Suprapubic catheterisation

Suprapubic catheterisation

Suprapubic catheterisation (SPC) carries a small but significant risk of bowel injury , especially in those who have undergone - previous abdominal or pelvic surgery , and so should be performed under ultrasound and cystoscopic guidance. SPC should be considered for those who require long-term catheter - isation, as it is often more comfortable with no risk of urethral trauma compared with long-term urethral catheterisation, as well as for those in whom urethral catheterisation is not suitable or possible. Contraindications to SPC insertion include known or suspected bladder carcinoma, abdominal wall infection at

(c) (d) (b) standard urethral catheter with an in /f_l atable (d) coudé tip catheter.

the site of insertion, uncorrected coagulopathy or the presence of a vascular graft in the suprapubic region. The procedure requires infiltration of local anaesthesia (1% lidocaine) to the skin and fascia of the suprapubic region, two fingerbreadths above the pubic symphysis in the midline. This procedure should only be performed in those with a palpable bladder. A Seldinger technique of insertion is the safest for percutaneous insertion ( Figure 83.26 ). A long needle is inserted in a perpendicular direction into the bladder and aspiration of clear urine confirms correct entry . A guidewire is placed through the needle, and the needle removed. A small skin incision at the site of the guidewire allows a trocar to pass over the guidewire and into the bladder, thereby dilating the tract. Through this trocar, a 16Fr catheter is placed and the balloon inflated. The trocar is removed and the catheter bag attached. If the bladder cannot be confidently identified, or in those with extensive abdominal or pelvic surgery , an open cystotomy should be performed to safely enter the bladder and ensure that there is no bowel in the path of the catheter.

18G hypodermic needle – 12 cm long Dilator and peelable sheath Low-profile silicone Foley catheter Balloon capacity 5–10 mL Set includes 2 × 10-mL syringe and a scalpel Figure 83.26 A suprapubic ‘Seldinger’ catheter kit.