From the Guidelines
Yes, you should change a suprapubic catheter (SPC) if there are signs of infection at the insertion site. The presence of a suspected infection at the catheter site necessitates prompt action to prevent further complications, despite the lack of strong evidence supporting routine catheter change as a preventive measure for catheter-associated urinary tract infections (CA-UTI) or catheter-associated asymptomatic bacteriuria (CA-ASB) 1.
Key Considerations
- Clean the area with an antiseptic solution such as chlorhexidine or povidone-iodine before replacing the catheter using sterile technique.
- After changing the catheter, apply a sterile dressing to the site.
- Collect a sample for culture and sensitivity testing to guide antibiotic therapy if needed.
- Signs of infection include redness, swelling, warmth, pain, purulent discharge, or foul odor at the catheter site, as well as systemic symptoms like fever in more severe cases.
Rationale
The decision to change the catheter in the presence of a suspected infection is guided by the principle of minimizing morbidity and preventing potential mortality, rather than solely by the evidence regarding routine catheter change intervals 1. Biofilms can form on catheters, harboring bacteria that are resistant to antibiotics, which supports the rationale for changing the catheter in the context of an infection to reduce the risk of further complications 1.
Clinical Approach
- Monitor the catheter site closely for signs of infection.
- Maintain good hygiene around the catheter site to prevent infections.
- Consider regular catheter changes (typically every 4-12 weeks depending on the type) as part of a broader strategy to prevent infections, although the evidence for this practice is not strong 1.
- Empiric antibiotics may be necessary for severe infections or when systemic symptoms are present, with adjustment based on culture and sensitivity results.
From the Research
Suprapubic Catheter Change in Suspected Infection
- The decision to change a Suprapubic Catheter (SPC) in the presence of a suspected infection at the catheter site should be based on evidence-based practice 2.
- There is no clear evidence to support the routine change of SPC in cases of suspected infection, but it is recommended to avoid unnecessary catheterizations and to remove catheters as soon as possible to prevent catheter-associated urinary tract infections (UTIs) 3.
- The use of hydrophilic-coated catheters for clean intermittent catheterization can effectively reduce infections, and preliminary results with chlorhexidine-coated catheters are promising 3.
- Changing the SPC is a simple and safe outpatient procedure, but it can be associated with complications such as catheter misplacement, balloon extrusion, and bowel perforation 4.
- The risk of infection with SPC is lower compared to urethral catheters, with 50% of patients developing urinary tract infection on day 40 5.
- Health professionals should be aware of the risks and benefits of SPC, including the potential for infection, and assess and inform patients accordingly 6.
Key Considerations
- Avoid unnecessary catheterizations and remove catheters as soon as possible to prevent catheter-associated UTIs 3.
- Use evidence-based practice to guide the management of SPC 2.
- Be aware of the potential complications associated with changing the SPC 4.
- Consider the risks and benefits of SPC, including the potential for infection, when assessing and informing patients 6.