Suprapubic Catheter

Aka: Suprapubic Catheter, Urinary Vesicostomy, Suprapubic Catheterization, Suprapubic Cystostomy

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II. Indications

  1. Urethral Trauma
  2. Complete Urethral obstruction (refractory to Urinary Catheter placement)

III. Contraindications

  1. Coagulopathy
  2. No urine in Bladder
  3. Infection overlying skin or abdominal wall region of Suprapubic Catheter placement
  4. Altered anatomy or anticipated significant adhesions (e.g. pelvic cancer, radiation, suprapubic mesh)

IV. Preparation

  1. Suprapubic Catheter Kit
    1. Kits vary but include a trochar and catheter with needle (some kits include a seldinger guidewire)
    2. In an emergency, if Suprapubic Catheter kit is unavailable, central venous catheter may be used instead
  2. Ultrasound preparation
    1. Use Curvilinear transducer (2-5 MHz)
    2. Survey the Bladder with transducer in short axis (transverse)
      1. Bladder must contain urine for safe procedure
      2. Identify overlying loops of bowel or other interfering anatomical structures
    3. Apply a sterile cover to Ultrasound probe
    4. Use sterile Surgilube packets (or similar sterile lubricant) for Ultrasound gel within probe cover
  3. Patient
    1. Position supine

V. Technique

  1. Prepare the Suprapubic Catheter
    1. With the plastic guard on the catheter to maintain its shape
    2. Insert the trochar within the catheter so the sharp tip protrudes from the end
    3. 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 repeatedly with Chlorhexidine or Betadine (allowed to dry)
    2. Drape the area
    3. Inject up to 10 ml Lidocaine 1% with Epinephrine at the insertion site
      1. Raise a skin wheel
      2. Inject along the anticipated tract
    4. Make a 4 mm 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. Attach a 20 to 60 ml syringe to a Suprapubic Catheter, needle and obturator unit
      1. Catheter should be locked into the obturator unit until Bladder entered
    2. Direct the catheter caudal (inferiorly towards the Bladder neck) at a 60 degree angle
    3. Observe the catheter tip on Ultrasound enter the Bladder dome (approximately 2 inches below the skin level)
      1. Aspirate while inserting the needle, until after urine is aspirated
      2. Unlock the catheter from the needle obturator
      3. Continue to insert the catheter an additional 2 inches (5 cm)
      4. Remove the trochar
    4. Confirm placement
      1. Inject saline and observe on Ultrasound the jets and bubbles inside the Bladder
      2. Aspirate urine
    5. Inflate the catheter balloon (if present)
      1. Withdraw the catheter until it stops against inside wall of Bladder
    6. Secure Suprapubic Catheter to skin with tape
    7. Connect urine bag to the catheter via extension tubing
  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)

VI. Efficacy

  1. Suprapubic Catheters carry lower risk of Urinary Tract Infections than uretheral catheters
  2. Suprapubic Catheters avoid Urethral Trauma and secondary Urethral Strictures that may occur with Urethral catheters

VII. Complications

  1. Bleeding from Bladder or skin
  2. Bowel perforation
  3. Bladder perforation
  4. Pelvic organ injury (vagina, Uterus)
  5. Secondary infection

VIII. Resources

  1. Medscape EMedicine Suprapubic Catheterization
    1. http://emedicine.medscape.com/article/145909-overview#showall

IX. References

  1. James and Palleschi in Pfenninger (1994) Procedures for Primary Care Physicians, p. 500-7
  2. Islam (2017) Crit Dec Emerg Med 31(11): 12-3

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Related Studies

Ontology: Urinary vesicostomy (C0087042)

Concepts Therapeutic or Preventive Procedure (T061)
MSH D003559
SnomedCT 129252005, 149707002, 176205002, 129251003, 40173000
English Cystostomies, Suprapubic, Cystostomy, Suprapubic, Suprapubic Cystostomies, Suprapubic catheterisation, Suprapubic catheterization, Suprapubic urinary catheterisation, Suprapubic urinary catheterization, Suprapubic urinry catheteristn, Insertion of suprapubic catheter, Insertion suprapubic catheter, suprapubic cystostomy (treatment), suprapubic cystostomy, Suprapubic catheter insertion, Insertion;catheter;suprapubic, insertion of suprapubic catheter, suprapubic catheterization, urinary cystostomy, suprapubic catheter insertion, suprapubic catheterisation, Urinary cystostomy (procedure), Suprapubic catheterisation (procedure), Urinary cystotomy, Suprapubic cystostomy, Urinary cystostomy, Suprapubic cystostomy (procedure), Urinary vesicostomy, Suprapubic Cystostomy, insertion of a suprapubic catheter
Portuguese Cistostomia Suprapúbica, Inserção suprapúbica de cateter
Spanish Cistostomía Suprapubica, Cateterización urinaria suprapúbica, vesicostomía urinaria, cistostomía urinaria, cistostomía urinaria (concepto no activo), cistostomía suprapúbica (procedimiento), cistostomía suprapúbica
German Suprapubische Zystostomie, suprapubische Einfuehrung eines Katheters, Suprapubische Blasenfistelung
Italian Inserzione di catetere sovrapubico, Cistostomia sovrapubica
French Insertion de cathéter supra-pubien, Cystostomie supra-pubienne, Cystostomie suspubienne, Cystostomie sus-pubienne, Vésicostomie sus-pubienne, Vésicostomie supra-pubienne, Vésicostomie suprapubienne, Cystostomie suprapubienne, Vésicostomie suspubienne
Dutch suprapubische inbrenging van katheter, Cystostomie, suprapubische
Japanese ﾁｺﾂｼﾞｮｳｶﾃｰﾃﾙｿｳﾆｭｳ, 恥骨上カテーテル挿入
Czech Epicystostomie
Hungarian Suprapubicus katéter behelyezés
Norwegian Suprapubisk cystostomi
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Suprapubic catheter (C0150798)

Definition (UMD) Urinary catheters designed for introduction directly into the bladder through a percutaneous incision above the pubic bone (i.e., suprapubic). Several techniques are used to place the catheters, including over the needle and through a cannula previously inserted using a trocar.
Definition (SPN) A suprapubic urological catheter and accessories is a flexible tubular device that is inserted through the abdominal wall into the urinary bladder with the aid of a trocar and cannula. The device is used to pass fluids to and from the urinary tract. This generic type of device includes the suprapubic catheter and tube, Malecot catheter, catheter punch instrument, suprapubic drainage tube, and the suprapubic cannula and trocar.
Definition (SPN) A suprapubic urological catheter and accessories is a flexible tubular device that is inserted through the abdominal wall into the urinary bladder with the aid of a trocar and cannula. The device is used to pass fluids to and from the urinary tract. This generic type of device includes the suprapubic catheter and tube, Malecot catheter, catheter punch instrument, suprapubic drainage tube, and the suprapubic cannula and trocar.
Concepts Medical Device (T074)
SnomedCT 286861005
English CATHETER AND TUBE, SUPRAPUBIC, CATHETER, SUPRAPUBIC (AND ACCESSORIES), Catheters, Suprapubic, Suprapubic Urinary Catheters, Catheters, Urinary, Suprapubic, catheters suprapubic, suprapubic catheter, catheter suprapubic, suprapubic catheters, Suprapubic catheter, SPC - Suprapubic catheter, Suprapubic catheter (physical object)
Spanish catéter suprapúbico (objeto físico), catéter suprapúbico
Derived from the NIH UMLS (Unified Medical Language System)

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