Suprapubic Urinary Catheter Care Suggestions

You have been discharged with a suprapubic urinary catheter, or SP tube. These tubes, usually made of latex rubber, plastic or silicone, are inserted through your lower abdominal wall into your bladder. Our intent is to remove the tube when your bladder has healed and you are able to urinate adequately.

Design
The catheter is a hollow tube with a hole on each end. Many types of SP tubes exist, but the most common is called a "Foley" catheter, named after the inventor. A side arm is on the side of the catheter. This allows a small balloon to be filled near the end of the catheter so the catheter does not fall out. The balloon must be deflated before the catheter can be removed. Other types of SP tubes exist, but they all have similar drainage holes to allow the passage of urine.

Connection
The catheter needs to be connected to a drainage bag to allow continuous and unimpeded drainage. It is important not to obstruct the flow of urine, unless you are specifically asked to do so. The time to block the flow of urine is when your bladder function is being tested as described below.

Drainage bags
These are the plastic bags to which the catheter is connected. The bags vary in design but all have a connection adapter for the catheter and a drainage port or spigot at the bottom to empty the bag. Some bags have long tubes so they can be attached to the bed or carried. Other bags have no tubing and must be attached to one's leg with straps.

Care
The major cause of irritation is at the exit site of the SP tube from the abdomen. Sometimes a silk suture is placed to secure the catheter and this can also be a source of irritation. You should wash this area with a mild soap and water at least once each day. (Ivory or baby shampoo is very mild.) Hydrogen peroxide, available at any drug store, is also effective in cleaning around the tube. Do not place Vaseline or any ointments around the catheter unless specifically instructed to do so.

In most cases, you will have less irritation at the exit site if the catheter is not pulling tightly. This is easily done, if needed, by taping the catheter to the skin so that it has a gentle curve on its way to the drainage bag. Tape is the best and least expensive way of securing the catheter. Movement or tugging on the catheter will then pull on the tape, not on the skin and bladder.

Cleaning the drainage bags
Rinse bags with warm water and soap every day or two, depending on how dirty they are and how much odor is present. One teaspoon of vinegar may be used in the rinse water to reduce the odor.

Emptying bags
Hold any bag over the toilet or suitable container and open the spigot at the bottom of the bag. Let urine flow until empty and then close the spigot.

Problems
The more urine that flows, the less the chance for a blockage. You should be drinking four to eight ounces of water every hour while awake.

Bleeding
Bleeding can be seen on occasion with any catheter. Small amounts of blood or clots are usually of little concern. Bleeding sufficient enough to make it impossible to see through the urine should be brought to our attention.

Blockage
Urine should drain constantly into the bags. If you see no flow for more than an hour and feel the need to urinate, a blockage of the tube may be present. Debris or blood clots are the most common causes and will need to be dealt with in the office during business hours, or the emergency room. The catheter will either be irrigated clear or it will be changed.

Bladder testing with the suprapubic catheter
Some patients will be asked to test the bladder function before removing the SP tube. Basically, we want to see if you can empty your bladder successfully and completely (or almost) so the SP tube is no longer needed and can be removed.

Wash your hands and the catheter connections with soap and water.

Clamp or obstruct the SP tube so it will not drain. (The bladder will now fill!)

Place a catheter plug in the end; or
Bend the tube in half and secure with a rubber band; or
Apply a surgical clamp or screw clamp to the tubing.

Note: Place the end of the drainage tubing into a clean plastic bag.

When you feel the urge to urinate, attempt to do so. Note the time and measure the amount that you are able to urinate. Write down the time and amount. This is referred to as "voided urine."

After every urination, unclamp the SP tube and allow it to drain, either into an empty drainage bag or into a jar or measuring cup. Write down this amount next to the voided urine amount.

Keep a log of all these measurements for us. When your residual urine is below two ounces, we can usually remove your SP tube. Each patient is different, so this number is not absolute. We usually want you to be able to empty at least 80 percent of the bladder by urination with only 20 percent left from the SP tube. When you begin to urinate successfully, let us know so that we can arrange to remove the tube.

Caution: Under no circumstances should you go more than six hours without urinating. If you do, open the SP tube and let it drain and note the amount. If you have the urge to urinate but cannot, open the SP tube and let it drain. If either of these situations occurs, reconnect the tube to drainage and try again the next day. If you still have no success, let us know.

At night, we recommend leaving the tube unclamped and allowing it to drain freely.

If you have severe bladder pain, bleeding, fever (greater that 100o Fahrenheit), or pus-like discharge draining around the SP tube, let us know. If the tube does not drain, let us know.

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