SUPRAPUBIC DRAINAGE,
CLINICAL SKILLS LAB
INTRODUCTION:
When a
patient is unable to empty the bladder normally, some kind of bladder drainage
may be necessary. Typically, this is a
urethral catheter. However, long term urethral catheter can give rise to
urethral discomfort, urethral erosions and penile discomfort in the male.
Moreover, in some patients, it may not be possible to insert a urethral
catheter e.g. because of urethral
stricture or prostatic enlargement. In
some patients who have contracture of the pelvis, the patients may not be able
to abduct the legs. It is also easier to
change a suprapubic catheter as compared to a urethral catheter. For patients
who require long term bladder drainage, it is preferable to have a suprapubic catheter.
PROCEDURE:
The
following steps are necessary in the insertion of suprapubic catheter:
(1)
Suitable
medical indication.
(2)
Informed
consent.
(3)
A
full bladder. The bladder may be filled
by the patient’s own urine or the bladder may be filled with an indwelling urethral
catheter, usually about 500 mls. A full
bladder will displace the abdominal contents, to reduce the risk of damage to
the gut.
(4)
Local
anaesthetic (1 or 2% Lignocaine) is injected at the site of insertion, usually
2 finger breaths above the symphysis pubis in the midline. The skin,
subcutaneous tissue and the anterior bladder wall have to be infiltrated,
usually with about 5 cc of the anaesthetic.
(5)
In an
obese patient, it may be necessary to confirm that the bladder is distended
with an abdominal ultrasound.
(6)
Skin
incision is made with a size 11 blade.
(7)
A
preliminary puncture may be made with a
21G needle to aspirate urine, also to send the urine for bacterial
culture.
(8)
Most
suprapubic catheters are of the peel away sheath type, before the
catheter is introduced together with trocar.
Once the trocar is in the bladder, urine will come out.
(9)
The
catheter is then inserted into the bladder.
(10) The trocar is then withdrawn, peeled away
and removed.
(11) The catheter is anchored in place by
inflating with a balloon, usually about 5 cc of water or saline. The catheter
can be anchored externally with a Silk sheath, for about a week until the
suprapubic tract matures.
COMPLICATIONS OF SPC INSERTION:
The most serious complication is that of injuries to the nearby organs, namely, the intestine or the rectum. This can happen if the patient has previous surgery with the intestine adherent to the bladder.
FOLLOW-UP OF SPC:
Catheters
in the body are usually for a limited time: the catheter can become blocked or fragmented.
Therefore, the suprapubic catheters are usually changed every 3 weekly
by deflating the balloon before removing, and inserting a new catheter. If the patient has sensation, Lignocaine gel
may help.
If the
bladder is continuously empty over a number of months or years, the bladder can
become contracted. Therefore, the catheter should be clamped for a few hours,
e.g. from 8 am to 11 am, to allow the bladder to expand. This will also allow the patient to have a
trial of urination. If the patient can pass urine well with minimal residual
urine (residual urine being measured by releasing the clamp), the suprapubic
catheter may be removed.
Written
by:
Dr
Clarence Lei Chang Moh, FRCS Urol, FEBU
Consultant
Urologist
email: clarencelei@gmail.com
4
September 2013
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