Suprapubic catheter insertion in the radiology department. Information for patients Urology

Transcription

1 Suprapubic catheter insertion in the radiology department Information for patients Urology

2 page 2 of 8

3 What is a suprapubic catheter? A suprapubic catheter is an indwelling tube that drains the bladder through a small hole made in the lower part of the abdomen. A suprapubic catheter should be managed using the same principles of good practice as an indwelling urethral catheter. What are the advantages of a suprapubic catheter? If you need an indwelling catheter (i.e. a catheter that is always in place) to manage your bladder for the medium to long term, the suprapubic route is preferable for several reasons: The position of the balloon in the bladder causes less irritation. It leaves the genital area free for sexual activity. It prevents erosion ( wearing away ) damage to the urethra (the passage leading from the bladder to the external opening). The catheter is more accessible, which makes self-care easier, particularly if you have reduced hand function. They are more hygienic and can be easier to change. Because the catheter cannot damage the urethra, a bigger gauge can be used if you suffer regularly from blocked catheters. The bigger the gauge, the longer the catheter takes to block up with encrustations. A suprapubic catheter may also be inserted on a temporary basis if necessary. It is easily reversible. Are there any disadvantages of a suprapubic catheter? You may pass urine down your urethra when the catheter is shut off for any reason. If a suprapubic catheter is pulled out, it may require another procedure to re-establish the route. page 3 of 8

4 Though they are normally more comfortable than an indwelling urethral catheter, sometimes they can cause pain and discomfort. They can sometimes be difficult to change if you are obese. They can sometimes discharge around the exit site requiring use of a small pad. How is a suprapubic catheter inserted? Your urologist will decide the most appropriate place to insert your catheter. Some patients are suitable for insertion of the catheter in radiology. The procedure will be performed under local anaesthetic. You may be offered intravenous sedation. The radiologist will fill your bladder with fluid using a urethral catheter. Using an ultrasound scan, your bladder will be visualised and a small incision (cut) made in your lower abdomen to pass the catheter through into the bladder. The catheter balloon is inflated and a stitch is inserted through the skin and used to secure the catheter. This reduces the risk of damage if the catheter is accidentally pulled. The stitch is removed 10 days later. There may be occasions where the radiologist will not be able to visualise the bladder. In this situation inserting the catheter will need to be delayed and you will be put on a waiting list for an operation. Are there any risks from the procedure? The procedure may cause a skin or bladder infection. You may continue to bleed through your catheter after the procedure (haematuria). You must ensure that you have let your urologist know if you are on any medication which increases your risk of bleeding so these can be stopped appropriately before the procedure. page 4 of 8

5 There is a small risk the operation may damage other organs in your abdomen (e.g. bowel). We take all practicable steps to minimise the risks of all these complications. However sometimes they do occur, but rarely cause lasting harm. What happens after the catheter has been inserted? After the procedure when the urology nurse is happy your catheter is draining (after approximately 4 hours) you will be discharged home. Is there anything I should look out for when I go home? If you become unwell you may need to come back into the hospital, specifically within the first 48 hours after the procedure if you experience: Temperature above 37.5 C Severe abdominal pain and vomiting (it is normal to feel soreness around the site of the insertion) Significant bleeding through the catheter or through the urethra. Some bleeding is normal but if continues to bleed through your dressing or it causes your catheter to stop draining you need to get in touch. Please contact the urology department on the numbers at the end of this leaflet if you are concerned about any of the above. page 5 of 8

6 Is there anything in particular I should know about managing a suprapubic catheter? Stitch removal The stitch attached to your catheter should be removed by the district nurse approximately 10 days after insertion. Drainage You should normally leave the catheter on free drainage for the first week or two after the procedure (firmer guidance will be given before you are discharged). After that, you may be advised to clip off the catheter using a Flip-Flow valve. Ideally the catheter should be clipped off for up to 4 hours at a time, then the urine drained off, with free drainage overnight. This helps you to keep bladder tone and capacity, and helps to drain sediment out of your bladder. If it is not possible for you to clip off regularly without leakage, it is advisable to clip off daily for ½ hour, preferably in the bath or shower, or when you can manage the leakage. Leakage Following insertion of a suprapubic catheter, there may be urethral leakage for the first few days. This usually settles fairly quickly but if it continues beyond the first month you should seek the advice of a urologist. Catheter change The same type of catheters and leg/night bags are usually used for urethral catheterisation, and are changed at the same intervals. The first suprapubic catheter change should always be performed by a nurse experienced in the procedure. If the catheter is not replaced swiftly, the hole may close. The first change will usually take place in the urology department. page 6 of 8

7 Discharge The hole into the bladder remains an open wound and there may always be some discharge around the catheter. If the wound does not discharge, it is not necessary to wear a dressing. What should I do if my catheter falls out? Avoid pulling the catheter. Even with a small balloon inflated they can be dislodged if pulled. If this happens, please call your district nurse immediately as you will need to get a new catheter put back in within two hours. After this time the hole will have started to heal up and it may not be as easy to get another catheter in. You may be advised to contact the urology department on the following numbers. Who should I contact if I have any concerns? If you have any concerns or questions, please contact the Urology department on the following numbers: Urology Admissions Unit (24 hour) You may also contact your District Nurse or GP for advice. page 7 of 8

8 Produced with support from Sheffield Hospitals Charity Working together we can help local patients feel even better To donate visit Registered Charity No Alternative formats can be available on request. Please Sheffield Teaching Hospitals NHS Foundation Trust 2017 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. PD8069-PIL3392 v3 Issue Date: August Review Date: August 2019