Suprapubic catheter care in children – information for parents and carers

Introduction

There are several different types of urinary catheter which are inserted and used in different ways, these are:

Intermittent catheters which are inserted, the urine allowed to drain and then the catheter is immediately removed again.

Indwelling catheters which are left in place for a length of time (days, weeks, or months) and are held in place with a small balloon. Indwelling catheters may be passed into the bladder via the urethra (wee tube) or directly into the bladder via the abdominal (tummy) wall. These latter catheters are called ‘suprapubic catheters’ or ‘SPC’

This leaflet provides information about indwelling suprapubic catheters (‘SPC’) in children.

What is a suprapubic catheter?

A suprapubic catheter is a drainage tube used to drain urine from the bladder. The catheter is inserted, under general anaesthetic, through a small incision (cut) in your child’s abdomen (tummy) below the umbilicus (tummy button) and into the bladder. The catheter is secured in place by either a stitch on the skin or a small retaining balloon within the bladder. A dressing is placed over the catheter at skin level to help prevent accidental dislodgement. The hole via which the catheter passes in the abdomen is called a ‘stoma’.

Why has a suprapubic catheter been advised for my child?

Suprapubic catheters may be used for several different reasons:

• After complex bladder or urethral (wee tube) surgery a suprapubic catheter may be used whilst your child heals.
• To drain the bladder after an injury the urethra (wee tube).
• In the management of incontinence when other types of catheter are not suitable.
• To permit investigations of the bladder function (called ‘urodynamics’).

How does the urine drain?

There are two options for urine drainage via a suprapubic catheter

Free drainage

Urine drains continuously down the catheter and into a urine collection bag (like the ones in the photo above) which is connected to the end of the suprapubic catheter. The catheter bag is intermittently but regularly emptied throughout the day.

Catheter valve

A catheter valve (photo above) is placed on the end of the suprapubic catheter tubing rather than a drainage bag. Urine is stored in the bladder and intermittently, but regularly throughout the day, the valve is opened and urine empties from the bladder. Using a catheter valve mimics the natural filling and emptying cycle within the bladder.

What are the benefits of a suprapubic catheter?

• Allows healing of the urinary tract when placed following complex surgery as urine is diverted.
• Ensures the bladder is adequately emptied when it is unable to do this on its own.
• Depending on the reason for your child having a suprapubic catheter, it may be possible for your child to continue to pass urine via their urethra (wee tube).
• It is reversible. When it is no longer needed the catheter can be easily removed and the hole will close quickly.
• Whilst the catheter is in situ your child can shower, swim, go to school and continue activities as normal as long as the catheter is secured in place.

What are the risks and potential complications of a suprapubic catheter?

• Urinary tract infection (UTI) can be more common when an indwelling catheter is used compared to an intermittent catheter and can be more difficult to treat.
• The catheter can become blocked and so require change.
• The catheter can displace (fall out or be inadvertently pulled out).
• Urine can leak out of the stoma (hole on the abdomen) which is called ‘bypassing’.
• The skin on the abdomen at the stoma site can become red and sore.
• Blood may be seen in the urine; this is called ‘haematuria’ – see section ‘Problems that can occur and action needed’.
• Bleeding can occur at the stoma site; this usually settles after a few days but may occur if the catheter has been accidentally pulled.
• Overgranulation may occur at the stoma site. See section ‘Problems that can occur and action needed’.

Are there alternatives to a suprapubic catheter?

What alternatives are available will depend on the underlying reason that your child requires a suprapubic catheter.

If you child has a suprapubic catheter whilst healing from complex bladder surgery or urethral injury, then no alternative will be available.

If your child has a suprapubic catheter to help manage long term continence issues, then two alternative options may be available:

• Use of intermittent catheters passed via the urethra (wee tube) like those ones in the photo below:

Intermittent catheters are passed into the bladder, urine drains out of the bladder via the catheter and then the catheter is removed.

