Patient education: How to care for a suprapubic catheter (The Basics)

What is a suprapubic catheter? — A suprapubic catheter is a thin tube that is placed through the skin on the lower belly, directly into the bladder. It lets urine drain from the bladder into a collection bag (figure 1). A person might have a suprapubic catheter for a few days to a few months, or even permanently, depending on why the catheter was placed.

The surgery to place a suprapubic catheter is called a "suprapubic cystostomy." In this procedure, the doctor makes a small opening (called a "stoma") just below the belly button. The catheter is placed through the stoma and into the bladder.

How do I care for myself at home? — Ask the doctor or nurse what you should do when you go home. Make sure you understand exactly what you need to do to care for yourself. Ask questions if there is anything you do not understand.

Before you go home, your doctor or nurse will talk to you about your suprapubic catheter and how to care for it. This includes taking care of the skin around the catheter, the catheter itself, and the bag that collects the urine. They will also make sure that you have the supplies you need.

Having a suprapubic catheter increases your risk of infection. This is why it's so important to take care of it.

You might need a family member or friend to help you care for the suprapubic catheter. Some people have a home health nurse come to their home to help with this.

How do I take care of the skin around the suprapubic catheter? — Keeping your skin clean and changing the dressing regularly can help to prevent infection. Clean the skin and replace the dressing around the catheter every day and as needed. You can shower with a suprapubic catheter in place. Do not use creams, powders, lotions, or sprays near the stoma.

If you have a dressing around the catheter, follow these steps to change it:

●Gather the supplies, and place them on a clean workspace. You need 2 pairs of clean gloves, a small bag for trash, soap or other cleanser, cotton swabs or washcloths, split gauze dressings, and medical tape.

●Always wash your hands well with soap and water before touching the catheter. Put on clean gloves.

●Hold the catheter with 1 hand as your take off the old dressing. Do not use scissors or sharp tools. They could cut the catheter. Do not pull on the catheter when taking off the dressing. Throw away the gloves and old dressing.

●Check the skin where the catheter enters for swelling, drainage, or redness.

●Wash your hands again, and put on clean gloves.

●Wet a clean cotton swab or washcloth with the cleanser or soap and water. Wash the skin around the catheter. Work in a circular motion, moving outward from the catheter, to clean the skin. Clean the entire area that will be under the dressing, about a 3-inch (7.5 cm) square.

●Use a clean swab or washcloth, and remove any crusted material around the catheter. Do not remove the stitch that secures the catheter to the skin. Rinse the area with clean water if you are using soap.

●Allow the area to air dry, or pat dry with a clean towel. Do not fan the area.

●Place a sterile split gauze around the catheter. Avoid touching the area of the gauze where it touches the skin or catheter. Place a second gauze pad over the first one. Tape the edges to secure the gauze. Secure the catheter and tubing with tape or a strap. The tubing should be loose, so it does not pull on the catheter.

●Remove the gloves.

●Wash your hands with soap and water.

How do I take care of the suprapubic catheter and bag? — Keep the catheter and drainage system secure. Do not pull on the catheter or catch the drainage tubing on anything as you move around. Keep the drainage bag below your bladder. Keep the tubing free of kinks or loops.

Some tips for taking care of the drainage bag:

●Drain the bag when it is half full. Wash your hands. Then, empty the urine into the toilet, or into a clean container if you need to measure the urine. Use the container only for urine. Keep the drainage spout from touching the container or floor when emptying the bag.

●Change the drainage bag each week or if it leaks. You might need a new bag if the old one becomes too stiff.

●To change the drainage bag:

•Wash your hands well with soap and water, and empty the drainage bag. Wash your hands again.

•Gather the supplies, and place them on a clean workspace. You need a clean drainage bag, connecting tubing, alcohol swabs, and clean gloves.

•Put on the clean gloves.

•Use the alcohol swabs to clean where the catheter and drainage bag tubing meet. Also use alcohol swabs to clean the end of the new drainage tubing where it will connect with the catheter tubing.

•Disconnect the catheter tubing from the used tubing and drainage bag. Attach the catheter to the clean tubing of the new drainage bag. Do not touch the end of either catheter.

●To clean the drainage bag and tubing:

•Pour warm, soapy water into the tubing and bag. Swish the soapy water around, and drain. Rinse well with clean water.

•The doctor might also want you to clean the inside of the drainage bag with another solution. Sample solutions include vinegar and water made with 1 cup (240 mL) of vinegar and 3 cups (720 mL) of water, or bleach and water made with 1 tablespoon (15 mL) of unscented bleach and 1/2 cup (120 mL) of water. Swish the solution all around the inside of the bag, and let it soak for 30 minutes. Drain, and rinse well with clean water. Hang the drainage bag with the drainage spout open to air dry.

•Wash your hands.

How do I change the suprapubic catheter? — A suprapubic catheter is replaced every 4 to 12 weeks. Your doctor or nurse will tell you when yours should be replaced. They will change the catheter the first time. After that, some people are taught how to change the catheter themselves. Other times, the doctor or nurse will change the catheter instead.

Do not leave the catheter out for too long, because the stoma can close.

To change the catheter:

●Gather the supplies, and place them on a clean workspace. You need a new catheter and clean drainage bag, 2 pairs of sterile gloves, syringes to add or remove water in the catheter balloon, soap or other cleanser, cotton swabs or washcloths, split gauze dressings, and medical tape.

●Always wash your hands well with soap and water before touching the catheter. Put on both pairs of sterile gloves, 1 over the other.

●Hold the catheter with 1 hand as your take off the old dressing. Do not pull on the catheter when taking off the dressing.

●Clean the skin at the site.

●Attach the syringe, and deflate the balloon by pulling out the water in the balloon.

●Hold the catheter near the insertion site, and gently pull the catheter until it comes out. The new catheter will be inserted at the same length.

●Take off the top pair of gloves.

●Clean the skin at the site again.

●Attach the clean drainage bag to the new catheter.

●Gently put the new catheter in the stoma as the other one was placed. If you have pain or feel resistance, pull the catheter out a little and try again. If you cannot get the catheter in, cover the opening and call your doctor right away.

●Once urine begins to flow, inflate the balloon on the catheter with 5 to 8 mL of sterile water, or the amount you were told to use.

●Place a sterile split gauze around the catheter. Place a second gauze pad over the first one. Tape the edges to secure the gauze. Secure the catheter and tubing with tape or a strap. The tubing should be loose, so it does not pull on the catheter.

●Remove the gloves.

●Wash your hands with soap and water.

What else should I know?

●You might still be able to urinate normally with a suprapubic catheter in place.

●If you cannot see any urine in your drainage bag, try changing your position. If there is still no urine in your bag after 6 hours, call your doctor right away.

When should I call the doctor? — Call your doctor or nurse for advice if you have any symptoms of a urinary tract infection. These might include:

●Fever of 100.4°F (38°C) or higher

●Needing to urinate more often

●Needing to urinate right away or in a hurry

●Blood in your urine

You should also call if:

●You cannot replace your catheter.

●You have very bad pain in your back, shoulder, or belly.

●Your urine is dark or coffee colored, has bits of anything solid in it, or looks like pus.

●The catheter starts to leak, breaks, or falls out.

●There is no urine in the drainage bag for more than 6 hours.

More on this topic

Patient education: Suprapubic catheter placement (The Basics)
Patient education: How to use a catheter to empty the bladder (The Basics)
Patient education: How to care for a urinary catheter (The Basics)