Suprapubic Catheter: A Guide for Care Teams

A suprapubic catheter is a tube that drains urine from the bladder through a small opening in the lower tummy, rather than through the urethra. A small balloon inside the bladder holds it in place. The British Association of Urological Surgeons (BAUS) describes it as often easier to manage than a catheter through the urethra.

This guide is for care managers and the staff who support someone with a suprapubic catheter. It explains why it's used, who inserts and changes it, day-to-day care, problems to watch for, catheter sizes, and a short word on self-catheterisation. It's awareness level: follow your local policy and the person's care plan.

Suprapubic vs urethral catheters

The NHS guide to urinary catheters sets out the main types:

• Urethral catheter: passed into the bladder through the urethra, the tube urine normally leaves by.
• Suprapubic catheter: passed into the bladder through a small opening in the lower tummy.
• Indwelling catheter: either of the above, left in for days or weeks and held in by a balloon.
• Intermittent catheter: put in to empty the bladder, then taken straight out.

The choice is made by the person and their urology team. NICE guidance on long-term catheters says an indwelling catheter should only be used once other options have been considered, and that intermittent catheterisation is preferred where it's clinically appropriate and practical. When someone does need an indwelling catheter for the long term, a suprapubic one may be suggested because it's often easier to live with day to day.

How a suprapubic catheter is put in

The first insertion is a planned procedure in hospital. According to the BAUS patient leaflet, a surgeon usually does it under a general or spinal anaesthetic, sometimes a local. The bladder is filled with fluid, and a telescope passed up the urethra or an ultrasound scan may be used to guide placement. The person may need to stay in overnight.

For a care team, the practical points are that the person may come back with a dressing over a new wound, some blood in their urine for the first few days, and a date for their first catheter change. BAUS says the first change is usually six to 12 weeks after insertion and is often done at the hospital.

Who changes it, and how often

After the first change, routine changes are usually done by community or district nurses, often wherever the person lives. How often depends on the catheter and the person. BAUS gives every three months as usual, and some specialist services recommend every six weeks, so check the person's plan.

In a nursing home, your own nurses may change suprapubic catheters once they've been trained and signed off. In some services, trained and signed-off senior carers do it too, where your policies and delegation allow. Either way, the care plan should say who changes it, how often, the catheter type and size, and when the next change is due.

Day-to-day care

Most of a suprapubic catheter's day-to-day care looks a lot like any long-term catheter. NICE's recommendations on long-term urinary catheters include:

• keeping the catheter connected to a sterile closed drainage system or a catheter valve
• attaching a night bag to the day bag or valve with a link system, so the original system stays intact
• cleaning hands before handling the catheter or drainage system
• not using bladder washouts to prevent infection

For the site itself, hospital leaflets advise cleaning a new site daily and keeping it covered with a dressing until it has healed, after which normal washing is usually enough. BAUS notes that a little discharge around the catheter is normal and doesn't need treatment, and that some people also leak a little urine from the urethra.

Beyond that, follow the person's care plan for emptying, bag changes and fluids. Our catheter care training covers bag changes, valves, specimens and hygiene for staff who look after catheters but don't insert them.

Common problems and when to get help

BAUS lists the problems people most often have with a suprapubic catheter:

• blockage, so the catheter stops draining
• bladder spasms, which can be painful
• urine leaking around the catheter or from the urethra
• repeated urine infections
• bladder stones, or debris in the urine

The NHS notes that the risk of infection goes up the longer a catheter stays in. Hospital discharge leaflets advise getting medical advice if the person has a temperature or feels unwell, redness or pus at the site, new blood in their urine, or a change in how the catheter is draining.

If it falls out, act quickly. BAUS says a suprapubic catheter that falls out must be put back as soon as possible, because the opening can start to close, and if it does the person may need another procedure. Contact the person's doctor, the community nursing team or A&E straight away, as your local policy sets out. Don't leave it until the morning.

A catheter that isn't draining also needs prompt attention. Follow your local policy for the checks to make, and escalate if it still isn't draining.

Catheter sizes: what Ch means

Urinary catheters are sized in Charrière, written as Ch, after the Paris instrument maker Joseph Charrière. The number is the outside circumference in millimetres, so each Ch is roughly a third of a millimetre across. A 12Ch catheter is narrower than a 16Ch.

The right size is a clinical decision. NICE says the type and gauge of an indwelling catheter should be chosen based on an assessment of the person. Record the size in the care plan so the same one is used at each change, and don't swap sizes without clinical advice.

Intermittent self-catheterisation

Intermittent self-catheterisation means the person puts a catheter in themselves to empty their bladder, then takes it out. There's no catheter left in between. NICE prefers it to an indwelling catheter where it's clinically appropriate and practical, and says people and their carers should be trained before they're discharged, with support available for as long as they need it.

In a care setting, your role is usually to support the person's own routine: privacy, clean hands, supplies to hand, and noticing if they're finding it harder. If you'd like your team to understand the bigger picture, see our continence care training.

How Kasorb can help

Our catheterisation training teaches nurses, care practitioners and senior carers to insert and manage urinary catheters, urethral (male and female) and suprapubic, using aseptic technique on anatomical models. It covers the rationale for catheterisation, anatomy of the urinary system, common associated conditions, managing cystitis and urine infection, hand washing and aseptic technique, and care planning for someone with a catheter. It runs on-site as a half day or full day for up to 10 staff, and each person demonstrates insertion on the models. Your trainer has used these skills for real. Certificates are emailed the next day, then your own supervised sign-off in practice confirms each person before they catheterise on their own.

FAQs

What is a suprapubic catheter?

A suprapubic catheter is a tube that drains urine from the bladder through a small opening in the lower tummy, instead of through the urethra. A balloon inside the bladder holds it in place, and it's usually changed every six weeks to three months.

How often should a suprapubic catheter be changed?

BAUS says routine changes are usually every three months, and some specialist services recommend every six weeks. The first change is usually six to 12 weeks after insertion, often at the hospital. The person's care plan should record how often and when the next change is due.

What happens if a suprapubic catheter falls out?

It needs putting back as soon as possible, because the opening can start to close. Contact the person's doctor, the community nursing team or A&E straight away, following your local policy. If the opening closes, the person may need another procedure.

Who can change a suprapubic catheter?

The first change is usually done in hospital. After that, community nurses or trained nurses in a nursing home usually change it. Some senior carers do so where policies and delegation allow, after training and a supervised sign-off in practice.

Is a suprapubic catheter better than a urethral catheter?

Neither is better for everyone. BAUS describes a suprapubic catheter as often easier to manage than a urethral one. The decision is made by the person and their urology team, and NICE prefers intermittent catheterisation over any indwelling catheter where it's appropriate.