Sunday, April 26, 2009

Insertion of Suprapubic Catheter

The video is a British video but the process is the same in the United States. Above is a picture of my suprapubic catheter. That is a 20 French silicone foley catheter. After my surgeries I had a rubber foley. My skin is very sensitive. The rubber made my skin very red. A resident who took care of my surgeries, and who is a doctor now, recommended a silicone foley. That is much more agreeable with my skin. Do you see the red spot where the catheter is coming out? It is a fleshy growth. My surgeon has burned it off at least three times with nitrate. The nitrate was on a long Q-tip, which my surgeon used to touch the growth to burn it off. The procedure was only a minute long but it is very painful. I have not asked him to burn it off anymore!

The bigger the Foley, the faster the urine drains out. The different types are 12 Fr, 14 Fr, 18 Fr, and 20 Fr. At the end of the Foley there is a balloon. My balloon is filled with 10 cc (10 ml) sterile water. I require my Foley catheter to be changed every 2.5-3 months. The process only takes less than 10 minutes. First, my urology nurse prepares my site. She puts a disposable pad under my pants so any blood or medicine she uses will not get on my pants.
She numbs the area around my site with lidocaine by inserting it into my site with a syringe. She uses a small syringe to deflate the balloon by drawing out the sterile water. She fills another syringe with 40-60 cc sterile water. She then inserts the syringe into my catheter and injects the sterile water into my bladder. She then slides the catheter out and puts a new one in.

Most of you who look at my blog know that I am 60 years old with a primary diagnosis of spastic quadriplegic cerebral palsy. To give you a little more information, on June 16, 2004 I had two surgeries: my colostomy and my supra pubic catheter insertion.

My colostomy and my supra pubic insertion were my decision and my decision only! George Klauber, MD (Pediatric Urologist) was my consultant on my surgeries. I am grateful to George for coordinating my surgeries in one day. In the 1980s, I worked with George at the Floating Hospital for Children at New England Medical Hospital doing research on Myelodysplasia. We stayed in touch and that is the reason I asked George if it would be possible to have both surgeries in one day.

At the time, I was 55 years old and I knew my recuperative period would be longer than it would have been if I were younger. Before my surgeries, I net with the two surgeons and asked them numerous questions. They were very honest with me and they told me the benefits and deficits of having these surgeries. I was prepared for both the benefits and the deficits to my increasing severity of weight bearing. As some of you know, weight bearing is standing up. The only transferring I did for myself was getting on and off the toilet. The other transfer was a stand-pivot with the assistance of my caregivers. I contacted George when I began to fall more often in the bathroom as a result of arthritis in my hip.

Dissection at the base of the bladder to reach the anterior vaginal wall and uterine cervix creates edema, interrupts the small nerve pathways, and thereby sets up the physiologic changes that produce urinary bladder atony. Therefore, catheter drainage of the urinary bladder is an essential feature of many pelvic surgical procedures. Fortunately, in most cases, these conditions reverse themselves in 3-5 days, and catheter drainage is no longer needed.

Suprapubic bladder catheterization is superior to transurethral bladder catheterization because it is cleaner. It also leaves the urethra open for voiding when urinary function has returned. The use of an ordinary Foley catheter (No. 16 French with 5-mL bag) is preferable to the commercially available suprapubic catheter kits because a Foley catheter, when inserted as described in this section, is usually not dislodged from the bladder during sleep or activity. In addition, the Foley catheter is less costly and is available in all surgical clinics. The instrument used for insertion of the Foley catheter is an ordinary Randall stone forceps. The fulcrum of this instrument is toward the rear, which keeps the overall diameter of the axis virtually unchanged except at the jaws and gives it an advantage over a Kelly clamp.

The operation provides drainage of the urinary bladder through a clean surgical incision and ensures that the catheter does not slip out of the patient or become dislodged within the abdominal wall.

Physiologic Changes.
The procedure reduces edema at the base of the bladder, allowing the return of normal vesical function.

Points of Caution.
After grasping the catheter with the jaws of the Randall forceps (Fig. 4) and before inflating the Foley balloon, the catheter should be drawn through the bladder until the tip can be seen in the urethral meatus. This ensures that the catheter tip and balloon are in the bladder and not in the subcutaneous or subfascial space.


This procedure can be performed in the inpatient treatment rooms of a hospital, clinic, or doctor's office. Local anesthesia is adequate for most patients. The bladder does not have to be empty. The patient is placed in the dorsal lithotomy position. The periurethral area and suprapubic area are surgically prepped and draped. A routine pelvic examination is performed prior to placement of the suprapubic catheter. If local anesthesia is to be used, a 4 x 4 cm area around the insertion site is infiltrated with 1% lidocaine. Infiltration should include the fascia and, if at all possible, a small area of the bladder wall.

A Randall stone forceps is inserted through the urethral meatus and used to elevate the dome of the bladder from the inside, pushing the suprapubic abdominal wall upward to the palpating finger.

Upward pressure is maintained on the forceps, and a small incision is made in the suprapubic skin and fascia until the forceps can be felt with the blade of the knife.

A sudden upward thrust of the forceps pierces the bladder wall and pushes the forceps through the incision. The jaws of the forceps are opened and used to grasp the tip of the Foley catheter.

The Foley catheter is pulled through the bladder, and the forceps is withdrawn from the urethra until the tip of the Foley catheter can be seen in the urethral meatus.

Traction is placed on the Foley catheter from above while the balloon is simultaneously inflated. This draws the catheter back into the body of the bladder.

When 5 mL of sterile saline solution have completely filled the Foley balloon, the catheter is firmly retracted upward.

It is not necessary to suture the catheter to the abdominal skin. A sterile dressing is applied, and the Foley catheter is connected to straight drainage.

No comments:

Post a Comment