From the Guidelines
To replace a bypassing suprapubic catheter in a patient with a possible UTI, the catheter should be replaced prior to the collection of cultures and initiation of antimicrobial treatment, as suggested by observational data 1. When replacing the catheter, it is essential to follow aseptic technique to minimize the risk of infection. The procedure involves gathering supplies, including a new sterile catheter of the same size (typically 16-18 Fr), sterile gloves, antiseptic solution, lubricant, drainage bag, and sterile dressing materials. The steps for replacement include:
- Cleaning the site with antiseptic solution
- Removing the old catheter
- Promptly inserting the new one through the established tract before it closes (which can happen within minutes)
- Securing the catheter
- Connecting it to a drainage bag
- Verifying proper function by observing urine flow Bypassing (leakage around the catheter) often occurs due to blockage, bladder spasms, or catheter size issues. If bypassing persists after replacement, consider increasing catheter size, treating bladder spasms with anticholinergics like oxybutynin, or addressing constipation if present. Regular catheter changes every 4-12 weeks help prevent complications like encrustation and blockage, as recommended by guidelines for the prevention and management of urinary tract infections 2, 3. It is also crucial to obtain a urine specimen for culture prior to initiating antimicrobial therapy for presumed CA-UTI, as recommended by the Infectious Diseases Society of America 2. Empirical treatment decisions can be made based on review of the individual patient’s urinary tract anatomy or dysfunction, allergies medication list for interactions, microbiological and prior treatment history, the type of UTI (eg, cystitis vs pyelonephritis), and the clinical severity of presentation 1.
From the Research
Replacement of Suprapubic Catheter
- The provided studies do not directly address the procedure for replacing a suprapubic catheter that is bypassing in a patient with a possible urinary tract infection (UTI) 4, 5, 6, 7, 8.
- However, it is mentioned that duration of catheterization is a leading risk factor for urinary tract infections, and catheter-associated bacteriuria are usually asymptomatic 6.
- The use of hydrophilic-coated catheters for clean intermittent catheterization can effectively reduce infections 4.
- Preliminary results with chlorhexidine-coated catheters are also promising in reducing catheter-associated UTIs 4.
Management of Catheter-Associated UTIs
- Empirical antibiotic treatment should be initiated with activity against multiresistant uropathogens in cases of serious catheter-associated UTI in patients with a history of previous antibiotic therapy or healthcare-associated bacteraemia 4.
- Antibiotic treatment does not decrease symptomatic episodes but will lead to emergence of more resistant organisms 8.
- Asymptomatic catheter-acquired UTI should not be treated with antimicrobials 8.