From the Guidelines
If a suprapubic catheter has been out for six hours, it should be replaced as soon as possible by a healthcare professional, ideally in a medical setting, to minimize the risk of complications and the need for surgical intervention. The replacement procedure requires sterile technique and typically involves inserting a new catheter through the existing tract before it closes, which can begin to narrow within hours 1. Contact your healthcare provider immediately or go to an emergency department, as the tract may start to close after 2-4 hours, making reinsertion more difficult or impossible without surgical intervention.
Some key considerations for the replacement of a suprapubic catheter include:
- The need for sterile technique to prevent infection
- The importance of acting quickly, as the tract can begin to close within hours
- The potential for complications, such as the need for surgical intervention, if the tract closes completely
- The preference for suprapubic tubes over urethral catheters due to the reduced likelihood of urethral damage, as noted in the AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder 1
While waiting for medical attention, cover the site with a clean, dry dressing to prevent infection. The urgency for replacement is because once the tract closes completely, a new surgical procedure would be required to create another opening, which carries additional risks and complications. Delaying replacement beyond 24 hours almost certainly requires surgical intervention to reestablish the tract. It is essential to follow the guidance of a healthcare professional and prioritize prompt replacement to minimize the risk of morbidity, mortality, and decreased quality of life.
From the Research
Replacing a Dislodged Suprapubic Catheter
- A dislodged suprapubic catheter that has been out for six hours requires prompt replacement to prevent complications such as urinary retention, infection, or bladder damage 2, 3.
- The replacement procedure should be performed by a healthcare professional, taking into account the patient's individual needs and medical history 3.
- The British Association of Urological Surgeons' guidelines suggest that suprapubic catheterization is a safe procedure, but there is a small risk of serious complications, and therefore, guidelines have been developed to minimize risks and establish best practice 3.
Procedure for Replacement
- The procedure for replacing a suprapubic catheter involves inserting a new catheter into the bladder through the existing suprapubic tract or creating a new tract if necessary 4.
- The Transurethral Suprapubic endo-Cystostomy (T-SPeC) device is a novel, minimally invasive device that can be used for suprapubic catheter placement via the transurethral approach 4.
- The choice of replacement procedure depends on the individual patient's needs and the healthcare provider's expertise 3, 4.
Post-Procedure Care
- After replacing a dislodged suprapubic catheter, it is essential to monitor the patient for any complications, such as urinary tract infections, catheter blockage, or expulsion 4.
- Proper catheter care and maintenance are crucial to prevent complications and ensure the patient's comfort and safety 2, 3.
- Patient education on catheter care and management is also vital to prevent future dislodgments and complications 2.