Suprapubic catheter care

Who needs a catheter?

Some people with bladder problems will need a catheter. The bladder is a balloon-like organ that holds pee. Some people aren’t able to empty their bladder properly. There are a few reasons why this might be, including problems that they were born with, surgery, and voiding problems.

If the bladder does not empty properly, or a child has retention, this causes a risk of infection. Urine can also track back up to the kidneys, which will cause damage. This can also cause incontinence. A catheter may be put in to drain your child’s bladder more effectively, which helps to reduce these risks.

What is a suprapubic catheter?

A catheter is a hollow tube made from a soft, flexible material. This allows pee to drain from the bladder. A suprapubic catheter goes in to the body through the skin of the tummy, below the belly button, and into the bladder. A balloon on the inside end of the tube is filled with water, to stop the tube from falling out.

Suprapubic comes from Latin, and it means ‘above the pubis’. The pubis is the area where your private parts are. So ‘suprapubic’ means above your privates, which is where the tube comes out.

The first time that a catheter is put in will be by a doctor at the hospital. This will be done under general anaesthetic, which is a medicine that makes someone go to sleep and stops them from feeling the procedure. It is a simple procedure, and it is usually done as a day case. This means that you can go home on the same day, as long as there are no problems.

What does the urine drain into?

Normally, a bag is put on the end of the catheter for the pee to drain into. The bag can be attached to your child’s leg with a Velcro strap. You will be given a bigger bag to use overnight, while your child is asleep.

Other children will have a valve on the end of their catheter. This can be used to control the flow of pee. The valve can be closed during the day, and then opened over the toilet to empty the bladder. This can give a child a sense of normality, as the bladder can fill and be emptied when able.

If your child gets a lot of infections, or has a large bladder, it might need to be continuously drained into a bag.

How do I change the bag or valve?

1. Get the new bag or valve ready.
2. Protect the floor, in case the catheter drips.
3. Wash your hands thoroughly.
4. Empty the catheter or bag into the toilet – if using a valve, make sure that the bladder is empty.
5. Squeeze the end of the catheter to prevent any pee escaping.
6. Take off the old bag or valve.
7. Firmly push in the new bag or valve.
8. Throw away the old bag or valve by double-bagging it, and placing in the household waste.
9. Wash your hands thoroughly again.

When will the catheter need changing?

It can stay in place for up to 3 months. The catheter will then need changing. It will be changed at hospital by a nurse.

If your child is very scared or worried about having their catheter changing, they may be able to have some Entonox gas. This will help them to relax while it is changed. Please be aware that this may only be offered for the first catheter change.

After some time, you or your child will be taught how to change the catheter at home by yourselves.

Catheter care

Keeping it clean

For the first few days after it is put in, the skin around the catheter should be cleaned every day. Boil a kettle of water and let it cool down to a comfortable temperature. Use this to gently clean the wound. Dry the skin, and then apply a light gauze dressing. After a few days, the site can be left clear with nothing on it.

The best way to keep the catheter clean is to have a bath or shower every day. Take extra care to make sure that the catheter site is dried properly, to stop it from becoming sore.

Turning the catheter

Gently turn the catheter every day. This helps to prevent it from sticking.

Keeping it secure

To stop the catheter from pulling, tape it securely to the leg or tummy. Make sure that there are no kinks in the tubes, so the pee can continuously drain.

Make sure that the catheter is taped below the bladder. This means that gravity can drain the bladder properly.

Common problems and solutions

The catheter site looks red and sore

This may be because the skin was not dried properly after washing.

Make sure that the skin around the catheter is properly dried after baths and showers.

If the problem continues, get in touch with your specialist nurse.

Pain and discomfort from the catheter

This may be caused by:

• bladder spasms
• the bladder not draining well

Check that the catheter is not kinked or blocked.

Get in touch with your specialist nurse, as your child might need some medicine to help with the spasms.

There is blood in the pee

Putting a catheter in is likely to cause some trauma. This means that there may be some small injuries, but these should settle after a few days. Accidental pulling and catching the catheter can also cause injuries.

This problem should settle by itself. If there is still blood in the pee after a few days, please get in touch with the specialist nurse.

Pee is smelly, or child feels unwell

This may be due to a urine infection.

Encourage your child to drink at least 1.5 to 2 litres of clear fluids, like water or dilute squash.

Get in touch with your GP to arrange for a urine sample to be sent.

There is a raised red area, or yellow discharge

This could be over granulation. This is when the body tries extra hard to heal a wound. Here, the body is trying very hard to heal the skin around the hole.

This is not an infection, and it does not need any antibiotics. Ask your specialist nurse for some cream to rub into the skin. This will help to settle the skin down.

No urine, or small amounts draining

This could be because:

• the catheter might be blocked
• the tube might be kinked
• the catheter is taped above the bladder
• your child has not had enough to drink

To fix this, you can try checking the position of the catheter. If needed, reposition it, and unkink the tube.

If there is not a problem with the tubing, encourage your child to drink more.

If this does not fix the problem, contact your specialist nurse. They will tell you how the flush the catheter.

Catheter has fallen out

The catheter may fall out if:

• the balloon has deflated
• the balloon has burst
• the catheter has been pulled on very hard

If this happens, replace the catheter straight away.

If the suprapubic catheter falls out, it needs to be replaced within around 20 minutes. After this time, the hole will begin to close.

Put the catheter back in as you were shown by your nurse. Instructions are also given in the next section. If you can’t replace the tube easily, get in touch with the specialist nurse, or attend the emergency department at your nearest hospital, so that a medical professional can help.

Changing the suprapubic catheter

You will need:

• 2 syringes
• new catheter
• jug or similar to collect urine
• lubrication
• tape
• new bag or valve

Place down something to protect the floor, in case any pee drips.

1. Boil a kettle of water and allow it to cool to room temperature
2. Fill 1 syringe with 5ml of the cooled, boiled water
3. Check that you have the correct size of catheter
4. Check that the catheter has not expired
5. Wash hands thoroughly
6. Put the empty syringe into the inflation port, and twist
7. Draw the water out, and remove the syringe
8. Remove the old catheter by gently pulling it
9. Lubricate the new catheter
10. Insert the new catheter gently into the hole, until urine starts to come out
11. At this point, push the catheter just a little bit further in
12. Take the syringe with the boiled, cooled water, and twist into the inflation port
13. Gently push in the water
14. Keeping pressure on the syringe, twist and remove
15. Tape the catheter in place
16. Make sure that it is draining the bladder
17. Place a clean bag or valve on the end
18. Throw away the rubbish
19. Wash your hands thoroughly again

If you have any problems with changing the catheter, please get in touch with your specialist nurse.

Frequently asked questions

Is there anything my child cannot do?

Having a suprapubic catheter should not stop your child from doing any of the things that they like to do at school or at home. This includes swimming and PE.

How will I know if there is an infection?

You should get in touch with your GP or specialist nurse if your child has:

• smelly pee
• vomiting or feeling sick
• a temperature
• abdominal (tummy) or back pain

You should take a sample of pee to the GP or hospital. Samples should be taken from the catheter, and not the drainage bag.

Urine samples should be taken before starting antibiotics.

Ask your child to drink more, at least 6 to 8 glasses. Water is best. This can help to start flushing out the bugs.

How do I get more supplies?

Bags, catheters, and valves are available to get on prescription from your GP.

Your specialist nurse will let you know about the home delivery service you can sign up for. It is then up to you to get in touch with your GP or the home delivery service when you need more supplies. They should also be able to supply you with new syringes when you need them. Get in touch with your specialist nurse if you cannot get these locally.