From the Guidelines
Management of a blocked suprapubic catheter requires prompt intervention to prevent complications such as urinary retention, discomfort, and infection, and the catheter should be changed immediately if flushing with 30-50ml of sterile normal saline fails. The evidence suggests that routine catheter change intervals are not well established, and the decision to change a catheter should be based on individual patient needs and the presence of complications such as blockage or infection 1.
Routine Catheter Care
For routine care, the catheter should typically be changed every 4-12 weeks depending on the type of catheter material (silicone catheters last longer than latex) 1. To prevent blockages, maintain adequate hydration (2-3 liters of fluid daily unless contraindicated), consider regular bladder irrigations with 30-50ml of normal saline if recurrent blockages occur, and implement a regular catheter change schedule.
Prevention of Blockages
Catheter blockages commonly result from encrustation with mineral deposits (particularly calcium and magnesium phosphates), mucus, blood clots, or sediment in the urine. Acidic urine helps prevent mineral crystal formation, so cranberry products may be beneficial for some patients 1. Patients should be educated to recognize signs of blockage including decreased or absent urine output, leakage around the catheter, abdominal discomfort, or autonomic dysreflexia symptoms in those with spinal cord injuries above T6.
Key Considerations
- Regular bladder irrigations with normal saline may help prevent blockages in patients with recurrent blockages 1.
- Cranberry products may be beneficial in preventing mineral crystal formation and reducing the risk of blockages 1.
- Patients should be educated to recognize signs of blockage and seek prompt medical attention if they occur.
- The decision to change a catheter should be based on individual patient needs and the presence of complications such as blockage or infection 1.
From the Research
Block Suprapubic Catheter Management
- The management of a blocked suprapubic catheter is a concern for nurses, particularly when the catheter becomes stuck due to a 'cuffing' effect of the deflated catheter balloon 2.
- This issue is especially common with 100% silicone catheters, and nurses need to know how to safely remove and change such catheters.
- To change a suprapubic catheter effectively, nurses must have the necessary knowledge and skills, and work within their competence limits 3.
- Patient involvement in shared decision-making about their suprapubic catheter care can increase their confidence and acceptance of the catheter and its function 3.
Complications and Satisfaction
- Suprapubic catheters are associated with a low incidence of urethral injury and stricture, but have similar rates of upper tract damage, vesicoureteral reflux, renal or bladder calculi, and symptomatic urinary tract infections compared to urethral catheters 4.
- Users of suprapubic catheters generally report being satisfied with them, but further studies are needed to understand patient satisfaction, stoma and skin care, and health-related quality of life 4.
- Most studies on suprapubic catheter management have focused on clinical urologic issues, rather than patient understanding, satisfaction, and quality of life 4.