Urology – Catheter Insertion and Management, Bladder Irrigation, Nephrectomy and Trans Urethral Prostatectomy (turp)

Background:

An SPC may be used for:

• 
  The management of long-term urinary incontinence or retention of urine
  
• 
  The drainage of urine post operatively in urological or gynaecological patients
  
• 
  Patients with urethral and/ or pelvic trauma where the utilisation of a urethral catheter is not possible
  
• 
  Patients with ongoing problems associated with urethral catheters such as irritation or continued blockage
  

The purpose of this is to provide guidelines for the management of a Suprapubic Catheter (SPC) including:

• 
  Insertion
  
• 
  Catheter Change
  

• 
  Inpatient
  
• 
  Community based patient
  

• 
  Dressing Changes
  
• 
  Removal
  
• 
  Management in the Community
  

This document pertains to adult patients requiring management of a SPC at the Canberra Hospital and Community based patients

4.1 Insertion of Suprapubic Catheter

Initial insertion of a SPC may only be performed by a Medical Officer. Further catheter changes may be attended in the community by nursing staff.
Equipment:

• 
  Alcohol based hand rub (ABHR)
  
• 
  Basic dressing pack
  
• 
  Sterile dressing towels x two
  
• 
  Sterile gown and gloves
  
• 
  Sterile water x 20 ml
  
• 
  10ml syringes x three
  
• 
  21g needle
  
• 
  1% Lignocaine x10ml
  
• 
  Drain sponge dressing
  
• 
  Foleys Statlock device
  
• 
  Suture material (as per medical officer’s preference)
  
• 
  Suture set
  
• 
  Suprapubic catheter introduction kit available from the operating rooms
  
• 
  Sterile urinary drainage bag
  
• 
  50ml bladder syringe
  
• 
  500mls bottle 0.9 Sodium Chloride at room temperature
  
• 
  Chlorhexidine skin preparation
  
• 
  Adhesive tape of choice
  
• 
  Safety goggles or shields
  
• 
  Procedure underpad
  
• 
  Clean gown
  

Alert: The patient will be required to have a full bladder for initial insertion to assist in the palpation of the bladder and to prevent perforation of the bowel. A full bladder is not required for routine subsequent changes.

Procedure:

1. 
   Inpatient: The medical officer must document the order for the SPC insertion and removal in the clinical record
   
2. 
   Community specific: Medical Officers Catheter Management
   
3. 
   Obtain the verbal consent
   
4. 
   Explain to the patient the process and purpose of the procedure
   
5. 
   Ask the patient if they have any allergies to dressings or tapes.
   
6. 
   Ensure the patient has adequate analgesic cover prior to procedure if required or requested
   
7. 
   Assist patient to the supine position, placing procedure underpad beneath the buttocks
   
8. 
   Don PPE
   
9. 
   Clean trolley with detergent impregnated wipes and disposable towel, wipe dry
   
10. 
    Set up equipment on trolley at the patient’s bedside
    
11. 
    Don clean gown prior to opening sterile equipment
    
12. 
    Open the procedure pack
    
13. 
    Assist the medical officer with gowning after performing a procedural wash
    
14. 
    Don clean gloves
    
15. 
    Expose the suprapubic area
    
16. 
    Attend hand hygiene by either hand washing or using ABHR
    
17. 
    Open further equipment required, such as the catheter pack, local anaesthetic, water for balloon, suture material
    
18. 
    Pour chlorhexidine skin preparation into sterile tray
    
19. 
    The medical officer will insert the SPC, provide assistance if required
    
20. 
    Reassure patient throughout the procedure whilst maintaining privacy
    
21. 
    Once SPC inserted, attach urinary drainage bag, ensuring drainage system is closed
    
22. 
    Place drainage bag below the patient’s waist height
    
23. 
    A leg bag may be utilised, however is not advised at initial insertion time
    
24. 
    Ensure Foleys Statlock device is securely attached to the patient’s skin and secure the catheter
    
25. 
    Apply drain sponge around SPC and secure with tape
    
26. 
    Discard equipment and gloves into clinical waste receptacle
    
27. 
    Clean trolley with detergent impregnated wipes
    
28. 
    Ensure patient is comfortable with new dressing change and understands when the next dressing change will be attended
    
29. 
    Document in the patient’s clinical record using the Urinary Catheter Label:
    
    • 
      Date of SPC insertion
      
    • 
      Type and size of catheter
      
    • 
      Amount of water in the balloon
      
    • 
      Amount of urine drained
      
    • 
      Patient’s response to the procedure
      
30. 
    Change dressing as frequently as required
    

Note: The insertion of a SPC for gynaecology patients on the ward may be performed under ultrasound.

Dressing Change

Equipment:

• 
  Alcohol based hand rub (ABHR)
  
• 
  Basic dressing pack
  
• 
  Sterile drain dressing
  
• 
  0.9% Sodium Chloride (30ml)
  
• 
  Adhesive tape of choice
  
• 
  Personal protective equipment (PPE) including clean gloves and safety goggles or shield
  
• 
  General waste receptacle
  
• 
  Clinical waste receptacle
  
• 
  Stat lock (optional)
  

Procedure:

1. 
   Attend steps 1 to 14 of Insertion of SPC
   
2. 
   Don PPE prior to opening sterile equipment
   
3. 
   Open the basic pack and position equipment using the setting up forceps
   
4. 
   Pour normal saline to tray
   
5. 
   Don clean gloves
   
6. 
   Expose the SPC site
   
7. 
   Remove the soiled dressing with setting-up forceps
   
8. 
   Discard the dressing and forceps and gloves into the clinical waste receptacle
   
9. 
   Inspect the SPC site for clinical signs of infection and healing
   
10. 
    If signs of infection notify the Medical Officer and consider swab
    

Note: Once the SPC insertion site is healed, it does not require a dressing. The site may be cleaned with warm soapy water during daily hygiene routines. Statlock device must remain insitu to anchor the SPC to the body to avoid dislodgement.

11. 
    Don clean gloves
    
12. 
    Use wound cleansing solutions at body temperature .Irrigate with normal saline solution to remove debris and contaminants
    
13. 
    Swab gently and in one direction only
    
14. 
    Ensure the site is dry before applying new dressing
    
15. 
    Apply new dressing and secure with adhesive tape or bandages
    
16. 
    Statlock device must remain insitu to anchor the SPC to the body to avoid dislodgement
    
17. 
    Discard equipment and gloves into clinical waste receptacle
    
18. 
    Clean trolley with detergent impregnated wipes
    
19. 
    Ensure patient is comfortable with new dressing change and understands when the next dressing change will be attended
    
20. 
    Change dressing or appliances as frequently as required to effectively remove excessive exudate or infected material
    
21. 
    Document in the patient’s clinical record and wound care chart:
    

• 
  A description of the wound
  
• 
  Type of dressing applied
  
• 
  Any change of dressing
  
• 
  The reason for the change
  

22. 
    Urinary bags are to be emptied and cared for as per Urinary Bladder Management
    
23. 
    Ensure the patient is involved in the care and management of the SPC in preparation for discharge
    

Alert: Maintain a closed drainage system as much as possible so as to prevent infection. Do not use talcum powder, creams or strongly scented soaps near the catheter site to avoid irritation.