NHS Ayrshire & Arran guidelines
- Urethral trauma
- Clients who require long-term catheterisation and who are sexually active
- Long-term catheterisation for intractable incontinence
- Following pelvic or urological surgery
- Some gynaecological conditions, e.g. colposuspension
- For easier management in patients with advanced neurological disease
- Clients who are unable to tolerate urethral catheterisation
- Clients make an informed choice
- Research undertaken has demonstrated a reduction in the incidence of urinary tract infection of supra-pubic catheterisation compared to urethral catheterisation3.
Assessment and treatment of patients who may require supra-pubic catheterisation
For some patients the insertion of an indwelling catheter supra-pubically, into the bladder through the abdominal wall, may offer advantages over the urethral route.
Supra-pubic catheterisation:
- Involves the insertion of a catheter into the bladder via an incision in the anterior wall of the abdomen, just above the symphasis pubis.
- It is known as cystostomy.
- The initial insertion is performed by a doctor in hospital and is done under general or local anaesthesia.
- Subsequent care and changing of the catheter may take place at home by a suitably trained nurse.
- This first supra-pubic catheter change should be organised for 6 weeks then all subsequent changes should be 12 weeks.
- Undiagnosed haematuria7
- History of bladder tumour7
- Unable to fill bladder to minimum of 300mls or beyond suprapubic bone
- Obese patients
- Extreme care should be taken with patients who have blood clotting disorders or who are on anticoagulant therapy
- Ascites
- Suspicion of ovarian cyst
- Previous abdominal surgery.