From the Guidelines
Management of a blocked suprapubic catheter requires prompt intervention to prevent complications such as bladder distension, discomfort, and infection, and the first step should be to attempt to flush it with 30-50ml of sterile normal saline using a bladder syringe, as recommended by general medical practice and supported by the principles outlined in 1 and 1. If a suprapubic catheter becomes blocked, ensure aseptic technique throughout the procedure to minimize the risk of introducing infection. If flushing fails to restore flow, the catheter likely needs replacement. While waiting for replacement, temporary measures include taking oral analgesics such as acetaminophen 650mg every 6 hours or ibuprofen 400mg every 8 hours (if not contraindicated) for pain management, as these are common practices for managing discomfort associated with catheter blockage. To prevent future blockages, maintain adequate hydration (2-3 liters daily unless contraindicated), consider regular catheter changes, although the evidence from 1 suggests that routine catheter change does not have a clear benefit in reducing the risk of catheter-associated urinary tract infection (CA-UTI) or catheter blockage due to encrustation. Implement a regular flushing schedule with sterile saline if recommended by your healthcare provider, as this can help prevent blockages due to sediment accumulation, but the effectiveness of this practice is not strongly supported by the evidence from 1, which found no significant benefit in reducing CA-bacteriuria or CA-UTI with bladder irrigation. Blockages commonly occur due to encrustation from mineral deposits, particularly in patients with alkaline urine, or from mucus and sediment accumulation, and some patients may benefit from acidifying the urine with cranberry products or vitamin C supplements to reduce encrustation, though this should be discussed with a healthcare provider first, considering the lack of strong evidence supporting these interventions as outlined in 1 and 1. Always monitor for signs of urinary tract infection such as cloudy urine, foul smell, fever, or increasing discomfort, which may require antibiotic treatment, emphasizing the importance of vigilance in preventing and managing CA-UTI as highlighted in 1 and 1.
From the Research
Block Suprapubic Catheter Management
Overview of Suprapubic Catheterization
- Suprapubic catheterization is a widely used and generally considered safe procedure for draining the bladder of urine 2.
- However, there is a small risk of serious complications, including bowel injury 2.
Insertion and Care
- The insertion of suprapubic catheters can be performed as a temporary or permanent measure in patients with urinary dysfunction or if initial urethral catheter insertion or recatheterisation is problematic 3.
- The care and management of suprapubic catheters include changing the catheters, drainage systems, and patient education 3.
Guidelines and Best Practices
- The British Association of Urological Surgeons (BAUS) has produced updated guidelines on the indications, safe insertion, and subsequent care of suprapubic catheters (SPCs) 2.
- These guidelines aim to minimize risks and establish best practice, and are largely evidence-based, with areas for future research and development highlighted 2.
Patient Considerations
- While SPC insertion is generally regarded as a safe procedure, the risk of serious morbidity and death must always be considered and outlined to patients 2.
- Patient education is an important aspect of suprapubic catheter management, to ensure that patients understand the procedure, the risks, and the care required 3.