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

4.2 Changing Suprapubic Catheter: Inpatient

First SPC change following initial insertion must be attended four to six weeks post insertion.

Medical Officers or Registered nurses may perform the first and subsequent suprapubic catheter changes, where the catheter is a balloon catheter (Foley) or a Bonanno (Pigtail) utilising aseptic technique unless otherwise specified by the Urologist.

If symptomatic urinary tract infection is suspected and patient is not on antimicrobial therapy then reconsider need for change of SPC prior to clarification of infection status. If change is still required then consult the medical team for consideration of treatment immediately after change ensuring a mid-stream urine is obtained once the new catheter is inserted.
Alert:

Size 16 and above catheters are recommended for Suprapubic catheterisations:

• 
  Latex SPC’s must be changed every two weeks
  
• 
  Silastic SPC’s must be changed every six weeks
  
• 
  Hydrogel coated and 100% silicone catheters can remain insitu for up to 12 weeks
  
• 
  It is recommended that Catheter changes are based on clinical indications such as infection, obstruction, or when the closed system is compromised within the manufacturers recommend time frame.
  

Equipment:

• 
  ABHR
  
• 
  Sterile dressing towels x two
  
• 
  Sterile gown and gloves
  
• 
  Clean gown
  
• 
  Catheter of choice – preferably silastic
  
• 
  Basic dressing pack
  
• 
  Gauze swabs x two packs
  
• 
  0.9% Sodium Chloride 30 to 60mls
  
• 
  Sterile water 20ml
  
• 
  Syringe 10ml
  
• 
  Syringe 20ml
  
• 
  Sterile urinary drainage bag
  
• 
  Drainage tube dressing
  
• 
  Foleys Statlock device
  
• 
  Sterile kidney dish
  
• 
  Clean clamp
  
• 
  Procedure underpad
  
• 
  Safety glasses or goggles
  
• 
  Adhesive tape of choice (if required)
  
• 
  General waster receptacle
  
• 
  Clinical waste receptacle
  

Alert: The patient’s SPC is to be clamped for 30 to 60 minutes prior to the procedure so as to allow the bladder to fill for easier palpation
Community specific: Patient to consume oral liquids 30- 60 minutes prior to SPC change to ensure bladder volume. Clamping of SPC not required in community setting. Clamping of SPC not recommended in patients with spinal cord injury at T6 level or above or patients with a diagnosis of Autonomic Dysreflexia
An assistant is required to assist gowning and to open further equipment such as the catheter, sterile water and drainage bag
Procedure:

1. 
   Attend steps 1 to 14 of SPC Dressing
   
2. 
   Don Sterile gloves
   
3. 
   Sterile catheter is placed in the sterile kidney dish
   
4. 
   Swab around catheter site with 0.9% Sodium Chloride and gauze swab
   
5. 
   Place sterile towels around SPC site
   
6. 
   Second person to withdraw fluid using 20ml syringe from catheter balloon insitu
   
7. 
   Catheter is then gently withdrawn; gentle rotation of the catheter may assist in removal
   
8. 
   Discarded into clinical waste receptacle
   
9. 
   Swab fistula site with 0.9% Sodium Chloride and gauze swab
   
10. 
    Sterile dish containing catheter is placed on the sterile field
    
11. 
    Catheter is inserted through the fistula at a 90 degree angle to the abdominal wall
    
12. 
    Insert the catheter approximately 8 to 10cm or until urine is returned
    
13. 
    Urine specimen may be collected if required
    
14. 
    Inflate the balloon with the sterile water and 10ml syringe following manufacturer’s instructions (5 to 10mls)
    
15. 
    Connect the drainage bag to the catheter ensuring closed system
    
16. 
    Apply drainage tube dressing if required
    
17. 
    Secure the catheter to the abdomen with Foleys Statlock device
    
18. 
    Discard equipment and gloves into clinical waste receptacle
    
19. 
    Clean trolley with detergent impregnated wipes
    
20. 
    Ensure patient is comfortable with new SPC and dressing change and understands when the next SPC and dressing change will be attended. Advise patient of signs and symptoms of infection and to notify to the medical officer in charge of their case and notify of any changes in the patients clinical condition post procedure.
    
21. 
    Document in the patient’s clinical record using the Urinary Catheter Label:
    
    • 
      Date of SPC change
      
    • 
      Type of catheter and size
      
    • 
      The amount of water in the balloon
      
    • 
      The condition of the fistula
      
    • 
      The patient’s response to the procedure.
      

4.3 Removal Suprapubic Catheter

Prior to the removal of the SPC ascertain if the patient is able to void by clamping the catheter for two hours prior to the removal procedure. Check the urine residual using a bladder scanner. The tip of the SPC is sent to pathology for analysis following removal where ordered by a Medical Officer.
Equipment:

• 
  Basic dressing pack
  
• 
  Sterile gloves
  
• 
  Stitch cutter or fine suture removal set, if required
  
• 
  Syringe one x 20ml
  
• 
  0.9% Sodium Chloride 30 to 60mls
  
• 
  Sterile specimen jar
  
• 
  Dry absorbent dressing
  
• 
  Adhesive tape of choice
  
• 
  Safety glasses or goggles (need to ensure this included in the steps)
  
• 
  Procedure underpad
  
• 
  Bladder scanner
  

Procedure:

1. 
   Attend steps 1-13 of SPC Dressing Change
   
2. 
   Collect catheter specimen of urine (if required)
   
3. 
   Don sterile gloves
   
4. 
   Remove the suture (if present) holding the catheter insitu
   
5. 
   If the SPC has a balloon, deflate using the relevant size syringe
   
6. 
   Gently withdraw the catheter in a steady continuous motion
   
7. 
   Using sterile scissors cut the tip off into a sterile specimen jar and send to pathology for analysis if required
   
8. 
   Use wound cleansing solutions at body temperature irrigate with normal saline solution, to remove debris and contaminates
   
9. 
   Swab gently and in one direction only
   
10. 
    Ensure the site is dry before applying new dressing
    
11. 
    Apply new dressing and secure with adhesive tape or bandage
    
12. 
    Discard equipment and gloves into clinical waste receptacle
    
13. 
    Clean trolley with detergent impregnated wipes
    
14. 
    Ensure patient is comfortable with new dressing change and understands when the next dressing change will be attended
    
15. 
    Document Inpatient’s clinical record using the Urinary Catheter Label:
    

• 
  Date and time of the SPC removed
  
• 
  Condition of fistula
  
• 
  If the catheter tip is sent for MC&S
  
• 
  Patient’s reaction to the procedure.
  

Note: It is not unusual for a small amount of leakage at the fistula site on removal of SPC. Regularly change the dry dressing and reassure the patient that this may continue for a few days, however, no medical intervention is required