Procedure

Suprapubic Catheter

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Suprapubic Catheter, Urinary Vesicostomy, Suprapubic Catheterization, Suprapubic Cystostomy

  • Indications
  1. Complete Urethral obstruction
  2. Urethral Trauma
  • Contraindications
  • Preparation
  1. Ultrasound preparation
    1. Use Curvilinear transducer (2-5 MHz)
    2. Survey the Bladder with transducer in short axis (transverse)
    3. Apply a sterile Tegaderm (10x12 cm) ro Ultrasound probe
    4. Use sterile Surgilube packets (or similar sterile lubricant) for Ultrasound gel
  2. Patient
    1. Position supine
  • Technique
  1. Prepare the Suprapubic Catheter
    1. With the plastic guard on the catheter to maintain its shape, insert the trochar within the catheter so the sharp tip protrudes from the end
    2. Remove the plastic outer guard
  2. Identify the insertion site
    1. Find a midline point three finger breadths (2 inches) above the symphysis pubis
  3. Prepare the insertion site
    1. Prepare the suprapubic skin with chlorhexidine or betadine
    2. Drape the area
    3. Inject Lidocaine 1% with Epinephrine at the insertion site
      1. Raise a skin wheel
      2. Inject along the anticipated tract
    4. Make a 1/2 inch horizontal incision at the insertion site
  4. Position the Ultrasound transducer
    1. Short axis (transverse)
    2. Superior to the catheter insertion site
  5. Insert the catheter
    1. Direct the catheter caudal (inferiorly towards the Bladder neck) at a 60 degree angle
    2. Observe the catheter tip on Ultrasound enter the Bladder dome (approximately 2 inches below the skin level)
      1. Aspirate while inserting the needle
      2. Insert the catheter and trochar an additional 2 inches
      3. Remove the trochar
    3. Confirm placement
      1. Inject saline and observe on Ultrasound the jets and bubbles inside the Bladder
      2. Aspirate urine
    4. Inflate the catheter balloon (if present)
      1. Withdraw the catheter until it stops against inside wall of Bladder
    5. Secure catheter to skin
    6. Connect urine bag to the catheter
  6. Catheter replacement
    1. Tract will mature over 4-6 weeks
      1. Once tract matures, catheter may be removed and new catheter inserted without difficulty
    2. Prior to tract maturation, catheter replacement can be difficult
      1. Risk of urine leakage out of Bladder into Abdomen
      2. Consider seldinger technique (place guide via old catheter, withdraw, and place new catheter over guide)
  • References
  1. James and Palleschi in Pfenninger (1994) Procedures for Primary Care Physicians, p. 500-7
  2. Medscape EMedicine Suprapubic Catheterization
    1. http://emedicine.medscape.com/article/145909-overview#showall