral catheters 6, 3.