# Percutaneous Suprapubic Catheterisation

## Overview

This module describes the percutaneous method of suprapubic catheterisation.

## Indications

## Contraindications

## Patient information and consent

Always verify your patient’s identity and obtain informed consent before proceeding.

### How do I explain this procedure?

“A suprapubic catheter is a tube placed through the skin of the lower tummy directly into the bladder, because your urine cannot drain out in the normal manner.”

### What can my patient expect?

“I will give you an injection to numb the skin. Then I will make a small cut to pass first a guiding tube and then a catheter into your bladder. The guiding tube is then removed and the catheter is fixed to the skin.”

### What is my patient’s role?

“Let me know if you have any allergies or a bleeding tendency, or use blood thinners. Fearing blood or needles is normal, but tell me if you have fainted from it. Keep as still as possible. If you feel strange sensations or severe pain, tell me immediately. Afterwards, don't fiddle with the stitches or catheter.”

## Preparation

Prepare a trolley with equipment. You will need an assistant to hold up your lignocaine and sterile water.

### Documentation

### Equipment

## Site and Positioning

Be sure to first percuss and palpate the patient’s bladder to determine its position. Place the patient in

Trendelenburg

Trendelenburg

This assists with ensuring no bowel loops are in the suprapubic area.

position.

## Procedure

Follow medical asepsis with sterile gloves.

## Troubleshooting

I do not have a sheath and trocar or equipment for Seldinger technique.

Deepen the original incision and cut the rectus sheath. Use mosquito forceps to widen the opening. Mount the catheter tip under tension on a urethral dilator. Push the dilator and catheter through the bladder wall. Inflate the balloon, then withdraw the dilator.

I cannot palpate or percuss the bladder

Do not insert a suprapubic catheter if you are unable to detect the bladder. Patients with obstruction might have had overflow incontinence after a massive build up and the urine might have trickled out. Do not discharge the patient as it will obstruct again. Rather monitor the patient, allow them to drink fluids and re-examine in an hour or two.

My patient has an obstruction and is in pain, but I don’t have a suprapubic catheter.

Follow the steps for suprapubic bladder aspiration to provide the patient with relief until either a suprapubic catheter is obtained or the patient can be transferred to an appropriate facility. Always document the aspiration procedure in your referral letter.

My patient has a longstanding suprapubic catheter in situ, which has come out. Do I need to do the entire procedure from scratch?

Many of these patients will have a fibrosed tract in situ, which means that you should be able to pass a new suprapubic catheter through this tract. If you are unable to, the tract has probably closed and you will have to insert the suprapubic catheter from scratch. Be sure to allow the bladder to fill before doing this.

## Risks

## References