• In older children who need long term bladder management, surgical formation of a Mitrofanoff may be possible. A Mitrofanoff (pronounced ‘my-troff-an-off) procedure (also known as the ‘continent urinary diversion’) creates a channel from the skin on the abdominal (tummy) wall into the bladder. An intermittent catheter can be passed through this channel to drain urine out of the bladder.

Please ask your nurse or doctor if you would like information on these alternative methods of bladder drainage.

How often does a suprapubic catheter need changing and who will change it?

The first change of suprapubic catheter will take place four to eight weeks after the initial insertion and will be undertaken by a specialist nurse or doctor at the hospital. Subsequent changes can be undertaken at home by a children’s community nurse. If your child requires their suprapubic catheter for long term management, you can be taught how to perform the changes with the support of a community nurse.

How will we obtain ongoing supplies of equipment?

You will be given enough supplies for 7-14 days before being discharged. Ongoing supplies will be available via a prescription (details will be provided by us to your GP). With your verbal consent we can arrange for home delivery of these ongoing prescribed items. The delivery company will contact your GP for the prescription and supplies will then be sent directly to you. Please contact the delivery company before you run low on supplies. Contact details will be given with your first delivery.

What are the most important points to remember?

• Meticulous attention to hand hygiene will help prevent infection. Always wash your hands before and after attending to the suprapubic catheter.
• Clean and re-dress the stoma site (hole where the catheter exits on the abdomen) daily. The dressing should also be replaced if it is wet, loose or soiled.
• Ensure your child drinks sufficient volumes of clear fluid to achieve clear urine.
• Keep the catheter taped securely to your child’s abdomen (tummy) so that it does not get pulled. We advise that the catheter is ‘looped’ under the dressing to help prevent accidental dislodgement and, that a ‘cath secure’ dressing is used (photos below). You will be taught how to dress the catheter before discharge.

• Aside from the loop in the catheter which is under the dressing, the remainder of the catheter tubing should be kept as straight as possible to prevent kinking.
• If your child’s catheter is draining into a bag, the bag should be kept below waist level (to encourage drainage) and off the floor (to prevent infection and the catheter being accidentally pulled).
• Drainage bags should be emptied before they are ¾ full or at least four times a day.
• If your child is using a catheter valve for drainage, the bladder should be drained regularly (two to three hourly) throughout the day. Your child may need a catheter bag for overnight drainage.

Steps to be taken when emptying the catheter using a catheter valve

• Wash your hands with soap and water
• Stand or sit your child near the toilet (or appropriate container)
• Clean the catheter valve with a wipe
• Open the valve by moving the tap to the open position
• Allow all the urine to drain
• Close the valve by moving the tap to the closed position
• Dry the valve using a piece of toilet paper then clean the valve with a wipe.

Steps to be taken when emptying a urine collection bag

1. Wash your hands with soap and water
2. Stand or sit your child near the toilet (or appropriate container)
3. Clean the tubing at the bottom of the urine bag
4. Move the tap to the open position
5. Allow all the urine to drain
6. Move the tap to the closed position
7. Dry the tap using a piece of toilet paper then clean with a wipe.

How often does the urine collection bag or catheter valve require changing and who will do this?

Catheter bags and catheter valves require changing every seven days using a sterile method. With your verbal consent we will arrange for a children’s community nurse to visit you at home to do this. If your child requires their suprapubic catheter for long term use you can be taught how to perform this with the support of the community nursing team.

What follow up will my child need?

All children will be reviewed after discharge. You will be advised at the time of discharge what follow up plan is advised for your child.

Chaperoning

During your child’s hospital visits they will need to be examined to help diagnose and to plan care. Examination, which may take place before, during and after treatment, is performed by trained members of staff and will always be explained to you beforehand. A chaperone is a separate member of staff who is present during the examination. The role of the chaperone is to provide practical assistance with the examination and to provide support to the child, family member/carer and to the person examining.

If you have any queries, please contact;

The ward you were on: ................................

Your nurse specialist: 01223 586973